A while back a blog reader emailed me to thank me for providing visibility for our specialty and to take issue with my blog byline: Inspiring Compassionate Professional Nursing in the Criminal Justice System. Seems that the word ‘compassion’ was not sitting well with this nurse leader who actually taught new correctional nurses to “check their compassion at the gate before they come in”. The email concluded with this statement: “I encourage new nurses to show compassion in the care they provide, but I clearly define the difference between showing it and actually feeling it. On the continuum of emotion, compassion is incredibly close to love and I challenge anyone in our profession to justify using the word love in the way we care for our patients.”
I appreciated hearing from this reader (email me at lorry@correctionalnurse.net anytime!) and have been pondering the perspect of showing compassion and not feeling compassion for a while now. Is that possible? What would that look like? Is it dangerous to deliver compassionate professional nursing in the criminal justice system?
The Issue
The compassion issue in correctional nursing hinges on the friction of care and custody so often encountered in our setting. Most correctional nurses work in a security conscious para-military setting where the predominant culture is punitive and uncaring. Many correctional patients live lives based on deceit and manipulation. How do we practice nursing in this environment? I discuss this issue in my book – The Wizard of Oz Guide to Correctional Nursing. It is a fitting analogy that nurses in the criminal justice system find themselves in a strange land with very different colleagues, language, and culture. Yet, we must remain professional nurses, all the same. Trying to ‘fit in’ in this new Land of Oz can lead to some dysfunctional work styles, as I describe in this earlier post.
Defining Compassion
One of the difficulties encountered right away is defining what compassion really means as it relates to health care practice. On a search for this answer I came across the national debate on compassion in healthcare currently going on within the British National Health System (NHS). Their chief nurse set out a vision for compassion in practice in 2012 that led to this definition of compassion.
Compassion is how care is given through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, and is central to how people perceive their care.
A concept analysis can sometimes help identify important components of the meaning of a word. Here are some key elements gleaned from an analysis of compassion done by a nurse researcher:
- Entering in to the suffering of another
- An internalized motivation for doing good
- Personal engagement in the alleviation of suffering
- Therapeutic empathy
- Empowers to not only acknowledge, but to act toward removing suffering or pain
In Defense of Compassion
Although poorly defined, compassion has been identified as foundational to professional nursing practice in key documents. For example, The Code of Ethics for Nurses Provision 1 states:
The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
The Correctional Nurse Scope and Standards of Practice list principles that guide correctional nursing practice (pg. 17). Among them is this one:
- Professionalism, compassion, care, and concern are displayed in every patient encounter.
So, it seems that compassion is a part of ethical practice and written in to our specialty’s guidelines.
Better to be Compassionless?
But, maybe correctional nursing is so different from nursing in other specialties that we must leave our compassion at the entry gate each shift. Maybe it is too risky to by empathetic to the suffering of our patients. Maybe we need to be emotionally detached from our patients and the care we render in order to maintain equilibrium. I think it is something worth pondering and may just be one of the most challenging dilemmas of nursing in the criminal justice system.
So, what do you think? Is compassionate professional care an inappropriate goal for nursing in the criminal justice system? Help me decide if I need to change my blog byline.
Photyo Credit: © Stocksnapper – Fotolia.com
Geney Streepy says
I treat my inmates patients, just as I would any other patient. They are all people. Inmates have made some bad choices in their life and they are paying for them by being incarcerated. What I am there for, as a nurse, has nothing to do with their crimes. I have compassion and empathy for all of my patients / inmates.
Laurie says
I act as a professional. I do not care about the crime. But if I am asked to be compassionate I say no. I have watched nurses being walked because they forget the line, and forget that inmates can and will manipulate them. I have also watched nurse go to far the other way. It is a fine balancing act.
Geney Streepy says
WOW!
Lee, LPN says
Nursing demands a certain amount of innate compassion, or decency, that sets us apart from non-nurses; we have nothing more to prove. I GIVE care to patients, I don’t CARE FOR them. I treat people who have largely made their own problems and conciously maintain them; compassion wold be wasted on them and used against me. I reserve compassion for those suffering thru’ no fault of their own…non-smokers lung cancer survivors, victims of child abuse, crack babies, innocent victims of DWI, drive-by shooting victims, rape victims, Alzheimers, etc.
mary says
I look at it this way… inmates are patients with security issues. I would no more cross the line outside the prison than I would inside the prison. I have compassion and I listen to them, but I don’t allow myself to be manipulated. But without compassion I don’t know how to be a nurse corrections or not.
