護理師在繁忙的病房中發現同事疑似出現藥物濫用的徵兆。護理師應優先採取哪項行動？
A nurse is working on a busy unit and notices a coworker exhibiting signs of potential substance impairment. Which action should the nurse take first?
- ADocument the coworker's behavior in the patient's medical records將同事的行為記錄在病患的病歷中
- BWait for more concrete evidence before taking any action採取任何行動前等待更具體的證據
- CDiscuss concerns directly with the coworker to encourage self-reporting直接與同事討論疑慮以鼓勵其自行通報
- DReport the observation to the unit manager or supervisor immediately✓ 正解立即向單位主管或監督者通報此觀察結果
當發現同事疑似有藥物濫用或精神狀態受損，第一要務是維護病人安全，這屬於護理行政中的法律與倫理責任。必須立即向單位主管報告，以便啟動調查程序，這不僅是為了保護病人，也是為了保護該名護理師。直接找同事對談（C）可能會打草驚蛇或引發衝突，且這類問題通常非個人能力所能處理；將行為紀錄在病人病歷（A）是不正確的，因為病歷是記錄病人狀況而非員工行為；等待更多證據（B）會讓處於危險中的病人持續暴露於風險之下，這在護理倫理中是不可接受的，因為護理師負有維護病人安全的直接義務。
When a coworker is suspected of substance abuse or impaired mental status, the first priority is to safeguard patient safety, which is a legal and ethical responsibility within nursing administration. The nurse must immediately report the observations to the unit manager or supervisor so that an investigation can be initiated; this protects both patients and the coworker. Confronting the coworker directly (C) may provoke defensiveness or conflict and is generally beyond an individual's capability to handle. Documenting the behavior in a patient's medical record (A) is incorrect because the chart is for documenting patient status, not employee behavior. Waiting for more evidence (B) leaves at-risk patients exposed to ongoing harm, which is unacceptable under nursing ethics, since the nurse has a direct duty to protect patients.
美國有針對藥物濫用護理師的轉介計畫（如 Alternative to Discipline），強調恢復與治療；台灣則傾向嚴格的職場行政處分，甚至通報衛生局，壓力體系較大。