Running head: DRUG DIVERSION IN NURSING

Issue Analysis: Drug Diversion in Nursing

Jennifer Mynhier
Ferris State University

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2
Abstract

This paper discusses the topic of drug diversion as it relates to nursing practice, and associated
problems such as substance abuse. Two nursing theories, the Self-Care Deficit Theory by
Dorothea Orem and the Systems Theory by Betty Neuman will be discussed in relation to drug
diversion. An anthropology theory by Charles Winick will also be applied to the topic. An
assessment of the healthcare environment will be communicated including current policies by the
Drug Enforcement Agency (DEA), Centers for Medicare and Medicaid Services (CMS), and
Spectrum Healths facility policy. Available resources to the drug addicted nurse include the
Health Professional Recovery Program (HPRP), Alcoholics Anonymous (AA), and Narcotics
Anonymous (NA). Quality and safety concerns can include patients that have not had their pain
needs met, nurse may make errors during care, and facilities could face lawsuits. If drug
diversion and substance abuse by nurses continues, implications and consequences of these
behaviors will be discussed as they relate to the patient, nurse, and the facility. Lastly,
recommendations for improvement in practice will be made using American Nurses Association
(ANA) standards and competencies by the Quality and Safety Education for Nurses (QSEN)
Institute as guidelines.

DRUG DIVERSION IN NURSING

Issue Analysis: Drug Diversion in Nursing

Drug diversion by nurses can be a major problem in the healthcare field. There is the
potential for large consequences to the nurse, the patient, and the facility involved. The purpose
of this paper is to outline the problem of drug diversion, including its impact on quality and
safety, and also to discuss potential recommendations for decreased incidence.
The Issue of Diversion
Drug diversion can have several definitions as it can apply to different scenarios. The
definition of drug diversion according to the National Association of Drug Diversion
Investigators (2014) is:
Any criminal act or deviation that removes a prescription drug from its intended path
from the manufacturer to the patient. This can include the outright theft of the drugs, or it
can take the form of a variety of deceptions such as doctor shopping, forged
prescriptions, counterfeit drugs and international smuggling. (para 1)
Therefore, by this definition, it is considered drug diversion anytime one is taking another
persons prescriptions, stealing medications, buying prescription drugs illegally, or even
demonstrating drug seeking behaviors. This paper is specifically focused on the issue of
diversion of drugs by nurses. In relation to nursing, a more appropriate definition is by Fleming,
Boyle, Billie-Lent, Carpenter, and Linck (2007), which states that drug diversion is the
unlawful taking of a patients medication by a healthcare professional for personal use (p. 200).
There are multiple reasons why a nurse may divert drugs. A study done by Berge, Dillon,
Sikkink, Taylor, and Lanier (2012) gives some very good statistics related to diversion. Typically
medications are diverted either for personal use or for financial gain. The most common type of
drug diverted is opioid pain medication, which can include morphine, oxycodone, fentanyl, and

DRUG DIVERSION IN NURSING

hydromorphone. Other drugs being diverted are non-opioid psychotropic medications such as
benzodiazepines, barbiturates, and stimulants. Drugs that are of higher value may be diverted for
financial gain, and can include antiretroviral medications and performance enhancing drugs like
erythropoietin and anabolic steroids. The article also explains some different methods of
diversion. This can include unopened vials, vials that have been tampered with such as dilution
or replacement with something else like normal saline, or removing discarded items from the
sharps container. Medications being diverted include oral tablets or patch forms as well.
The actual number of nurses who divert drugs is unknown for several reasons. One
reason is that many have not been caught, so it is unsclear how many nurses divert drugs but are
able to keep it a secret. Another reason is it is often kept quiet due to privacy concerns for the
nurse or for the hospital. Diversion data is not information that hospitals would necessarily want
known to the public. It is estimated by the ANA that 6-8% of nurses may have drug or alcohol
problems significant enough to impair their clinical judgment (as cited in Dittman, 2008, p.
324). Not all diversion incidents occur for personal use, but more than likely that is the primary
factor behind most diversion situations.
The importance of discussing this topic is the potential effect drug diversion can have on
quality and safety; not only for the patient, but for the nurse involved, and the facility at which
the nurse works. Possible consequences are explained by Fleming et al., (2007) as jeopardized
patient safety, discredited organizational reputations, compromised financial outcomes, and
endangered community trust (p. 200). It is important to know what to look for as probable signs
of drug diversion in healthcare in order to protect patients from harm.
There are various points of view to take into consideration when dealing with drug
diversion. These may include the reason for diversion; whether the drugs were taken for personal

