The nurse is caring for a client when the attending physician comes in to round on the client. At the nurses’ station, the nurse smells alcohol on the physician’s breath when he hands her the chart with new orders. Which action by the nurse is appropriate?

  1. notify the nurse manager and or/charge nurse
  2. confront the physician about the smell of alcohol
  3. tell the client and request a consult with another physician
  4. enter the new orders as written, since there was only a morning lab draw ordered
Number 1 is correct.
Rationale: The nurse has a legal and ethical duty to report any caregivers who may be impaired, whether it is a physician or an unlicensed assistive personnel. The nurse should immediately notify the nurse manager and/or the charge nurse. Facility policies will guide them on the proper response and whether to notify risk management or security. Since the physician may be impaired, any orders written may require review by another health care provider before implementing. Confronting the physician may result in escalating a potentially volatile situation and is inappropriate. The client should not be informed at this time of the physician’s possible impairment until the situation has been followed up per facility guidelines. Another physician should not be consulted by the nurse, as this is a situation requiring intervention by management. The nurse should not enter orders that were written while the ordering physician was possibly impaired, even if it is a routine lab and seems to be an appropriate choice. The nurse assumes liability for entering any such orders and could be held liable if the order caused any harm to the client.