Contact Hours: 2
This educational activity is credited for 2 contact hours at completion of the activity.
To provide healthcare professionals an overview of the role of the correctional nurse, and how to adequately care for the incarcerated patient while maintaining safety within the correctional environment.
In the correctional setting, the correctional nurse provides professional nursing and care to incarcerated individuals, who are their patients in various public and private correctional facilities, including juvenile detention centers, county jails, prisons, and state and federal holding facilities. The role of a correctional nurse varies by institution; however, all nurses must be proficient in meeting the common needs of the incarcerated patients that they care for, all while assisting in maintaining a safe, secure environment for themselves, their patients, and other staff members.
Upon completion of the independent study, the learner will be able to:
- Identify the difference between an inmate and an incarcerated patient.
- Describe the role of the correctional nurse.
- Review therapeutic communication, and how it can influence the care that is given to the incarcerated patient.
- Understand how to assist in maintaining safety within the correctional environment.
- Understand the seven guiding principles for the correctional nurse.
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|Correctional Facility||A building that many criminal justice systems use to detain offenders. These facilities may hold accused people prior to trial, convicted criminals, juvenile offenders, and other types of individuals.|
|Correctional Nurse||Nurses who provide care to people who are incarcerated in various public and private correctional facilities, including juvenile detention centers, jails, prisons, and state and federal holding facilities.|
|Correctional Officer||Someone who is in charge of overseeing and enforcing the rules of a prison or jail.|
|Incarcerated Patient||A recipient of a healthcare service or a person in need of treatment and care within a correctional facility.|
|Inmate||An individual confined in a correctional institution.|
|Negligence||Failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances.|
|Malpractice||Care that falls below the normal standard of care or service for a patient that may result in injury or loss.|
|Therapeutic Communication||The face-to-face communication technique between a healthcare professional and a patient that aims to enhance the patient’s comfort, safety, trust, health, and well-being.|
The number of those incarcerated in our nation’s prisons and correctional facilities is increasing, and just like regular civilians, incarcerated people have medical conditions that must be appropriately treated within a reasonable time frame. In the correctional setting, the correctional nurse provides professional nursing and care to incarcerated individuals, who are their patients in various public and private correctional facilities, including juvenile detention centers, county jails, prisons, and state and federal holding facilities. The job duties associated with being a correctional nurse are often like those of nurses who work in hospitals and other care facilities. Their typical duties may include ⁸:
- Perform wellness check-ups on incarcerated patients
- Perform intake screenings
- Review the incarcerated patient’s medical records
- Interview and educate incarcerated patients
- Assist incarcerated patients through drug detox
- Formulate and execute care plans
- Maintain accurate records and proper safety procedures
- Monitor medical supplies
- Assess the medical progress of incarcerated patients with pre-existing conditions
- Provide emergency first aid as needed
- Plan patient discharges
Correctional nurses face unique challenges in their work environments, such as limited resources and working in a secured facility. To be successful, these professionals need to possess the skills common to all nurses, such as having critical-thinking skills, possessing a great deal of emotional stability, and they must be able to keep solid boundaries between themselves and their incarcerated patients.
Nurses who work in correctional facilities have unique working environments that can present challenges, such as limited resources and freedom of movement within a secured facility. As such, these nurses should possess skills common to all nurses, including critical thinking skills, being detail oriented, having emotional stability, and maintaining professional boundaries when treating the incarcerated. ⁷
|Attention to Detail||Correctional nurses must identify and assess changes in a correctional patient’s health status. Strict attention to detail helps the correctional nurse to identify changes in a detainee’s medical condition.|
|Communication||Correctional nurses must be comfortable communicating with people of various ages and backgrounds. Fine-tuned communication skills help the correctional nurse explain instructions, such as how to care for an injury, and relay a correctional patient’s medical needs to correctional officers and other medical personnel while maintaining professional boundaries.|
|Compassion||Correctional nurses must be empathetic and caring. Compassion helps the incarcerated patient feel comfortable discussing their ailments with the nurse.|
|Critical Thinking||The type of care that a correctional nurse provides can vary daily. When medical emergencies happen, critical-thinking skills help nurses identify the correctional patient’s medical conditions and determine next steps.|
|Emotional Stability||Correctional patients may face a variety of stressors, such as being away from their loved ones, experiencing guilt about an offense, and feeling like they lack emotional support. Consequently, emotional resilience is needed to administer care in a corrections environment.|
The role of a correctional nurse varies by institution; however, all nurses must be proficient in meeting the common needs of patients that they serve. ¹ In the instance of incarceration, nurses who care for incarcerated patients must provide the same care that they would provide to a patient who is not incarcerated. Correctional nurses treat a wide spectrum of medical conditions; the common cold, chronic and newly diagnosed health conditions, and even provide care for emergent conditions. They also may provide treatment for mental health and drug dependence. For example, a report from the Bureau of Justice Statistics on the medical problems of state and federal prisoners found that in comparison to the general population, incarcerated individuals are more likely to experience chronic conditions such as cancer, cardiovascular problems, diabetes, and infectious diseases such as hepatitis C and tuberculosis. In addition, people who are incarcerated and have a history of mental health issues may experience increased symptoms while detained in the correctional setting. The prominence of health issues in correctional facilities is compounded by the fact that many people who are incarcerated may not have had consistent access to medical care prior to their incarceration, which can result in undiagnosed conditions.
