shift is wild

Other people in your chart

When a coworker seems unsafe during the shift

When the shift gets unsafe, your note needs facts, not amateur forensics or unit-lounge poetry.

8 min read built on 12 full opinions updated 2026-09-20

Written by a med-surg RN, ten years, day shift. Why there is no name on it

If someone on shift looks unsafe, you are not there to diagnose them. You are there to protect the patient, get the right person involved, and write a clean record of what happened.

The short version

  • Protect the patient first. Pause the task, get help, and tell the charge nurse, supervisor, or manager right away.
  • Do not write drunk, high, impaired, crazy, or addict unless your facility process has already made that call. Write what you saw, heard, and did.
  • In the patient chart, stick to patient care: what happened to the patient, your assessment, what you did, who you notified, and the outcome.
  • In the safety report or message to leadership, write the staff-related facts: time, place, behavior you observed, task affected, witnesses, who you told, and what happened next.
  • Keep it need-to-know. Do not gossip, guess, or start your own investigation.

What goes wrong

The usual mistake is turning the note into a label instead of a record.

Example: Nurse was high and unsafe all night.

That may feel clear when you write it. It is not clear later. What did you actually see? Slurred words? Falling asleep? Med errors? Staggering during a transfer? Patients left alone? Refusing to hand off keys or medications?

The label skips the facts people can use.

The other mistake is dumping the whole coworker issue into the patient chart. Do not do that. The chart should explain the patient care issue. Use the safety report, supervisor notification, or internal reporting system for the staff behavior that raised the concern.

It is not hypothetical

No case in our set speaks to this directly.

What to write instead

Here is the difference. The right side gives someone enough to understand the risk and what you did about it.

Instead of writing this Write this
1915 CNA Jane high, almost dropped pt. Charge aware.1915 During transfer from bed to chair, assigned CNA staggered backward and released gait belt. This RN held gait belt and assisted patient back to edge of bed. Patient denied pain or dizziness; skin intact; no fall. Charge RN M. King notified at 1917 and came to room. Transfer completed with 2 staff at 1925.
RN A.B. drunk at work. Took her cart.2035 Med room. RN A.B. had slurred speech, unsteady gait when walking from Pyxis to medication cart, alcohol-like odor on breath, and dropped two sealed medication cups while preparing 2100 medications for rooms 412 to 416. This RN asked A.B. to pause medication preparation and notified charge RN L. Thomas at 2037. Charge RN assumed medication cart at 2040. No patient injury known at time of report.
Night nurse forgot all meds because she was out of it.2135 On MAR review, 2100 metoprolol showed not administered. BP 148/82, HR 78. Order and parameters verified. Metoprolol administered at 2138. Charge RN notified at 2140. Patient resting in bed, no distress noted.
PCA is lazy and unsafe. I refuse to work with her.0245 Hall B. PCA C.D. was asleep in chair at nurses station during assigned 0200 rounds. Call light for room 218 active on board at 0246. This RN answered call light at 0247; patient requested toileting. Patient assisted to bathroom with walker and gait belt; no fall or injury observed. Charge RN notified at 0255 and reassigned rounding coverage.
RN is having a breakdown and should not have patients.1748 Nurses station. RN E.F. was crying, hands shaking, and stated they could not think clearly enough to take the assignment. E.F. was holding unopened insulin pen and MAR for patient 306. This RN asked E.F. to set insulin pen on counter and notified charge RN at 1750. Charge RN reassigned insulin administration. BG 286 at 1752; insulin administered by charge RN at 1800 per MAR.
I think she is stealing narcs.2310 Controlled substance count for drawer 2 was incorrect by one tablet of oxycodone 5 mg during shift count with RN P.L. Medication record and waste log reviewed by this RN and RN P.L.; discrepancy not resolved at time of count. Charge RN and pharmacy notified at 2318 per policy.