DRUG DIVERSION IN NURSING

use because of a substance addiction problem, to sell on the streets for money, or given to a sick
relative or friend who otherwise could not afford them. The consequences of the diversion
should be taken into account. For example, if the patient did not get the pain medications needed,
unsafe needle practices caused undue harm to the nurse or the patient, or the nurse may have
been working under the influence and due to impaired judgment, caused harmed to the patient. It
is also possible that there were no major concerns because the problem was discovered before
anything critical occurred. These are just some of the many circumstances that could be taken
into consideration when determining consequences of drug diversion by a healthcare worker.
One of the primary issues is to determine the appropriate interventions in a drug diversion
situation. The nurse could be fired immediately, have legal action taken, or could be offered a
rehabilitation program. It is important from a safety and quality standpoint for nurses and other
healthcare workers to understand the extent of drug diversion and the consequences, and be
informed on what to look for if diversion is suspected so that the proper steps can be taken to
stop the medication diversion before it becomes a much larger problem.
Theoretical Base
A nursing theory that relates to the issue of drug diversion is the Systems Theory by
Betty Neuman. The main theme behind it according to Taylor, Lillis, LeMone, and Lynn (2011)
is that humans are in constant relationship with stressors in their environment (p. 74).
Substance abuse issues can sometimes come with inability to cope with stressors, which may
lead a nurse into a situation of diverting drugs. Sinha (2008) explains that it has been known for
a long time that stress can increase the risk of addiction. There are many contributing factors of
stress to be considered, for example, the dimensions of intensity, controllability, predictability,
mastery and adaptability are important in understanding the role of stress in increasing risk of

DRUG DIVERSION IN NURSING

maladaptive behaviors such as addiction (p. 106). Nursing can be a very stressful job. Inability
to cope with these stressors, in addition to other stressors outside of work, can put a nurse at a
greater risk for addiction if unable to find more appropriate coping mechanisms.
A second nursing theory to relate to the issue is Dorothea Orems Self-Care Deficit
Theory. Taylor et al. (2011) explain that self-care is a human need, self-care deficits require
nursing actions (p. 74). A nurse who is diverting drugs or has an addiction problem, especially
while working with vulnerable patients, is most definitely not practicing to full potential. In the
instance of a substance abuse problem, it is imperative the nurse get the necessary help to get
better. The path of addiction can often lead one to cause serious harm to self or others.
The theory that relates most to the issue of drug diversion is explained by the National
Institue on Drug Abuse (1980), it is an anthropology theory by Charles Winick: A Theory of
Drug Dependence Based on Role, Access to, and Attitudes towards Drugs. There are three parts
to the theory which states that the incidence of drug dependence will be high in those groups in
which there is: access to dependence producing substances, disengagements from proscriptions
against their use; and role strain and/or role deprivation (p. 225). In summary, the theory goes
on to discuss different populations at risk and includes nurses, physicians, musicians, college
students, Native Americans, and soldiers. Drug use may decrease when access to the drugs
decrease, negative attitudes towards the drug use become clear, strong feelings of disapproval are
felt, and role strain is lessened. This theory can help to determine which subgroups of people are
more at risk and also which individuals within the subgroups may be more susceptible. Nurses
are at higher risk for substance abuse based on this theory due to the availability of prescription
medications, ability to divert them from their intended use, and high stress level as discussed
previously.

