Caring Within The Culture of Incarceration (podcast)

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cnt-podcast_cover_art-1400x1400Dr. Stacy Christensen, a nursing professor at the Central Connecticut State University in New Britain, CT, talks about her work with incarcerated women in the Connecticut State Prison System and her article about the application of Leininger’s theory of Culture Care in the correctional setting. Enhancing Nurses’ Ability to Care Within the Culture of Incarceration” was published in the June 2014 issue of the Journal of Transcultural Nursing.

In this episode she explains the key elements of Leininger’s theory of Culture Care and how incarceration can be thought of as a culture. The incarcerated patient population has a common language, customs, and rituals. Leininger defined culture as the learned, shared, and transmitted values, beliefs, norms, and lifeways of a group. Correctional nurses need to be culturally aware to effectively deliver care in this setting.

News Items

Coffee Consumption and Mortality

Findings from a meta-analysis of more than 20 published studies indicate that coffee consumption is inversely associated with all causes of mortality. Best mortality figures were for those drinking 4 cups per day. They also found no association between coffee consumption and cancer mortality. Although past studies indicated a concern for caffeine related to increased blood pressure, insulin resistance, and elevated lipids, habitual coffee consumption results in a tolerance for the acute effects of caffeine. Researchers aren’t sure what components of coffee are beneficial but indicate that coffee is a major source of antioxidants, which could be part of the positive effect. In addition to reduced mortality, coffee consumption was linked to reduced risk of suicide, Parkinson’s disease, and gallstones.

Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012

The CDC has published data on Increases in heroin overdose deaths between 2010 and 2012 in the latest issue of the MMWR – Morbidity and Mortality Weekly Report. There has been an alarming rise of heroin overdose deaths in the last two years – more than double. Deaths have increased across gender, age, ethinic groups, and geographic region – although the increase is more significant in the northeast and south regions. In a related news story, the study’s co-author Dr. Len Paulozzi, a medical epidemiologist at CDC’s National Center for Injury Prevention and Control, said that the over-prescribing of narcotic painkillers (such as Oxycontin and Vicodin), which has been going on for 20 years, is responsible for the increase in heroin use and overdoses. He continues by commenting that solving the problem of deaths from heroin overdose begins with stopping the addiction to narcotic painkillers. Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, is also quoted in the news item as saying that there is very little difference between heroin and Oxycontin or Vicodin and that the medical community has to prescribe more cautiously.

Do you think a theory of cultural care would work in correctional nursing? What do you think about the positive effects of coffee? Have you seen an increase in heroin addiction in your patient population? Share your thoughts and insights in the comments section of this post.

Eight Ways to Improve Clinical Judgment

医者の表情Although every nursing specialty has its challenges, correctional nursing involves complex situations that can appear simple, but aren’t. There are many unknown factors in sizing up a situation. Correctional nurses are most-often the first healthcare provider to see the patient situation. As a gatekeeper, the nurse must make a fairly autonomous judgment on what needs to be done and who needs to be involved. Therefore, clinical judgment skills are absolutely essential for nurses working behind bars. Recent posts have discussed the vital role of clinical judgment, reasons correctional nurses need clinical judgment, and clinical judgment booby traps to avoid. In this final post of the series, we are turning to ways to improve clinical judgment. Incorporate these methods from traditional clinical settings and educational programs to improve your clinical judgment and that of nurses you work with.

Clinical Practices

 Case Review

Case review is one of the best ways to develop clinical judgment, especially with nurses new to the specialty. Although you can use cases developed purposefully it may be even better to include review of actual cases as a regular part of the process of unit management. For example, reviewing actions, reactions, and interactions of a recent complex or emergent patient situation can allow nursing staff an opportunity to learn from the experience and from each other. Much can be gained by providing an opportunity for staff to dialog about clinical judgment and reflect on their practice and the practice of others. Of course, this dialog must be carefully facilitated so that team members develop abilities to critically review a case without being critical of each other. You want this to be an empowering experience rather than a disempowering one. Careful guidance is needed until staff develop the skills necessary to be encouraging, purposeful, and thoughtful in their dialog.

