Checklist: Characteristics of an Impaired Nurse

Does your employee demonstrate the following characteristics? Check those that best describe the current situation.

I. Current Behavioral Patterns

Employee’s appearance

  • sloppy
  • inappropriate clothing


  • withdrawn
  • sad
  • mood swings, high and low
  • suspiciousness
  • extreme sensitivity
  • nervousness
  • frequent irritability with others
  • preoccupation with illness and death (morbidity)


  • physically assaultive (or threatening)
  • unduly talkative
  • exaggerated self-importance
  • rigidity — inability to change plans with reasonable ease
  • making incoherent or irrelevant statements on the job
  • overcompliance with any routine (making it a ritual)
  • frequent argumentativeness
  • frequent outbursts of crying
  • excessive amount of personal telephone time

II. Job Performance


  • multiple instances of improper reporting of time off
  • excessive sick leave
  • repeated absences following a pattern (Monday/Fridays)
  • excessive lateness in the morning or upon returning for lunch
  • peculiar and increasingly improbable excuses for absences
  • high absenteeism rate for colds, flu, gastritis, general malaise, etc.
  • frequent unscheduled short-term absences (with or without medical explanation)
  • frequent use of unscheduled vacation time

"On the Job" Absenteeism

  • continued absence from job location more than job required
  • frequent trips to water fountain or restroom
  • long coffee breaks


  • physical complaints on the job
  • accidents on the job
  • accidents off the job

Work Patterns and Production

  • current work assignment requires more effort than previously taken
  • work takes more time to produce
  • difficulty in recalling instructions, understanding office procedures, etc.
  • display of disinterest in work
  • increased difficulty in handling complex assignments
  • difficulty in recalling previous mistakes (although these have been brought to the employee’s attention)
  • general absentmindedness, forgetfulness
  • alternate periods of high and low productivity
  • coming to work in an intoxicated condition
  • missed deadlines
  • mistakes due to poor judgment
  • outside complaints about the employee’s work
  • improbable excuses for these poor patterns
  • carelessness

Employee Relations on the Job

  • overreaction to real or imagined criticism
  • wide swings in job morale
  • borrowing money from co-workers
  • unreasonable resentments against co-workers
  • repeated and compulsive criticism of the company
  • persistent requests for job transfer
  • unrealistic expectation for promotion
  • abrasiveness with others (managers and/or co-workers)

Work Related Relationships in the Company

  • inappropriate behavior at company business meetings
  • complaints from the community concerning the employee

III. Other

Things to look for:

  • illogical or sloppy charting
  • wears long sleeves at all times
  • comes to work early and stays late for no reason — hangs around
  • isolated; wants to work night shifts; lunches alone; avoids informal staff get-togethers
  • elaborate excuses for behavior such as being late for work
  • blackouts; complete memory loss for events, conversations, phone calls to colleagues; euphoric recall of events on the floor
  • calls in to request compensatory time at the beginning of the shift

Suspicious Behavior Concerning Controlled Drugs

  • consistently signs out more controlled drugs than anyone else
  • frequently breaks or spills drugs
  • purposely waits until alone to open narcotics cabinet
  • consistently volunteers to be med nurse
  • vials appear altered
  • incorrect narcotic count
  • discrepancies between patients’ reports and other patients’ reports on effective medications, etc.
  • patient complains that pain medications dispensed by this nurse are ineffective
  • defensive when questioned about medication errors
  • too many medication errors