DRUG DIVERSION IN NURSING

These theories can be applied to an interdisciplinary standpoint. One reason is because

nurses are not the only healthcare workers who have the potential to divert drugs. Some of the
other healthcare workers who ould possibly divert medications include: physicians, residents,
operating room technicians, anesthesiologists, nurse anesthetists, mid-level practitioners,
pharmacists, or pharmacy technicians. All healthcare disciplines should be aware of the signs to
look for in diversion or substance abuse, as it could be anyone who can suspect a coworker of
these behaviors and can help to stop them. If there is suspected diversion or substance abuse
problems, it may require close cooperation between multiple stakeholders including, but not
limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel,
and human resources (Berge et al., 2012, p. 674).
Assessment of the Healthcare Environment
There are several different policies, resources, and quality and safety issues related to the
topic of drug diversion. These can range from broad to very specific. Many of these vary from
facility to facility; however, an overview is provided below.
Policies
One of the more broad policies is by the DEA which requires that all registrants provide
effective controls and procedures to guard against theft and diversion of controlled substances
(as cited by Schaefer & Perz, 2014, p. 882). Under this policy, hospitals are required to have
safeguards to help protect against potential diversion situations. Another policy is by CMS and
states drugs listed in Schedules II, III, IV, and V of the comprehensive Drug Abuse Prevention
and Control Act of 1970 must be kept locked within a secure area (as cited by Schaefer & Perz,
2014, p. 883). This indicates that any hospital in participation with CMS is required to keep
controlled substances within a locked area when not being used. Many hospitals have locked

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medication rooms that require a passcode or a badge to get into the room and then often there is
an automated dispensing system that requires a passcode or fingerprint. The narcotics in these
machines require a count each time to help keep track of at what point a medication may have
gone missing. The DEA has categorized controlled substances into Schedules II-V, ranging from
Schedule II as having a high potential for abuse to Schedule V which has a much lower potential
for abuse (as cited by Berge et al., 2012).
Each individual facility has more specific policies and these can vary from place to place.
Most of the State Boards of Nursing, according to McHugh, Papastrat, and Ashton (2011), have
mandatory reporting laws that require a hospital, health care facility, peer, or colleague to report
addicted or impaired co-workers who are not receiving treatment (p. 12). This article also
discusses that disciplinary action can be taken against the nurse or hospital in the result of failure
to report, but are often considered on a case-by-case basis.
A specific policy by Spectrum Health System (2014) discusses the policy on a smoke,
drug, and alcohol free environment and states that employees must not use, divert, possess,
store, manufacture, sell, or distribute controlled substances at any time (p. 3). The policy also
states that if there is any suspicion of drug use or diversion, an employee will be required to
undergo drug or alcohol testing, and any refusal to cooperate with the testing will result in
termination.
Resources
Many of the resources found are directed specifically towards treatment of those
healthcare workers who are diverting the drugs for personal use due to a substance abuse or
addiction problem. In Michigan, the program HPRP (2012) is designed to encourage health
professionals to seek treatment for substance use and/or mental health disorders before their

DRUG DIVERSION IN NURSING

impairment harms a patient or damages their careers through disciplinary action (para. 1). It is
available to a variety of health professionals and includes evaluation, treatment options, and
monitoring after treatment. Monitoring can include random drug screens, therapy, and periodic
reports. After successfully completing the program, all files are destroyed after five years
offering complete confidentiality to the healthcare worker who is compliant with the program.
This is a great option for healthcare workers who understand their need for treatment and are
willing to get help. Programs such as Narcotics Anonymous and Alcoholic Anonymous are also
great resources to help provide another resource for meetings and sponsorship for participants to
have an outlet for their addiction.
Quality and Safety
There is a plethora of quality and safety concerns related to drug diversion. Patient safety
is a huge concern. Safety issues can arise from a nurse taking care of a patient while under the
influence. Clinical judgment can become impaired and errors could occur such as an incorrect
medication given, breaking sterile technique, or forgetting to change a dressing. If the nurse is
stealing medications using unsafe needle techniques, the patient or nurse can become infected
with various diseases. If a nurse is discovered to be diverting drugs or working under the
influence, and it becomes public knowledge, patient satisfaction scores may be affected which
will then affect the hospital. Legal and financial concerns could also be a potential problem in
certain situations, not only for the nurse involved, but possibly for the facility as well.
In addition to safety and quality concerns, is the challenge of preventing diversion before
it begins. Even with all the protocols in place to prevent diversion, it will never be completely
stopped. Prevention and education are key in these situations, and it is the responsibility of the
hospital to follow protocols to keep the hospital safe from diversion activities. Hospital