Peer Review

Guided peer review is another way in which staff can develop clinical judgment skills. Similar to traditional physician peer-review, nursing peer review is a analysis of written documentation of past patient care on an individual practice basis. This process, by the way, is also helpful to encourage more thorough documentation. Learn more about nursing peer review in corrections from this series.

Reflection

Reflective practice is another clinical activity encouraging development of clinical judgment. Reflection on an actual significant clinical experience such as an unexpected death or near-miss experience can yield a wealth of wisdom for the nurses involved. By guiding the discussion toward analysis and synthesis of information, the experience can expand both individual and group learning. New staff members can be asked to keep a journal of their patient experiences that is reviewed periodically with the nurse manager or a senior staff member. The journal activity helps with reflection and the documentation can guide discussion into deeper meanings of assessments or a better understanding of facility processes.

Simulation

Another clinical activity that builds clinical judgment is simulation. Simulation allows a safe practice experience while developing procedural skill and team kills in collaboration and coordination of care. Use the disaster drill and man-down simulations to encourage clinical judgment development. Debrief the simulations as you would an actual experience and guide staff to truly think about why various decisions were made.

Educational Practices

Clinical judgment development can also be infused into standard educational programming. Many in-services involve a lot of information with little application. Instead, a better way is to provide foundational information and then engage staff in a dialog about how to apply this information in practical and realistic situations. An example of how not to do this is an inservice I taught on dealing with chest pain in correctional settings. It had a ton of information about assessment, interventions, and facility policy. We even talked about how to deal with the on-call physician. Participants left with a head full of what and how but not much application or critical thinking about dealing with chest pain. Here are some ways this program could have been improved to help develop clinical judgment.

Dialogue

Adding interaction and dialog to a learning experience engages the learners in thinking and applying the information. Providing real life examples and cases is an excellent way to encourage discussion.

Probing Questions

Probing questions combine with interactive dialogue to fully engage participants. A probing questions looks beyond yes or no and moves the thinker from reaction to reflection. Questions such as “What do you think would happen if……” or “Why do you think that might happen?” encourage learners to analyze a situation and work through possible solutions.

Mind Mapping

Mind mapping, also called concept mapping, is a creative method of displaying information and how it connects together. This process is gaining popularity in undergraduate nursing programs to help students think about the various elements of a clinical situation. Why not use it with practicing nurses? A mind map is a visual organization around a core concept. Here is an example of a mind map developed during a presentation on chest trauma.

mindmap

Algorhythms

An algorhythm is a decision tree that guides through a particular situation. While a mind map is based on relationship of information, an algorhythm is a decision tree and is expressed in a linear fashion, often answering questions of yes or no and then moving on. This example is from an ACLS course on responding to bradycardia. For the chest pain inservice I described earlier, I might have asked participants to develop algorhythms for respond to chest pain.

algorhythm

The key to clinical judgment development in an educational setting is to engage the learner with the thinking processes and to reflect on their own practice and how they might incorporate this new knowledge into their practice.

Do you have ideas for how to apply these eight processes in clinical and educational practices in your setting?

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Three Clinical Judgment Booby Traps to Avoid

Risk concept. Sign question on bear trap.Over time, as we develop our practice, we store up clinical reasoning helps that can speed our decision-making for commonly reoccurring scenarios. We begin, for example, to develop rules of thumb and analogies resulting from common pattern recognition that originate from past successes. The formal term for this is heuristics. In fact, clinicians rarely use formal computations to make patient care decisions in day-to-day practice. Rather, we develop an intuitive understanding of probabilities combined with a concoction of rules of thumb, educated guesses, or mental shortcuts.

Without care, other factors can cloud our thinking. In particular, we must be mindful of our biases, cultural background, and assumptions when making clinical judgments.

Biases

Biases are rooted in our human nature and hard to avoid. We can, however, mindfully consider them as we reflect to improve practice. A few biases of importance to avoid when making clinical judgment are described here.

