Helping a colleague

Balancing family and work can be challenging, especially in demanding professions like nursing and midwifery. As well as workplace pressures, nurses, midwives and students encounter all of the same life pressures and events as everyone else. At times it can be difficult to find a balance.

What should you be looking for to determine if a co-worker is just having a bad day or has a health issue that could impact their work? And if you do identify someone has a health issue, what options are available to you?

This is a guide to help you identify a colleague's potential health issues, which may require intervention, or increased support.

Often changes in behaviour and physical appearance occur over a period of time, and are indicative of worsening health. The changes observed can be subtle and difficult to identify, but add up to a concerning picture overall. Other signs may be more obvious and shouldn't be ignored.

Uncharacteristic behaviours

• unpredictable mood swings
• increased irritability or defensiveness towards co-workers
• less engaged emotionally with co-workers and/or patients and clients
• isolating or distancing behaviour at work — taking breaks alone and not joining social activities
• poor professional boundaries — disclosing personal information to patients or breaching confidentiality
• regularly late for work or increased absenteeism
• overreaction to criticism or tending to blame others 
• complaints of poor client or patient care
• increasing clinical errors or incident reports
• difficulty in concentrating
• attending work with hangovers frequently, or
• less interested in work.

Physical signs

• deterioration in appearance
• poor hygiene
• diminished alertness or drowsiness
• excessive sweating
• excessive tremor
• unsteady gait
• changes in speech — increased volume, rate of speech or slurring of speech, or
• smell of alcohol on breath.

Raising concerns about a colleague can be difficult for a range of reasons:

• not wanting to jeopardise an existing professional or personal relationship with the person
• thinking that is the responsibility of managers to respond to concerns
• your place in the workplace hierarchy — this colleague is in a higher position
• peer protection — a strong desire to protect a colleague
• issues are not deemed sufficient to warrant a formal report
• experiencing similar health issues
• fear that reporting will result in the colleague involved losing their job and registration
• not wanting to be accused of being a 'whistle blower'
• fear of retribution - scrutiny and criticism of your work
• fear your colleague may deny that any issues exist if questioned
• fear that if you discuss an issue with a colleague they may become angry and hostile
• justifying and dismissing concerns if no harm has occurred
• deciding that ignoring or covering up the behaviour is the best outcome for your colleague, or
• fear of ramifications from other colleagues in the team.

These are all normal concerns. It is important, however, that if you are concerned about an individual — you do something.

Sometimes you may openly discuss and seek support within your team when facing personal or workplace challenges. This provides an informal pathway to check in and validate your feelings. It also gives you an opportunity to actively encourage a colleague who is expressing concerns to seek support.

Colleagues may not openly discuss their personal and/or professional challenges and they may not be aware of the consequences that their health issues are having on their work performance or collegial relationships. They may also be fearful or ashamed to acknowledge that a health issue may be affecting their job performance.

It is important to acknowledge that concerning behaviours may be early warning signs that a colleague may be developing a physical or mental health issue (including substance use dependence) that could affect their ability to work.

Alternatively, the changes in behaviours and subsequent observations may be indicative of serious existing health issues. Regardless of the above scenarios if you have identified concerns relating to a colleague’s health or practice, you should act on these concerns.

Depending on your relationship with a colleague, a first step might be to have a confidential and private conversation with your colleague about your concerns. Use a simple, caring and compassionate approach “Is everything okay, I am concerned as I have noticed...”.

If during this conversation your colleague confirms your concerns, you can encourage them to seek appropriate professional support and speak with their manager.

Sensitive discussions relating to health concerns can be difficult. Many nurses, midwives and students report a sense of relief when their health issue is identified and support and treatment commences. If you are uncomfortable in raising your concerns with a colleague, or the situation requires immediate attention (for example, if you are aware that your colleague is working whilst intoxicated on drugs or alcohol), then it is essential that you speak with a manager or education provider.

As nurses, midwives and students you have a professional and legal obligation to report colleagues who may display concerning behavior that could harm clients or patients.

Why not use our service finder to find out about some of the services available.

Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.

If you would like to know a bit more about the service before getting in contact — take a look throughaccessing support.

Cadiz, D. M., Truxillo, D. M., & O'Neill, C. (2015). Common risky behaviours checklist: a tool to assist nurse supervisors to assess unsafe practice. Journal of Nursing Management, 23(6), 794-802. doi: 10.1111/jonm.12214

Dunn, D. (2005). Substance abuse among nurses-defining the issue. Association of Operating Room Nurses. AORN Journal, 82(4), 572-82, 585-8, 592-96; quiz 599-602.

Cares, A., Pace, E., Denious, J., & Crane, L. A. (2015). Substance Use and Mental Illness Among Nurses: Workplace Warning Signs and Barriers to Seeking Assistance. Substance Abuse, 36(1), 59-66. doi: 10.1080/08897077.2014.933725