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employees are also responsible to be on the lookout for suspicious activities from their
coworkers. This will help protect the safety of the worker, the patient, and the hospital.
There may be some underlying assumptions that can be related to the topic. For example,
anyone who would divert drugs is a wrongdoer, druggie, criminal, lowlife, or just a bad person in
general. The truth is that anyone can get addicted to medications, and addiction can lead to
desperate measures. Siegel and Forrey (2014) explain that:
It can be difficult to understand why medical professionals would risk their years of
training, professional reputations, and personal livelihoods to engage in drug diversion.
However, addiction knows no bounds, and anyone can develop a substance use disorder.
Among all drug users, most are functioning in the community and nearly 66% are
employed. Furthermore, an estimated 10% to 20% of nurses have substance abuse
problems, and they tend to abuse prescription drugs instead of street drugs. (p. 15)
Another assumption is the possible ramifications of reporting a coworker. McHugh et al. (2011)
explain that coworkers are reluctant to report an impaired colleague because of the widespread
belief among nurses that reporting an impaired coworker will automatically result in the
impaired persons loss of nursing license rather than treatment for the addiction (p. 12). As
discussed earlier, failure to report can cause serious consequences to that worker and possibly the
hospital as well.
Inferences and Consequences
As discussed, there are many consequences related to safety and quality that can stem
from diversion or substance abuse problems of the nurse. This can include treating a patient
while under the influence, not giving the pain medication or sedatives required, but instead
taking them for personal use, and the nurse putting personal needs before the patients needs.

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Undoubtedly, the biggest safety concern is infecting patients with some disease due to unsafe
needle practices in the process of diversion. A study done by Schaefer and Perz (2014) outlines
several outbreaks of infections that occurred directly related to drug diversion over a ten year
period in the United States. There were a total of six outbreaks, three of these were by nurses and
three by operating room (OR) technicians. Two of the outbreaks involved nurses using needles to
remove medications from patient controlled analgesia pumps for personal use, and a total of 34
patients being infected with gram-negative bacteremia. One of these nurses resigned when she
was discovered and no disciplinary action was taken. The other nurse was removed from
practice, pled guilty at trial, and sentenced to two years in prison.
Shafer and Perz (2014) also explained that in all of the other four incidents, each of the
four healthcare workers, working in OR areas, removed fentanyl for personal use, infected
themselves with hepatitis C virus (HCV), and subsequently infected a total of 84 patients. The
infected patients were all determined to have been infected by the employee based on matching
strains of HCV. All of these employees pled guilty to various charges and one received 41
months in prison, two received 30 years in prison, and one received 39 years in prison. As a
result of these four outbreaks, 30,000 patients were determined to have been potentially exposed
and advised to do blood-borne pathogen testing. The three OR technicians should not have even
had access to these medications, as it is not in their scope of practice. It is clear to see that nurses
and other healthcare workers who divert drugs are a major liability to their patients safety, and
all measures should be taken to prevent these scenarios from occurring.
Patient safety is not the only consequence to consider. As seen in the situations provided
in the last paragraph, these nurses can see prison time. They can infect themselves with any
number of blood-borne pathogens. They can suffer from any of the emotional concerns that