Geney says
I agree. What is a nurse without compassion???????
Lorry Schoenly says
This from Margaret in Oregon:
“Showing compassion is not the same as showing feelings for a patient. Compassion in Correctional Nursing is showing understanding, listening attentively to what is needed and providing care with the tone of voice and professionalism that every patient deserves.”
kellyccrn says
I agree with what Margaret said. They are not in prison/jail to be punished. They are there AS punishment. I have only been a Correctional Nurse for 8 months but have been an RN for 18 years. I show each inmate compassion but I also know well enough NOT to allow myself to be manipulated by the because I give compassion and respect to them. They are, afterall, human beings 😉
Art Beeler says
Lorry, I am doing a presentation at ACA entitled, Have we forgotten the C of care. It will indicate we have an obligation to demonstrate care but not caring. It is meant to be a cultural piece.
Jewel says
I was in correctional nursing for 22 years, mostly at a max prison. My first day I was told to leave my compassion in the parking lot. Not possible. I wasn’t there to be judge and jury, I was there to take care of medical & mental health needs. Over the years, there were several staff found in compromising positions. It’s a fine line. Inmates will always try to manipulate. Always a good idea to have another staff member when dealing with them.That’s a given in most prisons.
Ann Hunsicker says
Lorry, I think sometimes we confuse compassion with emotional involvement. We are nurses because we have compassion and without it we would be indifferent to human suffering. However, we work in a veritable mine field in corrections and are in constant danger of being manipulated. We are frustrated when we know we are being lied to or threatened and verbally abused- we are human too.”Trust but verify” is my motto. Being objective in assessment of patient symptoms and up front with our responses and actions goes a long way in setting boundaries. Getting emotionally involved with our patients clouds our judgement and compromises our professionalism. We need to know ourselves and where our weaknesses lie to prevent us from abusing our patients and/or being abused by them.
Lorry Schoenly says
Excellent, Art! Caring is not limited to nursing practice! Always appreciate your advocacy for humanizing the incarceration experience.
Lorry Schoenly says
I can’t agree more, Ann! I always like ‘trust but verify’ as well as ‘firm, fair, and consistent’ as mottoes for our practice.
Jeanne, RN says
We, as nurses, must and should have compassion for these individuals. And by us showing them compassion, they may realize that someone actually does care about them. Some inmates have never experienced the act of loving-kindness from another human being. This emotion is a part of our humanity. I’m glad I don’t check my compassion at the gate when I report for work. But I do remind myself to “remember where you are” every time.
Lorry Schoenly says
I think you are on to something, Lorraine. Boundary setting is a better response than being compassionless. thanks for contributing to our conversation!
Randi Sachs says
My son is an inmate who committed a violent crime after taking a prescription drug by his doctor. He has great remorse and compassion for his victim, who recovered fully. As a parent, please I beg you not to check your compassion at the door. Be the nurse you studied to be. There are plenty of other people being harsh, cruel, and punitive without your joining in.
Laurie says
I am the nurse that is not compassionate, but I am the nurse that goes the extra mile. Maybe it is more that I was trained by a great nurse. I assess each patient. I do not care about their crime or how they act. I care about what I see, what is documented. I see lots of nurse be rude and hateful. I know they have to be the same outside of the gate. If a patient needs xrays, shipped to a hospital or an advocate for meds I will do that.
Tea McAlpin says
I am a compassionate nurse! Key word here…NURSE! I am not security, an officer nor am I judge or jury. My job is to provide care for the population currently incarcerated. I provide the same care for this population I do for elders, olders, youngers and the bunch of bikers we occasionally hang with on runs. By leaving all the negative crap outside the double doors, it allows me to use my skills to render care to the best of my ability. If your arm is broken I will stabilize and get you to those who have more ability than I do. I don’t care who it is attached to.
Joanne Maki Ciesluk says
Compassion and nursing go hand in hand, so, there is no question that correctional nurses should be compassionate. The line is drawn, however, in how that compassion is shown. Experiences correctional nurses know that any external or physical sign of the caring or affection that is so common in practice outside corrections can be dangerous for the nurse who cares for inmates. We know our special population can can reacts or be manipulative in a vast array of ways that we can’t begin to imagine. So, stay compassionate but keep your pats, hugs, personal words, etc. to yourself. Treat ALL inmates with care and kindness and NEVER single out a few!
