Nursing care
Coworker appears impaired on shift: protect clients first, then report
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
When a coworker appears impaired, the priority is client safety: the colleague should be removed from client care and the concern reported promptly to the charge nurse or supervisor. Confronting the colleague alone, covering their assignment quietly or waiting to gather more proof leaves clients at risk. Nurses have an ethical and legal responsibility to report suspected impairment.
Recognise what the question is really testing
The stem may describe slurred speech, unsteady gait, the smell of alcohol, pinpoint pupils, frequent unexplained absences from the unit, sloppy charting or a pattern of controlled drug discrepancies. The nurse does not need to diagnose a substance use disorder or prove anything. What matters is that someone responsible for clients may not be safe to practise right now.
Professional bodies describe early recognition, reporting and intervention as fundamental to keeping clients safe. The same reasoning applies if the impairment seems to come from illness, exhaustion or medication rather than drugs or alcohol. The clients on that nurse's assignment depend on safe, competent care, so their protection outranks loyalty, awkwardness or fear of being wrong.
First action: remove from care and report
Report the observations to the charge nurse or supervisor immediately, describing specific behaviours and times rather than labels such as drunk or high. The charge nurse has the authority to relieve the colleague of duty, reassign clients and follow the facility's fitness-for-duty process. If the charge nurse is the person involved, the report goes up the chain of command.
Meanwhile, the nurse makes sure no client is left unsafe. That may mean checking on the colleague's clients, particularly anyone receiving high-alert medicines or unstable, and reporting any client harm already suspected. Documentation of observed facts follows facility policy. Reporting to the board of nursing usually happens through the employer's process, though individual nurses may also have a reporting duty.
Why confronting or covering fails, and what support exists
Confronting the colleague alone can escalate conflict, invite denial and still leave them caring for clients. Quietly taking over their work or covering a missing dose protects the colleague briefly but hides an ongoing risk and can make the reporting nurse complicit. Waiting until the end of the shift or gathering more evidence first delays protection for clients who need it now.
Reporting is not the same as punishing. Many boards of nursing run alternative-to-discipline programmes that promote early identification, require removal from the workplace and connect the nurse with evidence-based treatment and monitoring. Nurses who complete them can often recover, keep their licence and return to safe practice. Framing the report as getting help for a colleague can ease the hesitation many nurses feel.
What can wait and how to document
Arguments about whether the colleague is really impaired, discussions with other staff and decisions about discipline can all wait or belong to managers. The reporting nurse avoids gossip, keeps the colleague's privacy and does not search their belongings or test them. Those steps belong to the facility's formal process, not to an individual nurse on the unit.
Write down what was seen, heard and smelt, with times, and which clients the colleague was caring for, following facility policy on where such notes are kept. Factual records support a fair process for the colleague and protect clients. If a client may have received an incorrect or missed dose, assess them and notify the provider as a separate priority.
Prioritise a hypothetical scenario
In a hypothetical scenario, a nurse notices a colleague with slurred speech who has just drawn up an opioid dose for a client and has twice left the unit without explanation. Options are to ask the colleague privately whether they have been drinking, finish the colleague's medication pass without saying anything, report to the charge nurse now, or call the state board of nursing from the break room.
Reporting to the charge nurse now is the strongest answer because it is the fastest route to removing the colleague from care and protecting their clients. A private confrontation and silent cover leave the risk in place, and calling the board first bypasses the person who can act on the unit immediately. The prepared opioid dose is secured and checked before anyone gives it.
Sources and further reading
NCSBN: Substance use in nursing. Early recognition, reporting and intervention to protect patients, and the legal and ethical responsibility to report a colleague's suspected drug use.
NCSBN: Alternative to discipline programs. Earlier identification, immediate removal from the workplace, evidence-based treatment and licence retention for nurses who complete the programme.
Nursing and Midwifery Council: The Code. Duty to raise and escalate concerns about patient or public safety and to protect people at risk of harm.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our safe and effective care practice questions are the closest set to what this page covers.
One question from the safe and effective care set
A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
Rationale
Prioritization items are airway, breathing, circulation, in that order — the ranking survives every rewording. Audible gurgling around a fresh tracheostomy is a partially obstructed airway and it is the only option that can kill the client in the next few minutes. Fever, post-op pain, and a glucose of 232 are all real problems that need the nurse, just not first.
Answer: C
Common questions
Is the nurse required to be certain before reporting a colleague?
No. The nurse reports specific observed behaviour that raises concern for client safety. Investigation and any determination of impairment are the responsibility of managers and, where relevant, the regulator.
Should the nurse tell the colleague first as a courtesy?
Not as the first step. Warning the colleague can delay action and leave clients at risk. The concern goes to the charge nurse or supervisor, who manages the conversation and next steps.
What happens to a nurse who is reported for impairment?
Processes vary, but many boards offer alternative-to-discipline programmes combining removal from practice, treatment and monitoring, with the aim of safe return to work while protecting the public.
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