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could stem from any diversion or substance abuse circumstances, even if they do get help with
treatment. The hospital could face legal concerns due to consequences of a healthcare workers
diversion. The hospital could also see decreased patient satisfaction scores if the problem
becomes public.
Recommendations for Improvements
The first recommendation is a training program for the prevention and recognition of
drug diversion. Education is key, and a program for new hires that is periodically revisited
throughout employment for healthcare workers could be very beneficial (see Appendix A for tips
on diversion training). Better monitoring of wasting techniques is also very important in helping
to prevent diversion opportunities. Sharer (2008) gives an overview of different options for
wasting techniques, especially relevant to the OR as that is where the greatest number of
diversion activities occur. When medication vials or syringes are returned or wasted, they are not
typically tested to show that they are in fact the medication or some replacement such as normal
saline or water. There are technologies out there to test these returned medications which include
mass spectroscopy, high-performance liquid chromatography, and refractometry (p. 250).
Some of the limitations involved with these techniques can include: testing may be expensive,
time consuming, or even that in the refractometer, fentanyl looks just like normal saline,
therefore these methods are not all that effective. A good option for the OR is called enhanced
photoemission spectroscopy because it is only one to two dollars to run the test and the results
come back in minutes. The main limitation to this testing is that it must be centrally located, so it
would not be convenient to most other areas because the nurses would not be able to just put
these drugs into the sharps container as they do now. They would have to walk it to the specific

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location every time the medication is given; consequently, this is not practical for regular nursing
practice.
All diversion or substance abuse situations should be taken on a case-by-case basis, but
when possible, rehabilitation should be an option for the healthcare worker. The ANA
encourages the rehabilitation of impaired nurses so they can return to work where they can
practice safely through the abstinence from any mood-altering chemicals (as cited by McHugh
et al., 2011, p. 13). There is some question on whether treatment can work if a person is coerced
into it, either threatened by their employer, or legally forced. The research shows that treatment
programs and monitoring programs can actually be very successful in nurses with substance
addiction. These types of programs, according to Darbro (2009), demonstrate high retention;
low relapse rates and high success rates and also that the research supports the efficacy of legal
coercion on treatment retention, decreased drug use, decreased recidivism, and cost
effectiveness (p. 30). This supports rehabilitation as a primary option for nurses in need of
treatment.
Standards of Professional Practice
The ANA (2010) has 16 Standards of Practice for nurses. Three of these standards can be
directly related to the issue of drug diversion. Standard 7 is that the nurse will practice ethically,
and it states that the nurse takes appropriate action regarding instances of illegal, unethical, or
inappropriate behavior that can endanger or jeopardize the best interests of the healthcare
consumer or situation (p. 47). This directly relates to the coworkers being held responsible for
mandatory reporting of suspicious behaviors. Standard 10 relates to quality of nursing practice,
and it explains that the registered nurse demonstrates quality by documenting the application of
the nursing process in a responsible, accountable, and ethical manner (p. 52). A nurse who is

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diverting drugs, using controlled substances while taking care of patients, or a nurse who does
not report questionable behaviors is not fulfilling this standard to provide only quality care
practices. The third standard that can apply to the specified recommendations is Standard 15
which explains that the nurse should utilize appropriate resources to plan and provide nursing
services that are safe, effective, and financially responsible (p. 52). As discussed in the section
about resources, there are available means for the substance addicted nurse, and he or she should
utilize them as soon as a problem arises. Either by their own referral, their employer, or because
they are legally required. The mentioned training program is something that can be utilized as a
resource to help prevent diversion situations as well. Another resource to be utilized is the
monitoring of wasting techniques either by the hospital, and/or more accountability for the
nurses who are witnessing other nurses waste their controlled substances.
QSEN Competencies
The Quality and Safety Education for Nurses (QSEN) Institute has made several
competencies for pre-licensure future nurses to use in order to have the knowledge, skills, and
attitudes (KSAs) necessary to continuously improve the quality and safety of healthcare systems
within which they work (para. 1). One of the outlined competencies is Safety, and it can be
argued to be the most applicable to the topic at hand. An example of a knowledge
recommendation that is given states examine human factors and other basic safety design
principles as well as commonly used unsafe practices (such as, work-arounds and dangerous
abbreviations). A skill that is given is demonstrate effective use of strategies to reduce risk of
harm to self or others. The attitude listed is to value own role in preventing errors (QSEN,
2014). This is important because if a nurse is practicing under the influence, he or she is more
likely to make errors, and in turn potentially harm their patients. According to the National