Premature closure is one of the most common errors. In this bias clinicians make a quick diagnosis (often based on pattern recognition), fail to consider other possible diagnoses, and stop collecting data (jump to conclusions). In fact, even the suspected diagnosis is not always confirmed by appropriate testing. A premature closure issue common in correctional nursing might be “I know this patient-he is faking this condition to get attention”.

Confirmation bias occurs when clinicians selectively accept clinical data that support a desired hypothesis and ignore data that do not. Clinicians who rely heavily on pattern recognition and become overconfident in diagnostic abilities can fall prey to premature closure and confirmation biases. If a patient is acting erratically and an officer shares a high breathalyzer reading, a nurse may settle on an alcohol intoxication diagnosis when there are also signs of a head injury.

Availability bias results in overweighing evidence that comes easily to mind. This could be recent evidence or what we perceive as meaningful events. For example, if you have ever had a legal claim against you for a particular diagnoses or clinical action, you have had heightened awareness of that diagnoses for some time afterward.

Assumptions

Assumptions about what is and isn’t present can also affect our thinking and judgment. A simple example can underscore how assumptions can get us tripped up. Consider this puzzle that you must solve. A donkey is tied to a 6 foot rope. A bale of hay is 8 feet away from the donkey. Without biting through the rope, how can the donkey get to the bale of hay? Answer: He just walks over to it. There is not mention that the rope is anchored to the ground. Most people hearing this story, though, assume that the donkey is tethered. Sometimes we need to see what isn’t there as well as what is there when evaluating a patient, too.

Culture

Our culture can lead to unconscious ‘habits of the mind’ that affect clinical judgment. Repeated personal experiences and cultural socialization are absorbed into our ways of thinking about the world around us. For example, over time, correctional clinicians may absorb a jaded view of inmate intentionality or the surrounding security culture of the facility. Attitudes about patient motivation can cloud our judgment and alter subjective interpretation of symptoms.

Sometimes getting over our biases, assumptions, and culture in clinical judgment is as easy as changing the questions we ask ourselves. Imagine seeing a drawing of 2 triangles a square and a circle. If you ask yourself the question “What is this?” You may answer – 2 triangles, 1 square, and 1 circle. How might that change if you ask yourself “What could this be?” Maybe the answer now is – a jack-o-lantern or a clown face. Sometimes self-questioning can break us out of our biases, assumptions, and cultural norms.

How have you seen biases, assumptions, and culture affect clinical judgment? Share your experiences in the comments section of this post.

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Five Reasons Correctional Nurses Need Clinical Judgment Skill

Green plant mazeIn corrections, nurses are usually the first health care professional to assess a health concern or complaint. Patients present with virtually every type of health problem, and many have co-occurring conditions that can complicate the diagnosis and plan of care. Therefore, correctional nursing practice requires knowledge and experience with a broad array of conditions and presenting problems to make clinical judgments about the nature of the problem, actions to be taken, and urgency of response.

Correctional nurses also coordinate and negotiate for the delivery of care within the restrictions and expectations of the organization, which requires decision-making conviction. Clinical judgment guides direct care delivered by the nurse as well as communication with others to coordinate care and ensure patient safety. Accuracy in judgment improves patient outcomes and quality of care by eliminating unnecessary actions and reducing delay in definitive care and treatment.

Although every nursing specialty has its challenges, correctional nursing involves complex situations that can appear simple, but aren’t. There are many unknown factors in sizing up a situation. Correctional nurses are most-often the first healthcare provider to see the patient situation. As a gatekeeper, the nurse must make a fairly autonomous judgment on what needs to be done and who needs to be involved.

Here are five reasons clinical judgment is especially important for correctional nurses:

  1. Detainees or inmates are entitled to a clinical judgment under the 8th or 14th amendment whenever attention to a health concern is requested. See this post for more information on the right to a clinical judgment.
  2. Nurses most often are the first health care provider to see a detainee or inmate for any health concern. The nurse’s clinical judgment will determine if the person sees any of the other health care providers and if so, how soon.
  3. Ineffective clinical judgment affects the patient adversely now and perhaps in the future, it affects other nursing staff and providers. It can also affect our relationship with custody staff.
  4. Correctional nurses must make judgments in a wide array of situations from minor discomforts to life-threatening emergencies.
  5. And, they must do it while navigating the correctional environment with safety, location, and resource challenges.

