Correctional Nurse Perspective: Inmate or Patient?

“It’s not what you look at that matters, it’s what you see” – Thoreau

Perspective1Recently a correctional nurse manager commented that she was getting grief from correctional officers for referring to inmates as patients in the prison medical record. I have heard this issue before and often see medical record charting using inmate to refer to the person receiving health care. I also remember a long discussion with the workgroup as we determined how to refer to our patient population in various sections of the Correctional Nursing Scope and Standards of Practice.*

It may seem a small issue or even unimportant whether you deliver nursing care to patients or inmate. In fact, your perspective on your patient has everything to do with professional nursing practice in the criminal justice system.

Consider this dichotomy. When you look at your patient in a health care encounter, which do you see?

  • A criminal who happens to need health care
  • A patient who happens to have broken the law

Focus of Nursing Practice

Nursing practice in inherently patient-centered. Our professional values call us to seek the health and well-being of our patients. Our primary commitment, in fact, is to our patients. A patient perspective in correctional nursing practice, then, sets us squarely on a solid foundation clinically, ethically, and legally. The right to health care is universal and transcends all individual differences (Code of Ethics 1.1). In particular, a patient’s social status and lifestyle choices cannot be considered in our delivery of nursing care.

On the other hand, seeing the person receiving nursing care as an inmate is inherently custody-centric. Rather than focusing our intentions on seeking health and well-being, an inmate perspective can leave us in a defensive position or in an exchange relationship that can be both dehumanizing and depersonalizing. An inmate perspective does take into consideration the social status and lifestyle choices of our patients; becoming factors in our care decisions.

The Nurse-Patient Relationship

The basis of every nurse-patient relationship is therapeutic. Our patient’s interests are primary in this relationship. In a correctional setting, a patient’s interests can be abrogated by the security system. Nurses must engage in collaborative dialog to advocate for a patient’s health and well-being when the correctional culture is unnecessarily abridging health interests.

While a patient perspective is likely to lead to necessary patient advocacy, an inmate perspective blurs this focus and can unnaturally align nurses with a punitive or merely disinterested perspective toward an individual patient and the patient population, as a whole. In addition, mutual respect within the nurse-patient relationship is threatened when the patient is viewed as having less societal value, human rights, or inherent dignity.

Response to the Inmate-Patient Dichotomy

Do we care for patients or inmates in the criminal justice system? Our professional ethic calls us to care for patients and to view our patients from a perspective of human dignity and intrinsic value…..even when they may have shown themselves to be untrustworthy, selfish, or even evil.

The correctional nurse manager dealing with pressure to call her patients inmates has an opportunity to inform and educate the officer corps in her facility about professional nursing practice. The correctional setting is a unique environment with a unique patient population but the principles of nursing practice and the values that undergird that practice remain unchanged in the criminal justice system.

So, what do you think? Patient or inmate? Share your thoughts in the comments section of this post.

*We settled on using the term patient when discussing correctional nursing practice while using inmate when discussing the patient population of our care.

Leave a Reply

  1. This has been a subject of discussion for a long time at Washington DOC. I doubt that we’ve reached a real consensus yet. It also brings up a question that I would like to hear from others about………….. Should healthcare staff write infractions for healthcare related issues, ie: false medical emergencies, no show to call-outs, inappropriate behaviors directed at healthcare staff, etc.? Some of our staff believe that prison is a place where rules should be enforced versus those who believe infracting may set up a negative relationship with offenders who may fear disciplinary action if they need medical care. Does anyone have thoughts on this?

    • A good question for discussion, Dave. Although rules need to be enforced, the question is whether it is a nursing role to enforce them. The discussion needs to be how that aligns with the definition of nursing practice: treating and preventing illness and injury or alleviating suffering. Possibly you could make a case that reporting infractions for discipline is for the good of the patient but that defense is tenuous.

  2. Thank you for this great article! I have argued for years, to no avail, that the incarcerated individuals we care for are our patients, and custody’s inmates. When nurses use the term “inmate” it implies a sort of an alliance with the custody staff. When in fact, the nurse is a separate entity and is the patient’s advocate. They are NOT our inmates, they ARE our patient’s!
    Hopefully, the nurse involved can find an opportunity to educate custody (maybe incorporate it into the yearly training) as to what constitutes a nurse.
    I wonder if an attorney has ever used a nurses documentation of ” inmate” as a defense when his client (inmate) has claimed to have received inadequate medical care?

    • You have obviously thought this through, Mitzi! Never thought about the legal ramifications of using inmate in charting. I will ponder that….

    • I have wondered the same thing, Mitzi. I can see where an “inmate’s” attorney could have a field day with that kind documentation. I was ordered to stop documenting “patient”, by a previous supervisor, when I entered into correctional nursing nearly 8 years ago. I never liked using that term. But, as of late, with a new regime, have begun using the term “patient”, again and without challenge.