A correctional nurse’s job duties may vary based on the incarcerated population they work with. They may conduct intake screening or may be utilized in an on-call basis. Common tasks and responsibilities of the correctional nurse includes ⁷:
- Administering daily medications to ensure compliance
- Applying bandages and surgical dressings
- Assisting physicians with medical treatments
- Obtaining blood samples, stool samples, and other specimens for diagnostic testing
- Performing physical assessments of newly detained inmates and inmates who have recently been transferred from another facility
- Providing first aid and emergency care
- Reporting and logging changes in an incarcerated patient’s emotional and/or physical condition
- Reporting and logging an incarcerated patient’s reactions to medications
Prior to incarceration, many of the incarcerated may have lacked access to medical care, and often, they may arrive at correctional facilities with undiagnosed medical and/or psychological conditions. Correctional nurses can use various screening tools and techniques to examine, identify and address any clinical conditions and health care needs that a person who is incarcerated may have. They must be knowledgeable and competent to use the various screening techniques, and know the purpose of the screening, the focus of data collected, and the time frame in which the screening must occur. Reasons for screening in the correctional setting may include ²:
- After a use-of-force incident occurs
- Placement in segregation
- Referral to an alcohol or drug treatment program
- Restraint use
- Risk for substance withdrawal
- Transfer to another facility or to court
- Work clearance
Correctional nurses use their education, training, and professional judgment to determine the disposition of each incarcerated person who is screened. Once the screening is completed, the correctional nurse has a responsibility to communicate the findings of the screening and the subsequent decisions made. This includes providing custody officers or other personnel who are not part of the health care team with enough information to maintain a safe environment for themselves, the patient, and other personnel. The correctional nurse should also communicate the screening results and subsequent decisions made to the other members of the healthcare team through documentation in the health record and share the results with the incarcerated person so that they will know what to expect next, and how to request for additional assistance, as necessary.
Correctional facilities operate 24 hours a day, seven days a week. As a result, nurses working in a corrections environment may have to work variable shifts. In addition, they are often subject to additional workplace rules that are enforced, such as not bringing metal cutlery or cell phones inside a correctional facility. In some states, aspiring correctional nurses may need to pass a criminal background check and a general physical as part of the application process.
Therapeutic communication is described as the face-to-face communication technique between a healthcare professional and a patient that aims to enhance the patient’s comfort, safety, trust, health, and well-being. Correctional nurses use therapeutic communication techniques to provide education and support to patients, while maintaining objectivity and professional distance. There are a variety of techniques that may be used to engage in therapeutic communication with a patient. Some of these techniques include⁹:
- Ask for clarification to ensure that what the patient is trying to convey is understood.
- Engage in active listening by giving verbal and nonverbal cues that show the patient that the correctional nurse is engaged in the conversation.
- Provide acknowledgement to the patient that they have been heard.
- Summarize by restating what was said, which will verify listening and understanding of a topic.
- Use brief periods of silence to allow the correctional nurse and the patient an opportunity to reflect on what was said, or an opportunity to change the subject if needed.
- Use reflection to allow the incarcerated patient to think about a given situation and take ownership about any decisions that are made.
- Using open-ended questions to give the patient the opportunity to direct the flow of the conversation and decide what is most important to them.
