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, and negotiate, and work with correctional officers as legitimate members for the health care team. It is a mistake to minimize the impact of good communication among nurses and officers on safe patient outcomes. Armed with an understanding of the correctional officer role and responsibilities, correctional nurses can successfully advance inmate healthcare in a correctional setting.

Officers are Professionals, Too

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 health care team. Everyone has a role to play and it is important to both understand and acknowledge the different perspectives between security and health care. 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 disciplined, though, and it is important for correctional nurses to develop a keen understanding of the security perspective in order to successfully advocate for a patient’s health needs. Most of these differences come from different orientations; officers are taught that security and rule compliance is paramount, while nurses are taught that caring and compassion is paramount.  The truth is –  both are right.  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 a nursing perspective on the patient population. For example, officers may be critical of nursing concepts like compassion and patient advocacy. Their ethical framework is less bound by the nursing concepts of caring, advocacy, and human dignity. However, honesty, justice, and civil rights are all part of most professional codes, so there is strong overlap between the professions.

Correctional officers are professionals, too, and deserve 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.

Aretha was Right – R-E-S-P-E-C-T

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. This, of course, is difficult, but can also be empowering and powerful. In a culture of disrespect, respectful behavior stands out.

It is important to acknowledge and respect the security perspective without internalizing or modeling it. Correctional nurses are not custody officers and should not try to be so. As stated earlier, each team member has a role to play and should not try to play the position of other team members. Unfortunately, some nurses slide into a custody mindset without realizing it. It is helpful to regularly and mindfully 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.

Security personnel are like most people – they have preconceived notions about how nurses behave and think.  Sometimes, correctional staff can be critical of nursing concepts like compassion and patient advocacy, but they still do not like it when nurses do not act as expected.  Role modeling expected nurse behavior may invite some teasing, but generally the security staff will have greater respect for the nurses who remain true to their professional values.

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

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 boundaries, correctional nurses can be end up practicing outside practice boundaries in an attempt to be helpful.

Have a well-thought-out response for when you are asked by an officer or security administrator to perform a function that is outside your professional or ethical boundaries. Remember, these folks 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. Officers, however, do require information about an inmate’s health status when it is needed for the inmate’s health or for the health and safety of staff and the inmate population. Many times you need to enlist the help of a correctional officer.  They can be your eyes and ears in the housing unit if you ask them.

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 inmate’s work duty. Joint surgery may limit movements or abilities that security needs to be aware of. 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 is the 45 C.F.R. 164.512 (k) (5) (i) section of the code.

HIPAA permitted disclosure to correctional institutions if this protected health information is necessary for:

• The provision of health care to such individuals
• The health and safety of such individuals or other inmates
• The health and safety of the officers or employees of or others at the correctional institution
• The health and safety of such individuals and officers or other persons responsible for the transporting of inmates or their transfer from one institution, facility, or setting to another
• Law enforcement on the premises of the correctional institution
• The administration and maintenance of the safety , security, and good order of the correctional institution

Generally speaking, avoid discussing specifics about a patient’s medical or mental health conditions with officers except when:

• Officers need to be alert to an urgent need of medical attention such as an unstable diabetic, seizure disorder, or post-concussion mental status
• The condition needs special housing or activity interventions such as pregnancy, back injury, or joint replacement
• The patient is allergic to a common element in the environment or diet such as peanut butter or bee sting

If in doubt about the need or the advisability of communicating particular health information, seek guidance from the health supervisor or medical director. Be sure the information shared can be supported by one of the six necessity requirements listed above.

With a focus on maintaining professional nursing integrity while also understanding the correctional officer perspective, most nurses can successfully negotiate the caring-custody divide and establish a collegial and respectful relationship with officers at their facility.

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.

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