    • Mitzi,I would caution that we as healthcare providers in correctional environments DO have an alliance with security staff. It is necessary in order to maintain a safe environment for our patients and our coworkers. We are all part of a multi-disciplinary team and it is important that our patients not split us.
      Just some thoughts…love the discussion.

  3. Years ago the warden, at the time, instructed all staff to refer to the men as prisoner/prisoners. Patients are not patients anymore, they are clients. It matters not to me what the men are to refered to as. I see a man, who is asking for my help, and I see him as a nurse.

  4. Not one of us would describe ourselves as any one thing, or as having any one defined role. For example, I consider myself: a daughter, sister, aunt, nurse, athlete, artist, patient – albeit sometimes compliant and sometimes not so much; also, survivor, advocate, mentor, a teacher, citizen – both rule-breaking and law abiding, girlfriend, writer, the list goes on, and you get the picture. Some roles are permanent others transient. Some we grow into or out of, deny, embrace, or assigned to us, willingly or otherwise. Others likely see me very differently than i see myself. Accurately, maybe not.

    As a nurse, when I am in your presence to provide my health care evaluation, my assessment and to develop with you, your treatment plan, you are my patient. Everything else that you are defined by is only relevant to me based on how it affects your overall well being within your individual circumstances, which will dictate the choices and decisions you must make to for the health outcome for you. Hopefully, those being the best possible.

    If you are in inmate, you are sentenced guilty, or innocent until proven guilty. You are serving a punishment. As we know, not all inmates are guilty, and these are distinctions that we do not make, those are for the judge and jury. And by the way, There but for the Grace of God go I.

    I just don’t think this is an either or question, nor do I think it serves us as a profession to think of people under our care as just one or the other, but as people with many other roles, and as much under construction as you and I, with histories and stories to tell.

    • I would love to hear what your staff think, Kayla. We need to have this discussion across all of correctional nursing. It is time!

  5. When discussing healthcare with colleagues I use the term, patient. With DOC staff I use, inmate. If I advocate with medical and correctional staff I will use both terms. Trying to keep a balance advocates well for the patient but reminds us all of the population we are helping. Come on folks!

  6. Everyone we assess as nurses and treat are our patients. Wheather they are incarcerated or not. If we were working in a hospital and this same person came in for healthcare we’d assess and treat wheather he was a criminal or not. We all have the same responsibility and are bound by the same code of ethics. As far as being a part of punishment we have no place in that. We do have a duty to report. We’re not there to take their verbal or psychological abuse but we do have that obligation to ourselves,our co-workers and custody officers to report infractions that may compromise the safety of others. Don’t get caught up in the name game they are all people and deserve that basic respect. Our treatment and documentation should reflect prudent care for that person wheather he/she is an inmate/prisoner or not.

  7. I use the term ” Inmate”, I’m old school and at the jail that I work we are still very “old school” we still chart on paper and push and old school cart with the whole dorms meds for the month on cards. The use of Inmate helps to set the scene. Ex.
    S) Inmate brought to medical by security for c/o unwitnessed fall in the chow hall and back pain.
    I always end up charting a full page before I’m done. I agree that it shows unity between medical and security staff. I was told once that the term Inmate is now their title so don’t use Mr or Sir, just like the right to shower at any time is taken away so is the title.

  8. “she was getting grief from correctional officers for referring to inmates as patients in the prison medical record.” Since when do COs get to see medical records? They absolutely do not get to do that in my jail (FBOP, fwiw).

    • You caught that, Scott. I was surprised by that as well. Medical records are confidential documents. Not sure how officers were seeing what is written in the charts.

  9. I would encourage “old school” to recognize that times have changed. The rights and “titles” such as “Mr. or Ms.”, that have been taken away as part of punishment are just that–part of the crime’s sentence which is to be carried out by custody.
    These inmates in custody actually still have the Constitutional right to healthcare. And as healthcare providers we deliver healthcare to patients.
    References to “inmates” are commonly seen in legal cases and negligence/malpractice claims and lawsuits. Why? Because that title subconsciously results in biased actions and poor clinical judgments that do not lead to optimal healthcare outcomes.
    With the utmost professionalism, we must separate the subjective title of inmate and the negative influence of custody, from our objective duty to provide healthcare services to patients in need.

  10. I always use the term inmate in the jail except in my charting. In the medical record they are my patient and that is what I call them. If I ask an officer to bring one of my patients to medical, I use the term “inmate” because that is what they are to the officer and it is most clear. No need to bring it up as a topic of discussion among the corrections staff, we need a clear and cohesive working relationship with our officers. By the way, I am the Nursing Supervisor in our jail and that is my feelings on the matter.