Running head: BENCHMARK: ETHICAL DECISION MAKING 1

Benchmark: Ethical Decision Making

Makenna Tracy

Grand Canyon University: NSG-436 Leadership, Ethics, and Policy in Health Care

04/19/2020
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Benchmark: Ethical Decision Making

An ethical dilemma is a decision-making problem which usually involves a conflict of

interest and at least two possible moral constraints. This benchmark will discuss one ethical

dilemma within the healthcare system, standard application and providing safe patient care,

ethical decision making skill which would help to resolve the dilemma, and the solution which is

influenced by nurse leadership.

Ethical Dilemma and Justification

There are many ethical dilemmas which can arise in the healthcare system. These include

issues with drug diversion, LGBTQ populations, do not resuscitate (DNR) orders, etc. This

benchmark will focus on the ethical dilemmas pertaining to drug diversion because this issue is

widespread throughout the nursing profession and public. Drug diversion occurs when

prescription drugs and controlled substances are obtained illegally. When healthcare

professionals divert drugs, it puts patients at risk for impaired quality of care, for increased pain

due to denial of pain medications, and for infection if injectable medication is involved (Center

for Disease Control and Prevention, 2019). To compound the issue, drug diversion is not a

difficult task for the health care worker. They have access to medication, which is readily

available to them, so this makes drug diversion hard to detect and prevent (The Joint

Commission).

Standard Application and Providing Safe Client Care

If drug diversion is a prevalent problem on their nurse unit, the nurse manager has the

responsibility of working with upper management of the institution to implement certain actions.

The first action is to integrate prevention measures. There are systems which facilities should be

using which were designed to minimize drug mishandling. Additionally, facilities should train
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their employees to act appropriately within institution protocols when handling medication. If

prevention measures fail, then detection should be facilitated by video monitoring of high-risk

areas such as the pharmacy and drug dispensing areas that nurse have access to. Also, there

should be staff in place who are aware of and alert for behaviors and other signs of potential

diversion activity. After drug diversion has been detected, then a response is indicated. Nurses

should know the appropriate responses which include reporting to their superior, assessing harm

to patients, and consulting with public health officials and enforcement agencies when necessary.

It is important to follow the institution’s chain of command in these situations (The Joint

Commission).

Ethical Decision Making Skills

Nurses have the ethical responsibility to protect patient safety and well-being according

to the American Nurses Association (ANA) Code of Ethics. Provision II states that in any

situation in which a conflict of interest is involved, it is the duty of the nurse to go to their

superior and report it. Then, an answer to the problem can be created so the patient’s well-being

in ensured and the professional integrity of the nurse and institution is protected. Provision III of

the Code of Ethics overlaps slightly with Provision II. It states that promoting a culture of safety

is a main responsibility of both nurse leaders and non-leaders. Nurses should hold each other

accountable for their individual practices. This means remaining a silent bystander is not an

option, especially in a drug diverting situation because patient safety is at risk (American Nurses

Association, 2015).

Solution and Leadership Influence

The ANA’s position on drug diversion they do not view it exclusively as a crime

(American Nurses Association, 2016). For this reason, the solution to the drug diverting issue
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should include the nurse manager creating a just culture within the nurse unit. Rather than a

punitive system, a just culture focuses on finding where the error occurred, creating resolutions,

and educating on methods of prevention for the future. A just culture allows for less fear of

retaliation in nurses who come forward to report a problem. This is integral in encouraging the

nursing staff to say something if they see something (The Joint Commission).

Conclusion

The ethical dilemma discussed in this benchmark pertained to drug diversion. In this

situation, the ANA and Joint Commission promote the standard of “see something, say

something” especially within a just culture. It is the ethical responsibility of the nurse to protect

patient safety and keep their peers accountable for their practices as outlined in Provision II and

III of the ANA Code of Ethics. These provisions were created to reduce nursing errors which

can include drug diversion.

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References

American Nurses Association. (2015). Code of Ethics for Nurses. Retrieved April 15, 2020,

from https://www.nursingworld.org/coe-view-only

American Nurses Association. (2016, October). Substance Use Among Nurses and Nursing

Students. Retrieved April 19, 2020, from https://www.nursingworld.org/practice-

policy/nursing-excellence/official-position-statements/id/substance-use-among-nurses-

and-nursing-students/

Center for Disease Control and Prevention. (2019, November 26). Drug Diversion. Retrieved

April 19, 2020, form https://www.cdc.gov/injectionsafety/drugdiversion/index.html

The Joint Commission. (2019, April). Quick Safety: Drug Diversion and Impaired Health

Care Workers. Retrieved April 19, 2020,

from file:///C:/Users/MakennaTracy001/Downloads/Quick_Safety_Drug_diversion_FIN

AL2PDF.PDF