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Council of State Boards of Nursing, 68% of all disciplinary actions stem from impairment
activities (p. 325). Using some of the above recommendations could help reduce the risk of
diversion activities in the healthcare setting.
Conclusion
Drug diversion is a major concern for patient safety and quality of care. Impairment
activities can cause mistakes in patient care and diverting a patients medication can cause undue
discomfort. There are many policies and resources that can be used as guidance for possible
diversion. Due to the seriousness of the consequences related to drug diversion, it is vital to do
everything possible to help protect against these occurrences.
Recommendations include better education of nursing staff about the potential impact not
only on themselves, but also on the patient and the hospital as well. Hospitals can benefit from
more regular scheduling of education sessions. These sessions can help each nurse look for
diversion or impairment behaviors in their coworkers. Sessions could also instruct the nurses that
report of a coworker will not typically lead to the employee being fired or having their license
taken away, but hopefully into a treatment program to help the nurse overcome the addiction
when feasible. This will hopefully make employees more apt to go to a manager when suspicious
behaviors are observed. Better monitoring of wasting techniques can be advantageous to
determine the extent of diversion in a facility, and indicate the possible diverters. Anyone as the
potential to develop an addiction problem, and due to the extensive nature of the topic, it is
important to look at drug diversion from all angles in order to see the whole picture.

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References

American Nurses Association. (2010). Nursing: Scope and Standards of Practice (2nd ed.). Silver
Springs, MD: American Nurses Association.
Berge, K. H., Dillon, K. R., Sikkink, K. M., Taylor, T. K., & Lanier, W. L. (2012). Diversion of
drugs within health care facilities, a multiple-victim crime: Patterns of diversion, scope,
consequences, detection, and prevention. Mayo Clinic Proceedings, 87(7), 674682.
doi:10.1016/j.mayocp.2012.03.013
Darbro, N. (2009). Overview of issues related to coercion and monitoring in alternative diversion
programs for nurses: A comparison to drug courts: Part 2. Journal of Addictions Nursing
2009, 20(1), 2433. doi:10.1080/10884600802693256
Darbro, N. (2009). Overview of issues related to coercion in substance abuse treatment: Part I.
Journal of Addictions Nursing (Taylor & Francis Ltd), 20(1), 1623.
Dittman, P. (2008). Male nurses and chemical dependency: masterminding the nursing
environment. Nursing Administration Quarterly, 32(4), 324330.
Fleming, K., Boyle, D., Billie-Lent, W. J., Carpenter, J., & Linck, C. (2007). A novel approach
to monitoring the diversion of controlled substances: The role of the pharmacy
compliance officer. Hospital Pharmacy, 42(3), 200209. doi:10.1310/hpj4203-200
Health Professional Recovery Program. (2012). HPRP Brochure. Retrieved from
http://www.hprp.org/documents/HPRP%20Brochure.pdf
McHugh, M., Papastrat, K., & Ashton, K., C. (2011). Assisting the drug addicted nurse:
Information for the legal nurse consultant. Journal of Legal Nurse Consulting, 22(3), 11
14.

