Orders, handoffs and other people

When a coworker seems impaired

A coworker is off mid-shift. What to write, where it goes, and how to word it so it still stands when someone reads it aloud later.

9 min read built on 6 full opinions updated 2026-09-20

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

Denise reacting to this topic
All sections

You're halfway through the shift and a coworker is off. Slurred words, a med pass that doesn't add up, a 40-minute disappearance, an odor you can't place. You've got two jobs. Keep the patients safe right now, and leave a written record someone can act on later. Write it so it still holds up when somebody reads it out loud two years from now.

Key points

  • Patients first. If someone's in danger right now, step in, get help, and tell the charge nurse or supervisor. Writing comes after.
  • Write what you saw, heard and smelled, with times. Leave out what you think it means. You're not diagnosing your coworker.
  • Report it up your facility's chain (charge nurse, house supervisor, manager). Write down who you told, when, and what they said or did.
  • The patient's chart is about the patient. Chart what you assessed and what you did for the patient. Anything about the coworker goes in the incident report, or wherever your policy says.
  • Write it the same shift. A report that shows up weeks later carries a lot less weight.

What to write

How people write it How it reads better
RN Smith was drunk on shift.14:10: RN J. Smith's speech slow and slurred. Odor resembling alcohol noted at approx. 2 feet while discussing pt in room 412. Unsteady gait, held wall while walking to med room.
Aide seemed off all night, not herself.02:00 to 03:30: CNA A. Lee did not answer 3 call lights for rooms 6 to 8 (02:15, 02:40, 03:05). Found seated in break room 03:20, eyes closed, roused to voice on second attempt.
Coworker probably diverting.16:45: Pyxis shows hydromorphone 2 mg removed by RN K. Doe for pt in 418 at 15:02. MAR shows no administration. Pt states last pain med was this morning. No waste witnessed.
Pt was neglected by his nurse, I had to fix everything.11:30: assumed care of pt at charge RN request. Pt BP 88/52, last documented VS 07:00. Notified Dr. Patel 11:35, orders received.
Told charge nurse, she didn't care.14:20: reported observations to charge RN M. Ruiz in person at nurses' station. Charge RN stated she would contact house supervisor. 14:50: house supervisor B. Tran arrived on unit.
She snapped at me and was acting crazy.15:05: RN Smith stated, Leave me alone, I'm fine, raised voice, at nurses' station in presence of unit clerk.

Patient chart (just the patient's facts, nothing about the coworker):

11:30 Assumed care of pt. Full assessment completed, see flowsheet. BP 88/52, HR 112. Dr. Patel notified 11:35, new orders received and implemented.

Template

Message to charge nurse or supervisor (write it down even if you also say it in person)

To: [CHARGE NURSE / HOUSE SUPERVISOR NAME]
From: [YOUR NAME, CREDENTIALS]
Date/time sent: [DATE] [TIME]
Unit: [UNIT]

I am reporting observations about [COWORKER NAME, ROLE] during the [DAY/NIGHT] shift on [DATE].

At [TIME] I observed: [SPECIFIC BEHAVIOR, e.g. speech slow and slurred, unsteady walking, did not respond to name twice].
At [TIME] I observed: [SPECIFIC BEHAVIOR OR RECORD DISCREPANCY].
Words spoken by [COWORKER NAME] at [TIME]: [EXACT WORDS, AS CLOSE AS YOU CAN].

Patients affected or potentially affected: [ROOM NUMBERS, NO DIAGNOSES NEEDED HERE].
What I did for patient safety: [e.g. checked on pts in rooms X and Y at TIME, all stable / took over care of pt in room X at TIME].

I am requesting that a supervisor assess the situation and review patient assignments.

[YOUR NAME]
[PHONE OR EXTENSION]

Incident report (narrative field)

Date of event: [DATE]
Time range: [START TIME] to [END TIME]
Location: [UNIT, ROOM OR AREA]
Person observed: [NAME, ROLE]
Reporter: [YOUR NAME, ROLE]
Other staff present: [NAMES, ROLES, OR NONE]

Observations (in time order):
[TIME]: [WHAT YOU SAW, HEARD, OR SMELLED. ONE OBSERVATION PER LINE.]
[TIME]: [WHAT YOU SAW, HEARD, OR SMELLED.]
[TIME]: [RECORD FINDING, e.g. Pyxis removal at TIME with no MAR entry, if applicable.]

Statements made by the person observed:
[TIME]: [EXACT WORDS]

Patient impact:
[ROOM / PATIENT IDENTIFIER per facility policy]: [WHAT HAPPENED OR DID NOT HAPPEN, e.g. scheduled 14:00 meds not given until 15:10].
Patient condition after intervention: [e.g. VS stable, provider notified at TIME].

Notifications:
[TIME]: Reported to [NAME, ROLE] by [IN PERSON / PHONE / MESSAGE]. Response: [WHAT THEY SAID OR DID].
[TIME]: Reported to [NAME, ROLE]. Response: [WHAT THEY SAID OR DID].

Actions taken by reporter:
[e.g. Assumed care of rooms X and Y at TIME per charge RN.]