Professionalism in correctional nursing is the provision of quality care while upholding the principles of accountability, respect, and integrity. The Correctional Nursing: Scope and Standards of Practice¹ articulates seven guiding principles for Correctional Nursing practice that support Correctional Nursing professionalism:
|Principle 1||The core of correctional nursing practice is patient-centered care that respects the dignity and diversity of all persons.|
|Principle 2||The nursing process is fundamental to correctional nursing practice and critical thinking is used to provide individualized care to patients.|
|Principle 3||Professional nurses know their correctional role and recognize that their primary role is the delivery of nursing services.|
|Principle 4||Correctional nurses recognize the value of teamwork and collaboration by establishing partnerships with correctional staff, mental health staff, dietary staff, outside providers when incarcerated individuals are released.|
|Principle 5||A strong link exists between the professional work environment and the correctional nurse’s ability to provide quality care and achieve optimal outcomes for their patients.|
|Principle 6||Correctional nurses promote quality patient care through practice that is guided by nurse leaders who support personal and professional development.|
|Principle 7||Correctional Nurses demonstrate compassion and caring by providing culturally competent, age-appropriate care.|
One of the main concerns when working within the correctional environment is workplace safety. There are various concerns in regard to safety, and the notion does not solely rest on the behaviors of the incarcerated person. The following are considerations to maintaining workplace safety⁴:
|Back Injury||Very few correctional institutions employ ancillary care staff, and as such, correctional nurses may have to move infirmary patients, assist with wheelchair transfers, and help in 4-man lifts from the yard ground to a stretcher. In addition, housing locations may require correctional nurses to push heavy medication carts across outdoor yards or up slopes to get to an administration point. If medication carts are unable to be taken to an incarcerated person’s location, such as upper tiers in a housing unit, correctional nurses may need to use back packs or carry medication baskets up steep stairways. Back safety is of paramount importance in correctional nursing practice.|
|Harmful Chemicals||Many correctional institutions have challenging space issues. Older facilities were built without attention to healthcare needs, requiring some cell blocks to be converted to healthcare units. This can mean haphazard storage and fragmented supply space configurations. This, in combination with the restricted correctional environment can lead to environmental hazards. In addition, many correctional facilities use inmates to maintain general cleaning. Correctional nurses may come across mislabeled or unlabeled containers of hazardous chemicals, or they may need to handle medications that are considered hazardous, as there often is no onsite pharmacy available.|
|Mental Health||Correctional nurses are at risk of mental distress from incarcerated patients and colleagues. Disgruntled nurses or disillusioned correctional officers may transfer aggressions on colleagues. The correctional environment can often be a place of cynicism and distrust, which can lead to bullying among the staff and incarcerated patient population. In addition, the correctional nurse’s mental health can be jeopardized by compassion fatigue (form of stress or tension that arises from frequent contact with traumatized people, where they become preoccupied with the suffering or pain of another) when working with this disadvantaged population.|
|Needle Sticks||Needle stick injuries have decreased since the implementation of safety needles in healthcare. Although having a safety needle is an Occupational Safety and Health Administration (OSHA) regulation, the needles can still be misused, and their safety mechanisms can be disregarded, resulting in a needle stick. This is especially concerning because the incarcerated population has an increased number of bloodborne pathogens in comparison to civilian populations.|
|Slips and Falls||Unsafe walking surfaces are a huge concern in the correctional environment. Many correctional nurses must walk long distances to get to housing units or they may have to push heavy, unwieldly carts to administer treatment and medications to the incarcerated. In addition, when walking outside, weather conditions may cause slick or icy surfaces increasing the risk for falls, or a simple consideration of a fan or space heater that is often plugged into an outlet can pose a risk for tripping and falling. It is important for the correctional nurse to be aware of their surroundings and consider wearing nonskid shoes when working in the correctional setting.|
|Violent Patients||Personal and professional safety is of utmost importance for every nurse who works with incarcerated patients. People who are incarcerated are classified by level of violence and are monitored and housed by officers based on that classification. Someone who has a low threat for violence will likely have more privileges within the correctional environment than someone who has a high propensity for violence. The higher the risk for violence, the higher the classification, which results in an increased number of correctional officers who monitor the inmate who has a propensity for violence, and the increased likelihood that they will be segregated from the rest of the incarcerated population. Nurses will often state that working in a correctional setting is safer than any other facility, because they know who is likely to become violent, and there are correctional staff readily available to intervene. Regardless of this notion, the correctional nurse must be astute in their surroundings and maintain professional barriers when providing care to the incarcerated patient. The correctional nurse should also consider the following safety precautions when providing care to an incarcerated patient:Always be observant of your entrance and exit locations. Never place yourself in a position that allows the incarcerated patient to block your entrance or exit.Always have a partner or custody officer in observance when providing care.Always keep a change of clothes in your car – some locations require mandatory overtime – depending on your location, you could be assigned more than 16 hours.Always wear nonskid shoes.Carry an alarm or whistle when available.Do not allow an inmate or incarcerated patient to make a phone call on a public phone without notifying the correctional officers first.Do not bring objects/clothing/money into the correctional facility for an incarcerated patient.Do not bring weapons into the correctional facility.Do not offer or accept any gifts from the incarcerated patient.Do not perform any ‘favors’ for or make ‘exchanges’ with the incarcerated patient.Do not tell an inmate or correctional patient when they are being transferred to another facility. If an alarm sounds, make yourself visible to the custody officers.Never go onto a housing tier or into a cell alone.Never leave sharp objects/needles unattended around the incarcerated patient.Under no circumstances can you develop friendships or relationships with incarcerated patients.|
Legal implications of nursing practice are based on licensure, scope of practice, standards of nursing care, the state nursing practice act and other state and federal laws, and an expectation that a nurse will practice at a high professional standard which is framed by a nurse’s education, licensure, skills, and nursing standards. ⁵
In healthcare, legal actions may result from negligence, malpractice, and criminal acts of assault, abuse, or fraud committed in the nurse’s professional role. Any of these acts can subject the nurse to civil and/or criminal litigation.
