A nurse is working on a unit and suspects a coworker is chemically impaired. Which of the following members of the chain of command should the nurse notify first?

Choice A reason: Professional identity is not the correct answer, as it refers to the sense of belonging and alignment with the values and norms of the nursing profession. Joining a professional organization does not necessarily imply that the nurse has a strong professional identity, as they may have other motives or interests for doing so.

Choice B reason: Quality improvement is not the correct answer, as it refers to the systematic and continuous actions that lead to measurable improvement in health care services and outcomes. Joining a professional organization does not directly contribute to quality improvement, as it depends on the nurse's involvement and participation in the organization's activities and initiatives.

Choice C reason: Risk management is not the correct answer, as it refers to the process of identifying, analyzing, and reducing the potential for harm or loss in health care settings. Joining a professional organization does not affect risk management, as it does not change the nurse's responsibility or accountability for their practice.

Choice D reason: Professional commitment is the correct answer, as it refers to the degree of loyalty, dedication, and engagement that the nurse has towards the nursing profession. Joining a professional organization is an example of professional commitment, as it shows that the nurse is interested in advancing their knowledge, skills, and career, and in contributing to the development and improvement of the profession.

Choice A reason: Obtaining a detailed history is the first action that the nurse should take. History can help the nurse determine the cause, frequency, and severity of the bruises, as well as the child's relationship with the abuser and the risk of further harm. History can also help the nurse assess the child's physical and emotional state, and provide evidence for reporting the abuse later.
Choice B reason: Reporting the suspected abuse to the authorities is not the first action that the nurse should take. The nurse should report the abuse only after obtaining a history and confirming the suspicion. Reporting the abuse prematurely can jeopardize the child's safety and the nurse's credibility. The nurse should also follow the legal and ethical guidelines for reporting abuse in their jurisdiction.
Choice C reason: Requesting a social services referral is not the first action that the nurse should take. The nurse should request a social services referral only after reporting the abuse and ensuring the child's protection. A social services referral can help the child access resources and support, such as counseling, legal aid, foster care, etc. The nurse should also collaborate with the social worker and other members of the interdisciplinary team to provide holistic care for the child.
Choice D reason: Telling the child what will happen to her when the abuse is reported is not the first action that the nurse should take. The nurse should tell the child what will happen to her only after obtaining a history and reporting the abuse. The nurse should also use age-appropriate language and reassure the child that the abuse is not her fault and that she is not alone. The nurse should avoid making promises that they cannot keep, such as saying that the abuser will never hurt her again.