The ED Nurse's Four Requests

The test here is role clarity, not willingness to help. Being useful is not the same as being in scope.

• One-to-one observation. Partly inside scope, but not as described. Sitting with someone to keep them safe from harm is a nursing/security function; peer support is a conversation offered by choice. If the patient is medically stable and awake, you can offer peer support - "I can introduce myself and see whether he wants to talk; I can't be his safety observer or physically manage him." You do not restrain, block, or chase anyone. If the situation turns unsafe, you leave and call for help.
• Searching the duffel bag. Outside scope entirely. Searches are governed by hospital policy and belong to security or nursing. "I don't search belongings - that's a security procedure. I can stay with him while you get security."
• Interpreting the drug screen. Outside scope. Peers do not interpret laboratory results or tell clinicians what a person is "really" using, and a urine screen cannot do that anyway. What you can offer is behavioral observation and the person's own words: "I can tell you what he told me and how he presented. I can't read his screen for you."
• Readiness assessment signed as a clinical impression. Outside scope. Peers can complete a peer support contact note and contribute observations to a team discussion; a clinical assessment and signature belong to a licensed clinician. "I'll document my peer contact and share what he said. A clinical impression has to come from you."

The reasoning: scope creep usually arrives as a reasonable-sounding favor from someone with more authority. Refusing is easier when you offer the alternative in the same breath.

Three separate problems: information you hold, a potential dual relationship, and his right to choose.

1. The information is off-limits. What you learned in your own treatment came to you as a patient, not as a peer. You may not use it, hint at it, verify it, or write it down. Doing so would be both a confidentiality breach and a betrayal of the mutual expectation that made that setting safe. If he discloses the same facts, it now comes from him and you treat it as new information with his consent.
2. Disclose to your supervisor before your next contact. Shared small communities mean overlapping histories are common, but the supervisor needs the facts to decide whether an assignment change is warranted. This is not a confession; it is standard risk management.
3. Let him decide. When he is oriented enough for conversation, introduce yourself, name the overlap plainly and briefly ("We were in the same unit a few years ago; I won't bring up anything from then"), and offer the alternative: "If you'd rather work with a different peer, I'll arrange it and there's no problem with that." If he is still intoxicated or agitated, defer the conversation rather than pressing.

If he asks you directly what you remember, answer honestly but minimally - "I remember we were both there; I don't discuss anything from that time" - and redirect to what he wants now. Note that he may prefer not to be seen by you at all, and that preference is legitimate, not paranoia.

Document the peer service, not a clinical picture, and not what you know from elsewhere.

Include:

• Date, times, duration, modality (in person, ED bay), and who else was present.
• What the participant said, in his words and in quotes where possible: "Patient stated, 'I don't want to go to rehab, I just need to sleep.'"
• What you did as a peer: introduced yourself, offered choice, provided information about withdrawal management and peer services, discussed what he wanted the next 24 hours to look like, offered a follow-up contact.
• His response and any decisions he made, including declining.
• Referrals made, with the specific warm handoff (who called whom, appointment date/time, number given).
• Any safety information he volunteered relevant to discharge planning.
• Notification of your supervisor about the shared treatment history, if policy requires it.

Leave out:

• Any statement that he "appears intoxicated," "is drug-seeking," "manipulative," or "in denial" - conclusions, not observations.
• Interpretation of the urine drug screen or any clinical impression.
• Anything you learned in your own treatment three years ago.
• Details of your own recovery story. If a brief disclosure was clinically purposeful, record only that it occurred and the participant's response, per agency policy.

Finally, sign as peer support, not as a clinician, and correct any earlier entry by addendum rather than deletion.