What other reasons are there for correctional nurses to be skillful in clinical judgment? Share your ideas in the comments section of this post.

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Clinical Judgment: A Vital Correctional Nurse Competency

decisionsRhonda has been called to the booking area to medically screen a 44 year old man brought by the police on charges of driving a stolen vehicle and drinking while driving. On the way to jail he hit his head on the window of the squad car. Approaching the area she sees an obese white male, hands cuffed behind his back, leaning facedown on the booking counter, propped up by two police. The man is yelling that he is going to faint and can’t breathe.  A chair is brought so he can sit and Rhonda notes that he is diaphoretic and flushed in the face. He reports that he has prescriptions for two inhalers but otherwise has no medical problems. His voice tone is belligerent and he is dressed in shorts, a t-shirt and sandals;  inappropriate for the winter weather. Rhonda can see that his legs and feet are mottled and swollen. He also has a swollen area over his eyebrow on the right side and the eye on that side is swollen shut. There are four policemen waiting for the nurse to screen the arrestee and another six custody officers waiting to proceed with booking. 

Christine Tanner, a nurse researcher, has studied expert nurses to determine components of clinical judgment and when it is most specifically needed. She found that clinical judgment skills were particularly important when

  • The clinical problem or concern is undetermined;
  • The presenting data is ambiguous; and
  • When the situation presents conflicts among individuals with competing interests

Our case above has all three elements. Rhonda has a problem to solve and she needs to do it quickly amidst competing interests – the patient’s, the police, and the correctional officers. The patient condition is undetermined at the moment. Rhonda cannot merely review the patient’s medical record for a list of diagnoses. His presenting data is ambiguous and non-specific. The clock is ticking and the pressure is on.

Tanner reviewed 200 studies on clinical judgment in nursing practice. From this review she concluded that a nursing clinical judgment involved the following components:

  • Gaining a grasp of the situation holistically
  • Seeking an understanding of the situation which is beyond just the objective findings on assessment
  • Considering factors contributing to the presentation
  • Attending to the patient’s response to the nurse
  • Deciding an appropriate course of action
  • Reviewing outcomes and making changes as needed

What clinical judgment do you think Rhonda made in this situation? Even though there was pressure to book the man, she was concerned about a concussion and his respiratory condition. She did not approve him medically for booking and he was sent on to the hospital emergency room. There it was discovered that, although he was intoxicated, he did have a mild concussion, and, more importantly, was discovered to have moderate congestive heart failure. He was in the hospital for over a week.

Have you had a challenging patient presentation that seemed ambiguous at the time or had competing interests to consider? Share your story in the comments section of this post.

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What is Your Correctional Nurse Work Style?

Many different beautiful butterfliesA major challenge for many in correctional nursing is adjusting to the work environment. A correctional facility is not run like a hospital and health care is not the primary mission. Correctional officers often have different goals and worldviews than healthcare staff. Nurses can have difficulty assimilating into the organizational culture while maintaining a professional nursing perspective. That’s why I found this research about the work styles of jail nurses so interesting.

Hardesty, Champion, and Champion interviewed 26 registered and licensed practical nurses working in jails in three northern states. Patterns and themes emerged as the transcribed interviews were analyzed. One interesting finding was a proposed typology of jail nurse work styles. This typology chronicles the adjustment of a new nurse to the correctional culture and the effect of that adjustment on their ability to function successfully. The categories are based primarily on the balance the nurse is able to gain practicing professionally while understanding the security perspective and organizational culture.

Check out this continuum of jail nurse work styles and see if you can find yourself, or some of your nurse colleagues, in the descriptions.

