Discussion Debate – Addressing Employee Alleged Substance Abuse Issue

Case Study

You are the Nurse Executive (NE) of your hospital.

M.S. is a 33-year-old nurse who graduated five (5) years ago from a BSN program. He was a high achiever in school and maintained a 3.75 GPA while working as a Bartender in a local restaurant. M.S. is also a member of the local Nurses Association. M.S. has had several outbursts on the Stepdown CCU unit and attributes these outbursts to unruly visitors or patients and job related stress. He has been reprimanded by the nurse manager on numerous occasions due to unsatisfactory reports per various patients.

He is typically the second nurse on this 6-bed unit and work 1st shift opposite of E.S. on second shift. E.S. has arrived on numerous occasions where the narcotic count is off and M.S. appears somewhat fatigue, irritable, and sad; however, you know him to be a caring and competent nurse and you have become very fond of him and see him as not only a colleague but a friend. However, you have received reports from several colleagues too of their suspicion that M.S. is abusing opioids. You witness on numerous occasions that M.S. appears “really out of it.” During change of shift, the narcotic count is off again, while M.S. adjust for that count saying he forgot to record it on the medication administration record (MAR). After M.S. leaves, you also receive reports from patients too that they think something is wrong with him. You do have knowledge that M.S. has been out of work off and on and was on leave six months ago for chronic back pain relative to a severe fall.

The next day, you (Nurse Executive) received a call from K. M., the nurse manager of the Stepdown unit making inquiry into your impression of M.S. and what you believe is going on, which you gave her minimal information that did not implicate him at all. K.M. then followed up with the email below to you (Nurse Executive).

I spoke to M.S., privately by phone this morning and informed him of his colleague/friend’s assessment of him. I spoke to some patients who were also concerned about his health and wellbeing, which I informed him of that too. I advised that based on his colleague/friend’s and patients’ assessments, I feel he should not return to work. He began to cry uncontrollably stating he was a good nurse. He became very belligerent and threatened harm to himself; stating the loss of his job would be too detrimental to him. I was also fearful that he would retaliate with me as well. He was unable to listen when redirected that what I was doing was in his best interest. He was so distraught, I tempted to call his family member then I decided to call E.S., his friend to try and call to console him, however, I got her voicemail instead. I called security and let them know that he is not allowed back in the building and that someone should make arrangements to return his belongings. I have other duties and responsibilities and cannot deal with this behavior on a busy stepdown unit. He apparently is not psychologically well enough to be in the nursing profession and needs extensive counseling. K.M., CCRN, Nurse Manager – Stepdown Unit

Additionally, K.M. has sent several emails to her nurse manager colleagues on other units and has verbally discussed this with some of her subordinates too.

Answer the following questions following the criteria for evaluation:

1) What legal and ethical issues are involved in this case?

2) What do you perceive as the best way to manage this situation; with particular considerations of best practices in dealing with the nurse manager (K.M.) and the nurse (E.S.)?

3) As the N.E., how would you approach E.S. and what would be your observation of this situation and education to this nurse? In other words, how would you advise her to handle this matter?

(This requires some research to determine what those might be. Again, you are