Correctional nurses can be especially vulnerable to legal actions because they care for patients already within the legal system. ³ Correctional nurses have a duty to see and evaluate a patient’s complaints and determine the level of care required. A patient’s medical complaint can be submitted by paper form, through communication from the correctional officer, or through telephone if in-person contact is not allowed. Based on the information the correctional nurse gains from the incarcerated patient, the nurse will determine the type and level of care required, inform an advanced practice nurse, physician, or physician assistant of the need for higher levels of care as necessary, prioritize the care needed, and implement the appropriate care required that is within the correctional nurse’s scope of practice. The correctional nurse must also document all patient encounters, any health needs that are identified, any interventions taken, any patient education provided, and an evaluation of interventions and outcomes.
Failure to provide incarcerated patients with adequate access to healthcare needs can be litigated under the Eighth Amendment as deliberate indifference or under the 14th Amendment as a civil rights violation.
Ethical situations may arise often with the correctional nurse. These situations may be due to the nurse-patient relationship and its defining barriers and being a patient advocate while providing safe patient care of one who is incarcerated. ³ Although the nurse-patient relationship is based on the health and well-being of a patient, emotional, mental, and physical boundaries must be maintained when providing care to the incarcerated patient. In the correctional setting, a nurse’s caring behaviors cannot include physical touch. Instead, words and actions must be used to help establish a caring relationship.
In the correctional setting, a nurse has the responsibility to ensure that patients have access to care and eliminate barriers to care that are identified. Often, there may be pressure and influence from custody officers, the employers, and even other inmates to object to prioritizing the well-being of an incarcerated patient. In these instances, the nurse must have moral courage to remain strong and overcome fears of being ridiculed, ostracized, or unfairly treated when taking a stand for patient advocacy.
Moral resilience occurs when a nurse has the ability and willingness to speak and take appropriate, patient-focused actions when faced with moral and/or ethical adversity, all while knowing that they are correct in a given situation. Correctional nurses can develop moral resilience through gaining self-awareness by improving communication skills, negotiation, conflict resolution and interprofessional collaboration.
Correctional nurses are the foundation of the healthcare environment within a correctional setting. At most correctional facilities, correctional nurses provide care 24 hours a day, seven days a week. The care provided varies, such as the initial intake encounter, where the inmate will have the opportunity to discuss any medical or psychological ailments. During the initial interaction, the correctional nurse will be able to identity acute and long-term health needs. The correctional nurse must then communicate those needs to the appropriate staff and custody officers if it is safety related, and initiate care within a timely manner and within their scope of practice.
Correctional nurses are responsible for understanding each clinical process at their facility and carefully adhering to those processes. They should know and follow their state nursing scope of practice and their Correctional Nursing: Scope and Standards of Practice, which will guide their incarcerated patient-centered care in the correctional environment and will help them address the potential daily challenges that may arise.
The correctional nurse is also responsible for helping to maintain a safe environment for themselves, their patients, and the institution staff. This includes maintaining strictly professional interactions with inmates and incarcerated patients and notifying the appropriate personnel when there is a breach in safety.
American Nurses Association. (2020). Correctional nursing scope and standards of practice (3rd ed.).
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Gunderson, A. (2022). Inmate lawsuits and private prisons. Captive Market, 78-106. https://doi.org/10.1093/oso/9780197624135.003.0004
Legal issues. (n.d.). NCCHC leads in correctional health care accreditation and certification. https://www.ncchc.org/legal-issues
Professional development. (n.d.). NCCHC leads in correctional health care accreditation and certification. https://www.ncchc.org/cnp-prof-development
Safety for the nurse and the patient. (n.d.). Essentials of Correctional Nursing. https://doi.org/10.1891/9780826109521.0004
Schonely, L. (2016). Is correctional nursing for you? Quick start for correctional nurses.
Therapeutic communication in correctional nursing. (n.d.). NCCHC leads in correctional health care accreditation and certification. https://www.ncchc.org/cnp-therapeutic-communication
Therapeutic communication in correctional nursing. (n.d.). NCCHC leads in correctional health care accreditation and certification. https://www.ncchc.org/cnp-therapeutic-communication