Idealist

  • Rejects or fails to understand the security perspective
  • Nursing perspective is the primary consideration
  • Poorly socialized to the custody staff culture

Realist

  • Acknowledges and respects the security perspective
  • Nursing perspective remains the primary consideration
  • Socialized to the custody staff culture

Situationalist

  • Alternates between the security and the nursing perspective
  • Nursing perspective is optional
  • Not yet socialized to the custody staff culture

Acceptor

  • Accepts the security perspective
  • Minimally acknowledges the nursing perspective
  • Socialized to the custody staff culture

Identifier

  • Extreme acceptance of and identification with the security perspective
  • Considers nursing perspective not applicable in a jail environment
  • Well socialized to custody staff culture

So, what is the optimum work style? The researchers do not clearly note the best work style and suggest that more research is needed. My vote is for the Realist style as this nurse is able to maintain a professional nursing perspective while understanding the perspective of correctional officers and socializing to the correctional culture. This provides an atmosphere of respect and understanding among peers while allowing for professional nursing practice.

So, what do you think? Which work style is the most favorable for correctional nursing practice? Do you see examples of these work styles in your facility? How does it affect patient outcomes? Share your thoughts in the comments section of this post.

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Four Sources of Fast Correctional Nursing CE for Recertification or Relicensure

Stack of papers and clock isolated on whiteDoes this sound familiar? Notice arrives that your CCHP or CCHP-RN certification or your nursing license is due next month. Plenty of time to get the required continuing education (CE), right? The notice is set aside (if you are like me it gets printed and set on the pile on the right side of my desk) and the next time the paper shows up, submission is due tomorrow. Not that this has ever happened to me (well, alright, it did happen just last month….). So, just in case this might happen to you (I’m sure it won’t, but just in case) here is my list of four quick sources of correctional nursing continuing education that you can access online and complete immediately. First, though, is a clarification of requirements:

License Renewal

States vary as to the number of contact hours needed for a 2 year licensure period. Most states ask the licensee to maintain the official documentation (CE certificates) and attest to having completed the required number of hours. Documentation may be requested in a random audit of licensees. Here is a handy list of current state nursing board CE requirements for relicensure from nurse.com:

Nursing Continuing Education Requirements by State

Some states have specific content requirements as part of the total CE needed. For example, Florida RNs are required to complete 24 hours of appropriate continuing education (CE) during each renewal period, including two (2) hours relating to prevention of medical errors. In addition to these 24 hours of general CE, each RN must complete two (2) hours of domestic violence CE every third renewal for a total of 26 hours. Specific requirements are addressed by state in the link above.

CCHP and CCHP-RN Recertification

CCHP and CCHP-RN certifications have yearly CE requirements.

CCHP CE Recertification Requirements: Participation in 18 hours of continuing education (at least six of which are specific to correctional health care).

CCHP-RN Recertification Requirements: Completion of at least 18 nursing contact hours, with six specific to correctional health care.

If you have an excellent benefits package at work that includes an education allowance, try to get a National Commission on Correctional Health Care conference. You won’t regret it. However, that won’t work for a looming due date. Looming due dates require immediate results. Here are four go-to places for correctional nursing online CE.

Sources of Correctional Nursing Continuing Education

  • Pedagogy Correctional Health Care Campus: I’m a bit biased on this source since I develop the correctional healthcare specific continuing education here. The modules specific to corrections are in video format and have application checkpoints to hold your attention. Here are the ones available so far with more on the way:

o   The Correctional Health Care Patient and Environment

o   Correctional Health Care Processes

o   Safety in the Correctional Setting

o   Chronic Illness in the Correctional Setting

o   Control and Management of Infectious Diseases in the Correctional Setting

o   Legal Origins and Issues Behind Correctional Nursing

o   Psychiatric Nursing in the Correctional Setting

o   Women in Prison

  • Correctional Nurse Educator: Our friends over at Correctional Nurse Educator have some fantastic courses available, as well. Topics include Asthma, Chronic Care, Inmate Manipulation, Suicide Prevention, and much more. All are focused on correctional nursing practice.

That’s it for my quick list of correctional healthcare continuing education. Do you have a favorite online source that I missed? Share your secrets in the comments section of this post.

