Nursing Jurisprudence and Ethics for Texas Nurses Practice Exam

Chart audits find the following errors committed by a nurse with observed impaired behavior at work: NO physician orders for narcotics signed out by the nurse, and NO documentation that the nurse either administered or wasted the narcotics. The best decision for the Incident-Based Peer Review Committee to make is that:

1. the nurse must be reported to the BON because of the combination of practice errors with possible practice impairment due to substance use or abuse.

2. the nurse must be reported to the Texas Medical Board for signing out medications without a valid physician's order for controlled substances.

3. the nurse needs remedial education in how to document the rationale for and response to PRN pain medications.

4. the nurse should be terminated from employment at the facility for stealing drugs.

The correct answer is: the nurse must be reported to the BON because of the combination of practice errors with possible practice impairment due to substance use or abuse.

The decision to report the nurse to the Board of Nursing (BON) is grounded in the serious concerns raised by the combination of practice errors observed. The absence of signed physician orders for narcotics, paired with a failure to document the administration or disposal of those narcotics, suggests not only a lack of adherence to proper medication management protocols but also raises significant red flags regarding potential impairment due to substance use or abuse. When a nurse displays impaired behavior and simultaneously exhibits failures in critical aspects of patient care—such as proper documentation and following orders—it signals a risk to patient safety and the integrity of nursing practice. Reporting to the BON is appropriate because they have the authority and resources to investigate allegations of substance abuse or impairment, as well as the capability to intervene to protect public safety. This reporting process serves not only to hold the nurse accountable but also to ensure that any underlying issues, such as substance abuse, can be addressed appropriately, allowing for potential rehabilitation and safe return to practice, if warranted. Furthermore, the BON's involvement will provide a more comprehensive assessment of the nurse's practice and determine the necessary steps to ensure that similar issues do not recur in the future.