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Discussion Topic: The Chemically Impaired Coworker

Karen is a skilled emergency department (ED) nurse in a hospital that treats many trauma victims. In her personal life, she is struggling with issues of grief and loneliness and feels like “work is therapy because I can forget for a while.” One day she accidentally took home a discarded opiate. Feeling tired and unable to sleep, so she self-administered the morphine “just this once” to provide relief and some much-needed sleep. She tells herself she will not do it again. A week later, Karen purposely takes home and self-inject another morphine. Within a short period of time, she is diverting on a regular basis and realizes she will experience withdrawal unless she injects regularly. Karen finds herself working extra shifts, volunteering to medicate co-worker’s patients who need pain medications and isolating from other staff members in order to procure and use the drugs. Fellow nurses in the ED recognize something is wrong, but knowing how highly charged the department’s environment is, they assume it’s “just stress.” Karen’s supervisor, Ann, notices changes in Karen’s demeanor and behavior and decides to more closely monitor her practice. Ann also looks for medication irregularities or discrepancies, record falsifications, and any patterns of complaints by patients. The findings showed many narcotic discrepancies and patient pain complaints whenever Karen worked as their nurse.  Following the hospital procedure and investigating the situation, Ann questions Karen about her performance and behavior.

After reading the scenario, take some time to reflect on delegation, then answer substantively to the following questions.

1. Based on your knowledge of substance users, how would you expect Karen to initially respond? 
2. How do you believe Karen’s manager should respond to Karen’s situation? Describe in detail. 
3. Do you believe that Karen should be granted an option to return to work in the future?
4. Does treatment end for Karen after successfully completes the treatment program?