Reporter signature: [YOUR NAME, CREDENTIALS]
Date/time completed: [DATE] [TIME]

Patient chart entry (only if you took over care or found a care gap)

[DATE] [TIME] Assumed care of patient per [CHARGE RN NAME]. Assessment completed: [KEY FINDINGS OR see flowsheet]. Last documented [VS / MED / ASSESSMENT] at [TIME]. [MED NAME, DOSE] due at [TIME], given at [TIME]. [PROVIDER NAME] notified at [TIME] regarding [FINDING]. Orders received: [ORDERS OR NONE]. Patient [RESPONSE / CURRENT CONDITION]. [YOUR NAME, CREDENTIALS]

Words to avoid

Word or phrase Why What to write instead
drunk, high, intoxicated, impairedA conclusion you can't prove from the hallwayThe specific signs: speech, gait, pupils if you saw them, odor, response time
seemed off, not herself, weirdMeans nothing to someone who wasn't thereWhat was different: time, behavior, what she said
diverting, stealingYou're accusing someone of a crimeThe record: what was removed, what was charted, what the patient says
again, as usual, everyone knowsRumor and history you didn't see this shiftOnly what you saw on this date. Past events go in their own report, with their own dates
I think, I feel, probablyOpinion that weakens the fact next to itDelete it, keep the fact
neglected the patientSounds like a legal findingWhat wasn't done and when: vitals not done since 07:00, call light 25 min
smelled like boozeCasual, and assumes the sourceOdor resembling alcohol noted, with distance and time

Writing a conclusion with no facts under it

The mistake I see most is writing a conclusion: RN appeared intoxicated, aide was high, she's using again. It feels like the honest summary. On paper it gives you three problems.

One: nobody can check it. A manager, a board investigator or a lawyer can't confirm intoxicated from your note. They can confirm you saw a dropped syringe at 14:10, that her speech was slow and slurred, that the count was off by two tabs. A conclusion with no facts under it reads as opinion. Facts with no conclusion read as evidence.

Two: a conclusion can be wrong. That coworker might be hypoglycemic, post-ictal, having a stroke, or on a new prescription. If you wrote drunk, your note is now false. And it has your name on it. If you wrote what you saw, it stays accurate whatever the cause turns out to be.

Three: a conclusion starts a fight about the label. Everyone argues over whether impaired was fair. Nobody looks at the 40-minute gap or the morphine waste nobody witnessed.

The next most common mistake is putting it in the wrong place. Write patient's nurse appeared impaired in a progress note and you've turned that chart into a personnel file. The chart shows what happened to the patient: you reassessed, you notified the provider, you took over care at a certain time. The story about your coworker goes in the incident report.

Bottom line

Write what you saw, when, and who you told. The diagnosis is someone else's job.

Official guidance

  • Noticing signs of impairment in a colleague and reporting them is part of your professional responsibility. The guidance calls it ethically appropriate, and it says plainly that reporting isn't disloyal. (ANA Code of Ethics, Washington State Nursing Commission)
  • Base your concern on specific signs and behaviors you can observe. Write them down as you notice them. A general impression isn't enough. (CEUfast, Wild Iris Medical Education)

In court, 2002–2015

What happened in 6 court cases

Jeannie Owens v. Missouri State Board of Nursing: Missouri Court of Appeals, 2015. A nurse took two muscle-relaxant tablets before driving to work at a correctional center. She got dizzy and backed into a car in the parking lot. The Board revoked her license, writing: "A critical aspect of being a nurse is to be unimpaired and sober at all times." The appellate court still upheld the circuit court's reversal of the revocation. The specific legal ground the Board picked (a DWI plea as a crime of moral turpitude or one related to nursing) didn't fit. So even the Board's own strong words had to stand on the right facts and the right ground.

Kuechle v. Life's Companion P.C.A., Inc.: Court of Appeals of Minnesota, 2002. A home care agency fired a nurse with a letter saying she disobeyed a direct order and abandoned a client. Her supervisor and coworkers testified she'd only been asked whether she'd be around for a few minutes. The court didn't treat order versus request as a small detail. It upheld the defamation finding. It also noted the agency never interviewed the nurse herself: "The employer cannot simply rely on accusations made by other employees or on secondhand hearsay with no identified source." What that means for you: write the exact words that were said. Your summary of them won't carry the same weight.

Lark v. Montgomery Hospice, Inc.: Court of Appeals of Maryland, 2010. A hospice RN sent management a string of e-mails about coworkers' documentation and narcotic handling problems. Later she was fired. The court held she didn't have to go to an outside board first to bring her whistleblower claim. It also held that once a coworker's repeated violations are reported to a supervisor, the employer's failure to fix them counts as the employer's own act. Her written, dated e-mails sat at the center of the case.

Lesmeister v. North Dakota Workers Compensation Bureau: North Dakota Supreme Court, 2003. A coworker reported that an LPN slapped a nursing home resident. The Director of Nursing investigated and wrote that she was "unable to determine" whether it happened. The facility then ended the LPN's at-will employment without cause. When nobody writes down specific, firsthand detail at the time, an allegation about a coworker can easily land at undetermined.

Teamsters Union Local No. 2 v. C.N.H. Acquisitions, Inc.: Montana Supreme Court, 2009. A nursing home fired an LPN. An arbitration panel ordered her reinstated because the home hadn't given the written notice its union contract required. Only in court did the employer raise it, "for the first time, Crest alleged that Hennelly was an impaired nurse," and argue that reinstating her went against public policy. The court enforced the reinstatement. If a concern never gets written down when it happens, it's hard to put on the table later.

Serena Rucker v. St. Thomas Hospital: Court of Appeals of Tennessee, 2007. A longtime nurse working as a patient relations coordinator was removed from her job after what the hospital called poor judgment during "an incident involving an allegedly impaired nurse." She sued for retaliatory discharge. The trial court granted summary judgment for the hospital, and the appeals court affirmed. How staff handle a suspected impairment, including who they go to and in what order, can end up being the dispute itself.

Court decisions

Published decisions, linked to CourtListener.

All decisions behind this guide

From nurses online

Quoted as written. Opinion, not a source.

Other guides

Advice, not law.