Impairment, a Shared Shift, and a Near Miss
A radiographer is on a night shift with a colleague who is her equal in grade. At 02:00 she notices the colleague's speech is slightly slurred, he is unsteady on his feet, and he has just mislabelled a request form, catching the error himself. He says he is 'just tired' and has had 'a couple of drinks before coming in' but insists he is fine. He has 20 years' experience, is well liked, and is the only other person on site who can operate the second scanner. The department is short-staffed and two patients are waiting. The colleague asks her not to make a fuss and says he will finish the shift. The employer's policy requires any employee who suspects a colleague is unfit for work to report it immediately to the duty manager, who is contactable by phone overnight. There is no written policy on what to do if the duty manager cannot be reached.
1. What should the radiographer do in the next ten minutes, and why does the presence of waiting patients not change the answer?
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She should act immediately, not wait to be certain. The observable signs - slurred speech, unsteadiness, a labelling error, and admitted recent drinking - meet a reasonable suspicion threshold, which is all the policy requires.
In the next ten minutes: (1) ensure no patient is scanned by the colleague; (2) remove or secure his access to the scanner and request forms if that can be done safely and without confrontation; (3) call the duty manager as the policy directs and report the facts, not conclusions; (4) stay with him or ensure he is not alone and is not driving home; (5) keep patients informed of a short delay without disclosing the reason.
The waiting patients are a pressure but not a justification. A mislabelled form in imaging can mean wrong patient, wrong side, or wrong procedure - a serious harm event. Short-staffing is a management problem; scanning with an impaired operator converts a staffing problem into a patient-safety incident. His 20 years' experience and popularity are irrelevant to the fitness question and should not soften the report.
2. The duty manager's phone goes to voicemail. What is the correct escalation, and what should she not do?
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She should escalate up the chain the policy implies even though it is unwritten: leave a clear voicemail with time and call-back number, then try the manager's alternate number or the on-call clinical lead, then the site security or nursing coordinator if one exists. She should send a written message (text or email) so the report is timestamped, and record every attempt.
She should not: let the colleague continue scanning while she keeps trying; leave the department to find a manager, leaving patients unattended; take it upon herself to send him home as a disciplinary act - she can and should prevent him from operating equipment, but the formal fitness-for-work decision belongs to management; or promise the colleague she will not report it. She also should not attempt to diagnose him or label him as intoxicated - she reports observations.
If no manager can be reached and no safe cover exists, the correct outcome is to suspend the affected scanning and escalate the service interruption, not to proceed. Documenting the failed escalation protects her and exposes the policy gap.
3. What should happen after the shift, and what does this case reveal about the policy?
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After the shift: an incident report describing observations, time, actions, and escalation attempts; a note that the colleague was not left alone and was not permitted to drive; support for the colleague through whatever employee assistance or health program exists, since impairment may be health-related; and a debrief for the radiographer, who may find the night distressing.
The case exposes a clear policy gap: a mandatory reporting duty with a single point of contact and no fallback. A workable policy needs a named alternate, an out-of-hours decision-maker, a defined interim measure (for example, an authorised person may stand an employee down pending review), and explicit protection for the reporter against retaliation. The radiographer should raise this in writing through the incident report and, if she is a registered professional, consider whether her own code obliges her to report a colleague she reasonably believes is impaired - most do, and the duty is not satisfied by a voicemail alone.