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National Association of Drug Diversion Investigators. (2014). What Exactly is Drug Diversion?
Retrieved from
http://www.naddi.org/aws/NADDI/pt/sd/news_article/43411/_PARENT/layout_details/fa
lse
National Institute on Drug Abuse. (1980). Theories on Drug Abuse: Selected Contemporary
Perspectives. Retrieved from http://archives.drugabuse.gov/pdf/monographs/30.pdf
Rohman, C. (2012). Roads to recovery: Drug diversion surveillance programs. Nursing
Management (Springhouse), 43(3), 2831. doi:10.1097/01.NUMA.0000411906.85325.72
Schaefer, M., K., & Perz, J., F. (2014). Outbreaks of infections associated with drug diversion by
US health care personnel. Mayo Clinic Proceedings, 89(7), 878887.
doi:10.1016/j.mayocp.2014.04.007
Sharer, K. (2008). Controlled-substance returns in the operating suite. AORN Journal, 88(2),
249252. doi:10.1016/j.aorn.2008.03.017
Siegel, J., & Forrey, R. (2014). Four case studies on diversion prevention. Pharmacy Purchasing
and Products, 11(3). Retrieved from
http://www.pppmag.com/article/1469/March_2014/Four_Case_Studies_on_Diversion_Pr
evention/
Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York
Academy of Sciences, 1141(1). Retrieved from http://0onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1196/annals.1441.030/pdf.
Spectrum Health System. (2014). Smoke, Drug, and Alcohol Free Environment. Unpublished
internal document.

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Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and
science of nursing care. Philadelphia, PA: Wolter Kluwer Health: Lippincott Williams &
Wilkens.

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Appendix A

(Siegel & Forrey, 2014, p. 17)

GRADING CRITERIA FOR SENIOR ISSUE ANALYSIS PAPER

STUDENT:__Jenny Mynhier___________TOPIC__Drug Diversion__________

Grade and
Comments

Points
A. INTRODUCTION: This should include the issue and its
relevance to the nursing profession. Clearly focused and well
written introductory statement on an appropriate topic. The
question at issue should be made clear.

10

10
Discuss the importance and the purpose of the topic. How
widespread is the issue? What are the various points of view
that must be considered? What does it mean? What difference
does it make for nurses to become involved?
B. THEORY BASE: There should be relevant theoretical
support (concepts) provided from nursing. Theory (concepts)
from other disciplines should also be incorporated to
demonstrate how this issue can be looked at from an

20
20

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interdisciplinary and collaborative perspective.

C. ASSESSMENT OF THE HEALTHCARE ENVIRONMENT:
Use a systems framework to consider what policies,
resources, or quality and safety issues may be related to this
issue. What are the challenges and who or what entities are
involved? Also include underlying foundational assumptions
that may be pertinent.

20

D. INFERENCE/IMPLICATIONS/CONSEQUENCES: What is
the logical interpretation of the data about this issue? What
are the likely outcomes of the various positions on this issue?

20

E. RECOMMENDATIONS FOR QUALITY AND SAFETY

IMPROVEMENTS: Discuss realistic intervention strategies
that could be used by nurses in different settings and discuss
these interventions as they relate to a minimum of 3 ANA
standards of professional practice. This section should be
discussed from the perspective of how quality and safety will
be improved by incorporation of the recommended strategies.
QSEN competencies will be important to review or consider in
writing this section. (Support your identified interventions with
relevant research).
F. Appropriate References and Structure (professional
references and journals, minimum of 5 sources, incorporates
original nursing research, adheres to assigned length of 10-15
pages not including title page, abstract or refs)
Total Points
FINAL GRADE less Deductions: DEDUCTION OF UP TO 30
points will be made for
APA/writing/grammatical/punctuation errors.

20

20

20

20

10
10

100

100%
-2 = 98%

Jenny, Excellent job with your analysis paper on drug diversion Well written, and you
clearly and thoroughly addressed all required rubric sections. Your support from the
literature was strong, and you went above and beyond in terms of the number included.
Your inferences section was reflective, and recommendations were practical and clearly
based on appropriate ANA and QSEN standards/competencies. Youve done a great
job covering this topic over the semester!! There were a few writing issues noted
throughout (some weve already talked about), but these were relatively minor and
APA was strong, so only a 2 pt overall deduction for that. I appreciate your hard work on
this Jenny!

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