Words that do the damage

Avoid Why it causes trouble Use instead
drunkYou are naming a cause.alcohol-like odor on breath, slurred speech, unsteady gait, red eyes
highYou are guessing without testing or evaluation.nodding off, delayed responses, unable to complete task, repeated confusion about assignment
impairedIt may be a conclusion unless your facility process has made that finding.concern for fitness for duty based on observed behaviors
addictIt labels the person and does not help patient safety reporting.observed behavior or documented discrepancy
crazy, psycho, unstableIt is vague and judgmental.crying, shaking hands, unable to complete handoff, stated unable to continue assignment
lazy, uselessIt attacks character instead of describing the work.assigned rounds not completed, call light not answered, task not performed by scheduled time
almost killed the patientIt is dramatic and nonspecific.exact event, patient assessment, intervention, and outcome
stealing narcsIt accuses intent.controlled substance discrepancy noted; count incorrect by [NUMBER]; pharmacy and charge RN notified
not like herselfIt is too vague by itself.specific change from observed baseline, such as confusion, repeated questions, disorganized handoff, or difficulty following directions

What the guidance says

  • Chart what you observed, with times. Do not guess the reason. Include what you saw, where it happened, when it happened, and what care was affected. (CEUfast, NCBI Bookshelf)
  • Report unsafe practice or a possible fitness-for-duty concern through the right clinical chain. The goal is to protect patients and let the facility process handle the concern. (ANA, Nursing CE Central)
  • If patient safety or a patient condition is involved, keep your communication structured: what you noticed, what changed, what you did, and who needs to act next. (AHRQ, NCBI Bookshelf)
  • Keep the circle small. Treat a possible health, fatigue, or substance-related concern as need-to-know patient safety information, not a unit conversation. (ANA, Washington Nursing Commission)
  • Make the record easy to rebuild later: date, time, place, people involved, observed facts, patient impact, and notifications. (NCBI Bookshelf, CEUfast)

Copy this

Patient chart

``text [DATE] [TIME]: During [CARE/TASK], patient safety concern occurred when [OBJECTIVE EVENT AFFECTING PATIENT CARE]. Patient assessed: [ASSESSMENT FINDINGS]. Interventions: [WHAT YOU DID FOR THE PATIENT]. [CHARGE RN/SUPERVISOR NAME AND TITLE] notified at [TIME]. [PROVIDER NAME/TITLE] notified at [TIME] if clinically indicated. Patient response/outcome: [RESPONSE/OUTCOME]. Plan: [MONITORING/FOLLOW-UP]. ``

Message to charge nurse, supervisor, or manager

``text [DATE] [TIME]: I am reporting a patient safety concern involving [STAFF NAME/ROLE] on [UNIT/LOCATION]. At [TIME], I observed [SPECIFIC OBSERVABLE BEHAVIORS]. The concern affected or could affect [PATIENT CARE TASK/ASSIGNMENT]. Patient(s) involved or potentially affected: [ROOMS/NAMES OR NONE KNOWN]. Immediate action taken: [WHAT YOU DID TO PROTECT PATIENTS]. I notified [NAME/TITLE] at [TIME]. Instructions received: [INSTRUCTIONS]. I will complete required reporting per facility policy. ``

Safety or incident report

``text [DATE] [TIME]: Location: [UNIT/ROOM/AREA]. Staff involved: [NAME/ROLE]. Observed facts: [BEHAVIOR 1], [BEHAVIOR 2], [BEHAVIOR 3]. Patient care task involved: [TASK OR NONE]. Patient impact: [NO PATIENT CONTACT/DELAYED CARE/MISSED CARE/FALL RISK/MEDICATION CONCERN/OTHER]. Immediate safety steps taken: [STEPS TAKEN]. Notifications: [NAME/TITLE] at [TIME]; [NAME/TITLE] at [TIME]. Witnesses: [NAMES/ROLES]. Patient outcome at time of report: [OUTCOME]. Follow-up needed: [COVERAGE/REASSIGNMENT/MONITORING/OTHER]. ``

If you remember one thing

Write the behavior, the patient impact, and who you notified. Not your diagnosis of the coworker.

Read the decisions yourself

Every case below is a published decision on CourtListener. Open them. Nothing on this page asks you to take our word for what a court said — and where we only had the search result rather than the full opinion, it says so.

All the decisions behind this guide, in one page — searchable by court, year, or what happened.

What people say on the floor

Nurses talking to each other about this, quoted as they wrote it. This is opinion, not a source. It is here because it shows what the argument actually is — the rules above come from the decisions and the published guidance, not from these threads.

What everyone else says

Guidance from professional bodies, insurers and other people who write about this. Useful, but it is advice, not law — that part is above.

How would you chart it?

This is the part we cannot research. If you have a way of writing this that has held up — put it here. No account, no name needed. Nothing that could identify a patient: no room numbers, no dates of birth, no MRNs. Use placeholders, the example still works.

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