One reason correctional nursing is a specialty is that we deal with a unique patient population. Many of our inmate patients have lived much of their lives on the margins of society. These individuals have learned to deal with life, many times, through manipulation and deceit. Like an illusionist, they can distract and divert attention while accomplishing their goal. This is the first of a series of post explaining some common inmate tactics to obtain secondary gain in their interactions with healthcare staff. The challenge is to be ever alert to the potential for manipulation in the nurse-patient relationship without becoming jaded or cynical in dealing with our patient population. For more on maintaining a good nursing perspective in corrections, check out this Correctional Nursing Today podcast.
Tactics used by inmates to gain an advantage with correctional nursing staff:
- Flattery – Simple statements like “You look good today” or “You are the only nurse who knows what to do around here” flatter the nurse and create relationship.
- Empathy/Sympathy– The patient seeks to establish an identity that is ‘just like you’ by making empathetic comments about the work experience like “I know what you are going through. I used to have a very stressful job.”
- Helplessness – Once a relationship is established, a request for help, other than appropriate healthcare, may result. Examples could include mailing a letter, gaining access to other resources, or bringing in information about a community program. These requests sound innocent, but are intended to have the nurse break some type of facility rule.
- Sensitivity – A patient can begin to show personal sensitivity to the nurse’s condition. This may also be a ploy to create a wedge between the nurse and other staff members. “I can see how the other nurses are treating you. You deserve better.”
- Confidentially – The patient shares a secret with a nurse that may be inconsequential or even inaccurate but moves further into an intimate relationship and creates a bond. An example might be, “I overheard Officer Jones ask Nurse Smith for a date.”
- Isolation and Protection – Rumor and innuendo could be shared that can lead to isolation, such as sharing that the other staff members are talking about the nurse. The patient might indicate they ‘stood up for you’ and protected the nurse. “I told them you were the best nurse ever and they shouldn’t talk about you like that.”
- Touching – If the verbal relationship moves along well, physical contact can start. An innocent-appearing brush of hands, tap on shoulder or body bump, if not immediately addressed, will progress to further and more frequent physical contact.
- Sexual Innuendo – If touching is not addressed immediately it gives the impression that it is ‘OK’ and sexual innuendo will follow. At this point, the nurse may be pressed for sexual favors.
- Coercion and Intimidation – Once a nurse has bent rules with or for an inmate-patient, coercion and intimidation can follow quickly. A nurse might be told to bring in contraband or break security rules. If refused, the inmate will threaten to reveal to the authorities the prior, more innocent actions taken. At this point the nurse has been ‘hooked’ by the con game and can feel trapped.
As can be seen from this list, a progression of action can take place over multiple interactions and leads to a nurse falling into the power and influence of an inmate-patient. If you see this happening to yourself or a fellow staff member, act immediately to break the progress. Stop before it gets worse. An inmate is not your friend; an inmate is your patient.
Have you seen this happen to you or a colleague? Share your inmate experiences in the comments section of this post.
Information in this series comes from a presentation given by Lori Roscoe, PhD, MPA, BSN, CCHP-RN at the Nursing Forum of the 2012 National Conference of the American Correctional Health Services Association (ACHSA). Dr. Roscoe is Executive Director of Clinical Services at CorrectHealth Companies and has great information for correctional nurses at her website The Correctional Nurse Educator.
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