Leadership, Conflict and the Impaired Colleague
When a colleague may be impaired, client safety comes first: remove them from patient care and notify the supervisor immediately. You do not confront them alone, you do not wait to be certain, and you never cover for them or agree to keep it quiet: failing to report is itself a licensure issue. For conflict, the answer the exam rewards is almost always collaboration: address it directly, privately, and with the person involved.
Quality improvement, errors and the impaired colleague: what the nurse reports, to whom, and how.
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These Management of Care items look like office politics and are really about two reflexes: when safety is involved, act immediately and report up the chain; when it is an interpersonal disagreement, talk to the person directly and privately before anyone else.
The impaired colleague
Signs the exam uses: the smell of alcohol, slurred speech or unsteady gait, frequent unexplained absences from the unit, mood swings or defensiveness, a pattern of clients reporting unrelieved pain, discrepancies in controlled-drug counts, volunteering to give other nurses' narcotics, excessive wastage witnessed by no one, or arriving early and staying late without reason.
| Order | Action |
|---|---|
| 1 | Remove them from client care immediately. No further assignments, no medication administration |
| 2 | Notify the charge nurse or supervisor — the chain of command, not a peer and not a rumour |
| 3 | Ensure the colleague's own safety — they are not permitted to drive themselves home |
| 4 | Document objectively what you observed — behaviours and quotations, not conclusions about addiction |
| 5 | Follow facility policy and the board of nursing's reporting requirements. Many jurisdictions run alternative-to-discipline programmes aimed at treatment and monitored return to practice |
Three wrong answers appear again and again: confronting the nurse alone, waiting to gather more evidence while they keep working, and agreeing to say nothing because they are a friend or promise to seek help. Reporting is not disloyalty; it is the only route that protects clients and gets the colleague help.
Leadership styles
| Style | How it works | When it fits |
|---|---|---|
| Autocratic | Leader decides, others carry out | Emergencies — a code, a disaster. Speed matters more than consensus |
| Democratic / participative | Team consulted, decision shared | Most day-to-day unit decisions; builds engagement but takes time |
| Laissez-faire | Minimal direction, team self-directs | Experienced, self-motivated experts. Poor for new staff or a crisis |
| Transformational | Motivates through shared vision and development | Long-term culture change and retention |
| Situational | Style adjusted to the task and the staff member's competence | The realistic answer for a charge nurse |
If a stem describes a cardiac arrest and asks about leadership, the answer is autocratic — the one time directive leadership is the correct choice.
Conflict resolution
| Approach | What it looks like | Verdict |
|---|---|---|
| Collaborating | Both parties work toward a solution meeting both sets of needs | The exam's preferred answer. Win–win, but takes time |
| Compromising | Each side gives something up | Acceptable when time is short and the issue is not fundamental |
| Accommodating | One side yields | Reasonable when it matters far more to the other person, or you are wrong |
| Competing | One side wins by authority | Only in an emergency or a non-negotiable safety issue |
| Avoiding | The issue is not addressed | Almost always wrong, except a trivial matter or to let tempers cool briefly |
How to answer conflict items: choose the option that speaks directly to the person involved, privately, using “I” statements and specific behaviour — “When the report is late I cannot check the medications before rounds” rather than “You are always late”. Going over someone's head before speaking to them, discussing it with other staff, or ignoring it are the distractors.
Delegation, supervision and the unsafe assignment
When the assignment itself is the problem:
- Do not simply refuse and walk away — that can constitute abandonment once you have accepted responsibility for clients.
- Raise it with the charge nurse first, describing the specific safety concern and what you need.
- Escalate up the chain of command if unresolved — nursing supervisor, then administration.
- Document the concern objectively and in writing, through the facility's process.
- Accept the assignment under protest where required while continuing to escalate — unless you are asked to perform something outside your scope of practice, which you decline, because doing it is a licensure violation regardless of who directed it.
Other Management of Care scenarios that recur
- A colleague breaches privacy — looking up a friend's record, discussing a client in the lift. Address it directly and report per policy; it is a legal breach, not a lapse of manners.
- A provider's order seems wrong or unsafe — do not carry it out. Clarify with the prescriber; if unresolved, escalate. “The doctor ordered it” is never a defence.
- A colleague makes an error — the priority is the client's safety, then reporting through the proper channel. You do not conceal it and you do not chart their care for them.
- Witnessing incivility or bullying — address it, support the target, and report. Tolerating it is a patient-safety problem, not just a culture one.
NCLEX tip: Two patterns settle most of these questions. When safety is involved — impairment, an unsafe order, a scope violation — act immediately and report up the chain. When it is an interpersonal disagreement, talk to the person directly and privately before anyone else.
Educational use only: this article supports nursing review and does not replace clinical judgment, facility protocols, or instructions from an authorised prescriber.
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Frequently asked questions
Common follow-up questions on Prioritization, Delegation & Management of Care.
What should the nurse do if a colleague appears impaired?
Remove them from client care immediately and notify the charge nurse or supervisor. Do not confront them alone, do not wait for more evidence while they continue working, and do not agree to keep it quiet: failing to report is itself a professional violation.
Which conflict resolution style does the NCLEX prefer?
Collaboration, because it addresses the underlying needs of both parties rather than suppressing the issue. Compromise is acceptable under time pressure, while avoiding is almost always wrong.
When is autocratic leadership appropriate?
In emergencies (a cardiac arrest, a disaster, an immediate safety threat) where clear directive decisions must be made faster than consensus allows. Outside those situations it damages engagement and is not the preferred style.
Can a nurse refuse an unsafe assignment?
The concern is raised with the charge nurse and escalated up the chain of command with written documentation, rather than simply refusing and leaving, which risks abandonment. A task genuinely outside the nurse's scope of practice is declined outright, because performing it violates the licence regardless of who directed it.
What are the signs of drug diversion by a colleague?
Discrepancies in controlled-substance counts, frequent wastage without a witness, volunteering to administer other nurses' narcotics, a pattern of that nurse's clients reporting unrelieved pain, unexplained absences from the unit, and arriving early or staying late without reason.
What should the nurse do about a questionable provider order?
Do not carry it out. Clarify directly with the prescriber, and if the concern is unresolved escalate through the chain of command. Following an order known to be unsafe does not transfer responsibility away from the nurse.
Sources and references
- Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of Nursing. 10th ed. Elsevier; 2021; Chapter: Managing Patient Care.
- National Council of State Boards of Nursing. Substance Use Disorder in Nursing: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs. Chicago, IL: NCSBN; 2011.
Reviewed by the NCLEXPace team, October 2026.
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