14.3 Responding to Unethical or Unlawful Practice, Negligence & Impaired Coworkers
Key Takeaways
When a PCT sees unethical or unlawful practice, the first step is to protect any patient in immediate danger, then report through the chain of command.
If a supervisor is involved or does not act, the PCT goes to the next level, such as the nurse manager, compliance or ethics hotline, or risk management.
Signs of possible coworker impairment include the smell of alcohol, slurred speech, unsteady gait, frequent unexplained absences, and unusual interest in controlled substances.
A coworker who appears impaired is reported to the supervisor immediately so they can be removed from patient care; the PCT does not confront or investigate alone.
NCCT's Code of Ethics asks certificants to be honest, obey the law, and own up to their mistakes and work to make them right.
Responding to Unethical or Unlawful Practice, Negligence & Impaired Coworkers
Two NCCT Law and Ethics tasks deal with what a PCT does when someone else's conduct puts patients at risk: respond appropriately to observations of unethical or unlawful practice and report and document negligence and incompetence (for example, substance abuse). They are uncomfortable tasks, because the person involved may be a friend, a senior coworker, or a supervisor. But patient safety comes before loyalty, and silence can make the PCT part of the harm.
What Counts as Unethical or Unlawful Practice?
| Category | Examples |
|---|---|
| Falsification | Charting vital signs, turns, or rounds that were never done; backdating entries; signing for someone else |
| Working outside scope | Unlicensed staff giving medications, starting IVs without authorization, or interpreting results for patients |
| Abuse, neglect, and boundary violations | Rough handling, threats, ignoring call lights, romantic or sexual contact with patients |
| Theft and diversion | Taking patients' money or belongings; taking controlled substances meant for patients |
| Privacy violations | Looking up records without a care need, sharing patient information on social media (Section 13.2) |
| Fraud | Billing for care that was not provided, falsifying time records |
| Unsafe practice | Skipping safety checks, ignoring infection control, working while impaired |
| Discrimination or retaliation | Treating patients or staff unfairly, punishing someone for reporting |
NCCT's Code of Ethics commits certificants to honesty in all professional interactions, respect for the law, following workplace safeguards, protecting patients' privacy, seeking help when a problem is beyond their skills, and encouraging others to act professionally. Violations can lead to NCCT Board of Testing sanctions, up to revocation of the credential.
How to Respond: Step by Step
- Protect the patient first. If a patient is in immediate danger (for example, a coworker is handling a patient roughly), intervene safely, stay with the patient, and call for help.
- Do not participate or cover up. Refuse to sign, chart, or perform anything false or outside your scope (Section 13.1).
- Report promptly through the chain of command. Usually this means the charge nurse first, then the nurse manager or supervisor.
- Go higher if needed. If the supervisor is involved, or the concern is not addressed, use the next level: the department director, the compliance or ethics hotline (often anonymous), risk management, or human resources.
- Use outside channels when appropriate. Examples include the state health department, the state board of nursing for licensed staff, NCCT for an NCCT certificant, the HHS Office for Civil Rights for privacy complaints, and OSHA for workplace safety complaints.
- Document objectively. Record the facts (date, time, place, what you saw and heard, who was present) in an incident report or in the format your policy requires. Chart only care-related facts in the patient record (Section 14.2).
- Do not confront aggressively or investigate on your own. Gathering evidence, questioning coworkers, or accusing someone publicly can endanger you and interfere with a proper investigation.
- Keep it confidential. Share the concern only with the people who need to act on it.
Protection From Retaliation
Healthcare organizations must have policies that forbid retaliation against employees who report concerns in good faith, and many federal and state laws protect workers who report safety hazards, fraud, or patient harm. Reporting what you honestly observed, through proper channels, is a professional duty, not disloyalty.
Negligence vs. Incompetence
- Negligence is failing to use the care a reasonably prudent, similarly trained person would use, causing harm (the four elements are in Section 14.1). Examples: leaving bed rails down on a confused patient against the care plan, or not reporting a critical finding.
- Incompetence is a lack of the knowledge, skill, or fitness to perform duties safely. Examples: repeatedly mislabeling specimens, being unable to perform a skill after training, or ignoring procedures.
Report patterns as well as single serious events. A coworker who keeps making the same unsafe mistake needs retraining or supervision, and the unit leader cannot fix a problem no one reports.
Impaired Coworkers and Substance Use
Substance use disorders affect healthcare workers too, and access to medications raises the risk of drug diversion (taking drugs meant for patients). Possible warning signs include:
- The smell of alcohol, slurred speech, unsteady gait, or drowsiness on duty
- Pinpoint or dilated pupils, mood swings, irritability, or unusual behavior
- Frequent, unexplained absences from the unit or long bathroom breaks
- Frequent lateness, sick calls, or errors
- Unusual interest in controlled substances: volunteering to care for patients who receive opioids, frequent medication "wastes," or counts that do not match
- Patients who report that their pain medication is not working when the same coworker cares for them
- Long sleeves in warm weather (possible injection sites)
What the PCT does:
- Report immediately to the charge nurse or supervisor. An impaired worker must be removed from patient care right away.
- Do not confront the person alone, search their belongings, or try to handle it privately.
- Describe observations, not diagnoses: "She smelled of alcohol and was unsteady at 0730," not "She's drunk."
- Understand that many facilities and states offer treatment-focused programs (often called peer assistance or alternative-to-discipline programs) that help impaired health professionals recover while protecting patients. Reporting can be the first step toward help.
Owning Your Own Mistakes
The same duty applies to your own practice. NCCT's Code of Ethics asks certificants to own up to mistakes and work to make them right. If you make an error, such as mislabeling a tube, check the patient's safety, tell the nurse right away, complete the incident report, and help correct it. Hiding an error is a second, more serious error.
Clinical Trap: The Friendly Favor
A coworker says, "I didn't get to Room 12's vitals; just copy the ones from 0400 so we're not behind." Copying old values is falsification, and a patient whose condition changed would be missed. The correct response is to refuse, take the vital signs now if you can, and let the charge nurse know the round was missed.
A PCT sees a coworker enter vital signs for a patient the coworker never visited during the shift. What is the most appropriate response?
Ignore it, because the patient's earlier vital signs were normal
Confront the coworker loudly at the nurses' station so others learn from it
Report the observation to the charge nurse or supervisor through the chain of command and document the facts per policy
Correct the coworker's entries yourself by changing them in the chart
At the start of a shift, a PCT notices that a coworker smells of alcohol, has slurred speech, and is unsteady while walking to a patient's room. What should the PCT do?
Notify the charge nurse or supervisor immediately so the coworker can be removed from patient care
Offer the coworker coffee and quietly cover their patients for the day
Wait until the end of the shift to see whether the behavior continues
Search the coworker's locker for evidence before reporting
A PCT reported unsafe practices to the charge nurse, but the charge nurse is the person involved and has taken no action. What is the appropriate next step?
Drop the matter, because the charge nurse outranks the PCT
Post a description of the problem on social media to get attention
Tell other patients so they can protect themselves
Take the concern to the next level, such as the nurse manager, the compliance or ethics hotline, or risk management
Sections you finish are checked off in the contents.
You've completed this section
Continue exploring other exams