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Struggling to Define Caring in Correctional Nursing

rock climbingCorrectional nurses face a daily struggle to care for their patients while delivering much-needed healthcare in a restricted environment where they may also fear for their own personal safety. How can nurses truly care for and care about their inmate patient population? This is a question many of us in the specialty grapple with as we try to elevate the professional status of correctional nursing. Caring has been described as the essence of professional nursing practice, therefore we must establish the characteristics of this concept as it is enacted in the criminal justice system.

Weiskopf studied nurses’ experience of caring for inmate patients and discovered a number of limitations in our setting .  Nurses in this study described the need to negotiate boundaries between the culture of caring and the culture of custody to establish relationship with custody staff in order to be effective. One surprising finding of the study was the extent to which the negative attitudes and behaviors of other nursing staff affected nurses who were attempting to provide compassionate nursing care.

Many nurses working behind bars feel an obligation to care and often struggle to find ways to do this in a hostile environment. Yet, developing a structure and process for caring may be the core defining characteristic of our specialty. Here are some suggested ways nurses enact caring behaviors in corrections:

  • Educating patients about their health conditions and self-care principles
  • Maintaining a nurse-patient relationship that is within the helpful zone of professional boundaries
  • Advocating for the health care needs of a patient when necessary
  • Showing compassion and respect
  • Presenting a non-judgmental manner
  • Listening to what the patient is saying
  • Helping patients through a difficult situation

Correctional nurses are confronted daily with a struggle against a tidal wave of organizational culture convinced that we should not be caring ‘too much’ for our patients. Caring for murderers, rapists, and criminals takes true grit and a more serious definition than a superficial application of a warm positive emotional response or empathetic word. We are the ‘Tough Love’ folks on the nursing caring continuum.

Consider these unusual ways that a correctional nurses cares for patients:

  • Not accepting a gift from a patient
  • Letting a patient know that you know the rules and they should not ask you to violate them
  • Asking the patient to complete a sick call request for their rash that they want treated during pill line
  • Being diligent with mouth checks during pill line

All of the examples above constitute an action or activity that is helpful for the patient; whether it avoids penalties, provides boundaries, or prevents self-harm. Caring seeks the best for the other in any situation.

Have you found it difficult to care for patients in the criminal justice system? Share your thoughts in the comments section of this post.

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The foundation of this post originally appeared in the Essentials of Correctional Nursing blog

Correctional Nurses: Always on Guard

Stasi-Gefängnis HohenschönhausenPersonal safety is a growing concern in all nursing specialties. Patient violence can take place in the emergency room, on inpatient psychiatric units, and dementia wards. Correctional nurses are no strangers to the need for personal safety. We have visible proof all around us that our patients may turn violent. Officers often escort nurses around the compound and many locked doors must be negotiated to gain access to deliver care. The routine nature of security operations can blunt our continuing vigilance, however. I like to consider personal safety as multi-dimensional with the very basic start being physical safety. Here are some tips in three areas of safety concern for correctional nurses.

Guard Your Body

• Be aware of your surroundings and the location of the nearest security officer.
• Travel in pairs whenever possible. Always tell others in your unit where you are going and when you expect to return.
• Observe all security procedures. Wait for clearance before entering any area, including when responding to an emergency.
• Do not leave sharps and other potential weapons out on surfaces. Keep equipment locked and maintain counts of all potential contraband items.
• Be careful to limit personal conversation or discussion of facility procedures when patients are present.

Guard Your Mind

• Our patient population can be a difficult one to care about. Patients may have cruel or violent histories. To avoid developing a judgmental attitude, do not seek out information about the crimes of your patients. Focus your mind on nursing care provision and the health care issue at hand.
• Our patients can also seek health care for secondary gain such as a privileged status, more comfortable accommodations or items to fuel the underground prison economy. Guard your mind toward manipulative behaviors while maintaining a professional nurse-patient relationship.
• Because inmate patients can try to con you or game the system, it is easy to become jaded or cynical. Guard your mind against these attitudes that decrease your ability to deliver care.

