In most settings where nurses practice, the interdisciplinary team includes other health care professionals such as physicians, diagnostic technicians, and pharmacists. Sure, there may be unlicensed ancillary staff in the mix such as admissions clerks and supply personnel, but everyone is generally focused on the goal of providing health care. Not so in a correctional facility. Here, in addition to other health care professionals, correctional nurses must also collaborate, negotiate and work with correctional officers as important members of the health care team. Don’t minimize the impact that good communication among nurses and officers can make on safe patient outcomes. Armed with an understanding of the correctional officer role and responsibilities, correctional nurses can successfully advance patient healthcare in a correctional setting.

 

Officers are Professionals, Too

Correctional officers are professionals, too, and we should develop a collegial relationship with them. We may come from different worldviews and we may have differing opinions, but both professions have a vital role in the facility.

If you are a team sport enthusiast, you know that everyone on the sports team has a position to play and each player needs to play their position as well as understand the role of other team players. It is no different for the correctional healthcare team. Everyone has a role to play and it is important to both understand and acknowledge the different perspectives between custody and health care staff. Correctional officers are professionals in their field and their perspective is important to many of the health care decisions needed for the patient population.

There are likely to be philosophical differences between the two disciplines, though, and it is important for correctional nurses to develop a keen understanding of the security perspective in order to successfully advocate for their patients’ health needs. Most of these differences come from different orientations; officers are taught that security and rule compliance are paramount, while nurses are taught that caring and compassion are integral to positive patient outcomes. The truth is –  both are important.  Some call this the custody-caring friction between the security and nursing perspectives. It may be a difficult adjustment to learn to work with officers without sacrificing your nursing perspective about the patient population. For example, officers may be critical of nursing concepts like compassion and patient advocacy, and their ethical framework may not include concepts of caring, advocacy and dignity, but there is overlap – honesty, justice and civil rights are included in most professional ethical codes.

Respect

Civil and respectful communication and behavior among the disciplines is the secret to collaboration success. This means respecting the role officers play in successful health care outcomes. Nurses can role model respectfulness even if custody officers are less than civil in return. Certainly this is difficult, but can also be empowering and powerful. In a culture of disrespect, respectful behavior stands out.

While it is important to acknowledge and respect the security perspective, correctional nurses must be ever mindful not to internalize or model the custody perspective. We are not custody officers and should not try to be so. Unfortunately, some nurses slide into a custody mindset without realizing it. It is helpful to regularly and intentionally recenter your mind to your role as healer. It may be helpful to establish a ritual where this mindfulness takes place as you daily enter the security checkpoint.

When Asked to Do Something that is Out-of-Bounds

Correctional officers don’t always know what nurses do and may have misconceptions about what can be asked of a nurse. If unprepared for these requests or unknowledgeable about licensure scope of practice, correctional nurses can end up practicing outside of their scope in an attempt to be helpful.

Thus, it is helpful to have a well-thought-out response for when you are asked by an officer or correctional administrator to perform a function that is outside your professional or ethical boundaries. Remember, these individuals may not know they are asking you to do something unlawful or unethical. Give them the benefit of the doubt. Here is an example to get you started thinking about how you can respond respectfully and collegially. “I’d really like to help you out with this issue but what you are asking me to do is beyond what my nursing license allows (or is not considered ethical for a nurse to do). Let’s see if we can come up with a solution that works for all of us.” Having a prepared response will ease the stress of declining a request, and start the discussion toward a solution.

HIPAA and Officer Need-to-Know

Although it is important to consider correctional officers as part of the health care team, their legal access to patient health information is limited. They do, however, require information about a patient’s health status when it is necessary for the health and safety of the patient or staff or the other incarcerated persons in the facility. We expect that confidentiality will be upheld regarding any information shared with non-medical personnel and it is important to remind correctional staff of this when sharing.  

That means officers may need to know about medical conditions or disabilities that require special equipment or scheduled appointments. Some medication side effects require additional attention or changes in the incarcerated individual’s work assignment. Fortunately the Health Insurance Portability and Accountability Act (HIPAA) regulations take into account the need for some information sharing within the correctional setting and have spelled this out in the 45 C.F.R. 164.512 (k) (5) (i) section of the code.

With a focus on maintaining professional correctional nurse integrity while also understanding the correctional officer perspective, correctional nurses can successfully negotiate the caring-custody divide and establish a collegial and respectful relationship with officers at their facility, which will positively impact our patients’ outcomes.

Have you been in a difficult negotiation situation with officers at your facility? Share your story and tips in the comments section of this post.