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How Nursing Culture Impacts Diversion Prevention in a Hospital Setting.

In honor of National Nurses Week Kit Check is publishing this article originally published in Nursing Management on May 3rd. 2021. 


By Jessica Hodges, BSN, RN, Implementation Specialist at BluesightⓇ


Nurses play one of the most essential roles in any hospital or health system. They’re constantly interacting with patients and other healthcare staff members to ensure that everyone is staying safe and receiving the best care possible. They also work closely with other nurses and, although they are individually responsible for patients, have a close camaraderie that comes from the teamwork and support they offer each other. 


However, their constant workload, dedication, and compassion for their patients, while making the job worthwhile, can be stressful. Nurses are on their feet performing crucial care-related tasks for shifts that last as long as 12 hours. Because of their connection to their patients, it can be especially challenging for them to watch patients get increasingly sick or sometimes pass away.


Nurses’ role in preventing diversion

In addition to patient-related responsibilities, nurses are also responsible for a variety of other tasks, such as medication administration and tracking within an organization. This often positions them as the first line of defense against a threat that nearly every hospital experiences: drug diversion.


According to Kit Check’s 7th annual survey of hospital pharmacists, 44% reported that they had experienced a diversion event within the past 12 months. Even more concerning, 24% are aware of a colleague who has diverted opioids, and 10% have observed colleagues changing their behaviors to evade diversion prevention technology. 


Because nurses are familiar with handling and dispensing medications constantly, they’re often able to identify suspicious or unusual behavior that could indicate diversion. Nurses must also act as witnesses when it comes to administering and wasting medications, which is a prime opportunity for diversion if not done properly.


Manually combing through records trying to identify potential diversion incidents can be like trying to find a needle in a haystack. It’s incredibly time consuming for already busy nurses and staff and can impede on their already overwhelming workload and take away valuable time for assisting patients. 


Luckily, there are technology solutions that can help. Many diversion detection technologies on the market use advanced algorithms, such as artificial intelligence and machine learning, to identify patterns and highlight areas of concern, making it easy for nurses and other hospital staff to open investigations and potentially intervene. 

Some even offer assistance when it comes to managing the technology and parsing the data in the form of a live consultant.


Diversion and Mental Health

This isn’t to say that nurses are never the ones engaging in diversion. In fact, Kit Check’s recent Diversion Quarterly publication, which examines controlled substances, revealed that 8.6% of cases involving a nurse contained a variance, or a discrepancy between a medication order and the administration of the medication. Though this is a very small, in a percentage of cases, the effects of a diversion incident can be especially jarring because of how tight-knit nurses are and how involved they typically are with each other. 


Therefore, it’s critical for nurse managers to be involved in auditing nurses. A diversion event will not only impact the staff hours available and lead to more work for the diverter’s colleagues, but it could do significant damage to the general morale of the team. 


One of the major reasons that diversion takes place among any hospital staff member is diminishing mental health due to the stress and strain of working in a healthcare environment. This has been exacerbated by COVID-19, which has increased the patient load healthcare providers must deal with while also compounding the trauma they may face daily. 


However, leadership can play a huge role in helping nurses manage their mental health and deal with threats of diversion. Hospitals can’t take care of patients without nurses. It’s essential for them to feel respected and supported by ensuring they have a safe space or an outlet if they’re concerned about potential diversion incidents or if they’re experiencing a mental health crisis themselves. 


If nurses are engaging in diversion, supportive leadership must step up and ensure they get the treatment they need and no longer serve as a threat to themselves, patients, and other staff. 


The Culture of Nursing 

Each individual nurse plays an important role on their own, but they’re indispensable when they come together as a team. Creating a culture where nurses are respected, valued, and given the tools they need to succeed helps form a positive hospital environment for everyone involved. 


This includes equipping them with the appropriate technologies to help manage their workload and ensure that they have a trusted leadership structure to report any issues or concerns. With the right systems in place, nurses can play the role they were meant to in the hospital— compassionate, caring, and crucial to care


About Jessica Hodges, BSN, RN 

Hodges is a licensed RN and implementation specialist at Bluesight, where she works on the ControlCheck™ team. Prior to joining Bluesight, she was a senior applications analyst working with Cerner at Mon Health Medical Center in Morgantown, W.Va. A BSN graduate of Fairmont State University, Hodges is currently working on her MSN in Nursing Informatics.