Guard Your Heart

• Regular contact with the inmate population can lead to professional boundary crossing in relationships. Some patients may seek additional ‘favors’ from nursing staff. Be firm, fair, and consistent in all patient interaction. Immediately report any such requests to your manager.
• Guard your heart toward flattery or flirtatious comments and actions by inmates. Respond firmly and initiate security procedures with the slightest indication of personal contact. You are guarding yourself from harm and protecting the patient from disciplinary action.
• Agree with your fellow nurses to watch out for each other. Comment on observations of inappropriate conversations or behavior toward patients.

Do you have additional safety tips to add to this post? Use the comments section to expand on these points.

This post originally appeared in the Essentials of Correctional Nursing blog.

Five Mistakes New Correctional Nurses Make

Mujer  arrepentida equivocada cubriendo sus ojos.I’ve worked with a lot of new correctional nurses over the years; many of them succeeded and embraced the unique nature of our specialty. Some, however, quickly abandoned their positions even before they gave themselves time to adjust to their new role. Sometimes it is just not a good fit. For example, some nurses just can’t bear to hear the bars click shut behind them when they enter the sally port after security clearance. However, many times nurses make preventable mistakes that land them in trouble on the ‘inside’. Based on my experiences, here is a list of common mistakes nurses can make in their first correctional position.

Not paying attention to security procedure

Many seasoned correctional nurses will tell you that working behind bars is one of the safest jobs aroung. In fact, correctional nurses have more security presence than most emergency rooms or mental health units in traditional settings. That being said, nurses must know the security procedures and follow them. For example, nurses need to know where officers are located and how to activate the alarm system. We also need to let others know where we are headed and when we expect to return when moving within the various facility areas. And, whenever possible, travel with someone else. Nurses who don’t pay attention to security procedure can find themselves vulnerable to injury or assault.

Disrespecting correctional officers

Correctional officers are professionals, too, and deserve civil and respectful treatment. Nurses who are arrogant or act superior to their correctional colleagues don’t last in the specialty. We may come from different worldviews and we may have differing opinions, but both professions have a vital role in the facility. The happiest correctional nurses are those who build collegial relationships with the officers with whom they work.

Not treating the inmates like patients

Some nurses enter the correctional setting and find affinity with the officer role, even identifying with it. These nurses easily absorb the jail culture and abandon their nursing perspective. In a poor environment, this can easily degenerate into a cynical and punitive attitude toward the patient population. Research into correctional nurse working styles identified four types:

  • Idealist: Nursing perspective is a primary consideration and does not understand the security perspective
  • Realist: Respects the security perspective while continuing to function from a nursing perspective
  • Situationalist: Alternates between a security orientation and a nursing perspective depending on the situation
  • Acceptor: Identification with the security perspective with no application of nursing perspective while in the correctional setting

By focusing on becoming a realist, new correctional nurses can successfully navigate in the criminal justice system while providing substantive nursing care to their patients.

Treating the inmates like patients in other settings

This one sounds contradictory of the previous mistake but hear me out. While we must treat inmates like patients, nurses make mistakes when they treat incarcerated patients like they might a frail elderly hospitalized patient. What I mean is that the common signs of compassion and care provided in a traditional setting such as a shoulder squeeze or other touch can be misinterpreted in the correctional setting. Successful correctional nurses find other avenues to show care or concern.

Leaving the nursing license at the door

I know it can be hard to believe but I have seen this more than once. Nurses start working in a correctional facility and fall into practices that are definitely unsupportable to a licensing board. These practices can be as mundane as poor or missing documentation. They can also be as egregious as participating in a use of force against an inmate. A nursing license governs every employment setting, no matter how untraditional it might be.  New correctional nurses are successful when they practice within their licensure requirements when ‘behind the wall’.

Do any of these sound familiar? What advice do you give new correctional nurses? Share your thoughts in the comments section of this post.

PS – For a short time, you can get a free downloadable copy of my new ebook – The Correctional Nurse Manifesto by signing up for my email list. Use this link

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