Following change of shift report, a nurse manager suspects that the oncoming nurse is under the influence of a chemical substance.
Which of the following actions should the nurse manager take?
Provide personal counseling to address the nurse's substance use.
Arrange transportation for the staff nurse to go home.
Schedule a meeting with the nurse within 72 hours.
Ask the nurse to complete the shift under close supervision.
The Correct Answer is B
Choice A rationale
The nurse manager's role is to ensure patient safety and follow administrative protocols, not to provide personal therapy or clinical counseling to employees. Chemical dependency is a complex medical condition that requires professional intervention from addiction specialists. While the manager should be supportive, they must maintain professional boundaries. Offering counseling themselves could delay the nurse getting appropriate help from an employee assistance program or a structured treatment center designed to handle substance use disorders.
Choice B rationale
If a nurse is suspected of being under the influence, they are considered impaired and unsafe to drive. Arranging transportation is a vital safety measure to protect the nurse and the public from potential accidents. This action fulfills the manager's duty of care toward the employee after they have been removed from clinical duties. It ensures that the nurse reaches a safe location without incident while the manager proceeds with the necessary administrative and diagnostic steps.
Choice C rationale
When a nurse is suspected of being under the influence, the manager must take immediate action to remove them from patient care. Waiting 72 hours to address the situation is a violation of safety protocols and leaves patients at risk. The nurse should be confronted immediately, removed from the floor, and requested to undergo drug testing according to facility policy. Delaying the meeting would also allow the substance to clear the nurse's system, making testing ineffective.
Choice D rationale
Allowing an impaired nurse to complete a shift, even under supervision, is a significant risk to patient safety. Chemical impairment affects judgment, motor skills, and reaction times, which are all critical for nursing tasks like medication administration. If an error occurs while the manager knows the nurse is impaired, the manager and the facility could be held legally liable. The only appropriate action is to immediately relieve the nurse of all clinical responsibilities to ensure safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
The right person involves ensuring that the individual delegating the task has the correct authority and that the person receiving the delegation possesses the necessary skills and knowledge. In this scenario, the nurse has the authority to delegate, and an assistive personnel is generally the appropriate person to perform basic activities of daily living like morning care. There is no indication in the prompt that the personnel lacks the fundamental competency for this role.
Choice B rationale
The right direction or communication requires the nurse to provide a clear, concise description of the task, including its objective, limits, and expectations. Simply instructing the AP to provide morning care to a client with left-sided weakness is insufficient. The AP needs to know specific safety precautions, which side to support, how to position the client, and what specific observations to report back to the nurse. Lack of detail makes this direction incomplete.
Choice C rationale
The right task refers to delegating activities that are repetitive, require little supervision, and do not require nursing judgment or complex application of the nursing process. Providing morning care, which includes bathing and grooming, is within the standard scope of tasks for assistive personnel. Since this is a routine functional task that does not involve clinical assessment or medication administration, the task itself is appropriate for delegation to an AP.
Choice D rationale
The right circumstance involves considering the setting, the stability of the patient, and the available resources. While a patient with left-sided weakness has a physical deficit, providing basic morning care is typically safe if the patient is stable. If the patient's condition were rapidly changing or required complex monitoring during the care, the circumstance might be inappropriate, but the primary issue here is the vague instructions provided by the nurse.
Correct Answer is A
Explanation
Choice A rationale
A nurse practice act is a state law that defines the scope of nursing practice and provides the legal framework for nursing within that jurisdiction. One of its primary functions is to establish the criteria and requirements for obtaining and renewing a nursing license. This ensures that all individuals practicing nursing meet a minimum standard of competency to protect public health. This includes educational requirements, examination standards, and the definition of different nursing roles.
Choice B rationale
Certification for specialty practice is typically managed by private professional organizations, such as the American Nurses Credentialing Center, rather than by state nurse practice acts. While the act may recognize advanced practice roles, the actual process of providing specialty certification is an extra-legal professional achievement. The state's role is focused on the legal right to practice, while specialty boards focus on validating expert knowledge and skills in specific clinical areas like oncology or critical care.
Choice C rationale
Nurse practice acts generally govern licensed professionals rather than the specific actions of students, who practice under the faculty's license and educational exemptions. While the act might define what constitutes a nursing education program, it does not usually provide the daily regulatory oversight for student clinical activities. The responsibility for student practice typically falls under the guidelines of the nursing school and the clinical facility, aligned with the broad standards set by the state board of nursing.
Choice D rationale
The code of ethics for nursing is developed and maintained by professional organizations like the American Nurses Association. It is a set of moral principles and values that guide nursing practice but is not a law enacted by state legislatures. A nurse practice act is statutory law, whereas a code of ethics is a professional standard. While they complement each other, the act focuses on legal mandates and the code focuses on the ethical obligations of nurses.
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