Cindy CCHP, RN says
I began to form my own concept of compassion 10 years ago after finishing up one of my first solo assessments of an inmate at our state prison. During our brief encounter; I assessed. I listened. I formulated my nursing diagnosis. I formulated my nursing care plan. I explained the interventions to the inmate and evaluated his understanding of these interventions as I knew I may not see him again unless he “kited” about the same issue. At the end of our time together he turned as he left the exam area, paused and said, “Thank you for treating me like I am a human.” I contemplated his statement for quite some time. I couldn’t imagine treating a patient any less! I have carried that comment with me through my entire practice in corrections. I believe there are boundaries that must be clearly marked and NEVER crossed in all nurse/patient relationships and prison is certainly no exception. But one boundary that must never be smudged is that bottom line…our prisoner patients ARE human and are to be cared for with dignity and respect. I believe that anytime we treat another human in that manner we are showing compassion at its deepest level without becoming otherwise involved. Compassion is not about how you feel, it’s about how you act. Keep the boundaries clear and keep your roots as a nurse even clearer!
Lorry Schoenly says
Well said, Cindy! We should all carry that reminder with us into work each day. Thanks for contributing to our dialog.
Lee, LPN says
“During our brief encounter; I assessed. I listened. I formulated my nursing diagnosis. I formulated my nursing care plan. I explained the interventions to the inmate and evaluated his understanding of these interventions as I knew I may not see him again unless he “kited” about the same issue. At the end of our time together he turned as he left the exam area, paused and said, “Thank you for treating me like I am a human.” ”
I am reminded of the many MANY articles about guarding against possible manipulations by inmates. I daresay that seamstress in the NYS prison was ‘appreciated’ months before she agreed to help 2 convicted murderers escape.
Cindy CCHP, RN says
There is an important, important difference between sympathy and empathy. Trouble comes when prison staff smudge that boundary and let “feelings” rule. It’s a line of professionalism that must never be crossed. We must also keep our scope and practice act very clear in our minds…our patients are inmates. I also practice in a community setting and use the same principles concerning sypmathy and empathy. I have also found very strong “manipulative behavior” in patients outside the prison walls. Manipulation is not unique to corrections. It’s unique to humans. Upon introspection, I have found that I actually am a very good manipulator too. We as nurses just need to keep ahead of the manipulation and stick to our nursing process during every nurse/patient encounter and treat all patients with dignity and respect.
We as corrections nurses also have a duty to our fellow staff. We need to be watchful when we notice staff who have or are in the process of crossing boundaries. The situation in NY went on for months. It’s hard to believe that other staff were not aware. I am troubled that no one came alongside and helped this gal do the right thing before the situation spun so out of control for her. She needed someone to reach out and help her have the courage to report to her supervisors…maybe even to take that walk with her. That’s empathy. That’s compassion.
Melanie, RN says
Randi, I totally agree with you and as nurses we know in our gut well at least I do a lot of the time and I go by my instincts I do not let people manipulate me but I do agree with you my brother was incarcerated I have an interview Saturday for our county jail and I believe I am a very good fit for this position I will not leave my COMPASSION at the door or in the parking lot. I believe I know the difference also I do have empathy these human beings made mistakes they are paying their consequences. It is true some maybe most inmates were never shown empathy or compassion I believe in compassion and I also know when I’m being manipulated and when to draw the line. I believe in putting myself and everyone shoes and their situations us as nurses could possibly make their day a lot better because I’m sure they are not having good days in prison
Laura M says
I agree 100% with this statement. I couldn’t be a nurse and not show compassion. As long as you are careful and don’t cross that “line”, they deserve compassion just like any other patient we would care for. And no one can change my mind on that. I’ve been compassionate toward them for going on 16 years in a prison environment, and have never been treated with anything but respect by the inmates.
Laura M says
Very well stated, Cindy
Kate M says
Setting boundaries, or “tough love” is part of compassion.
Lorry Schoenly says
So true, Kate!
Laurie says
Love so many of the the comments. I hear a lot of judgemental comment about inmates. I think here we use every skill we have to know which inmate is faking and which one is heading into the golden hour, the one who needs to talk, and the one who is trying to manipulate you. But i would not trade this work for anything. So rewarding when you find your place
Laura Mish says
Of course we need to be compassionate. If we aren’t then we have no business working as a nurse, no matter where we work. I don’t understand how a nurse could not be compassionate, even working with prisoners. I’ve learned more about being compassionate and non-judgemental with inmate patients than with any other type of patient I’ve had in my 25 years as an RN.
Laurie says
Love these comments. There is a difference that people do not understand. I can not say that I am compassionate, but you are going to get what you got coming. Diabetic get info on stress management, exercise and diet. Chronic last eye exam ekg and labs. Even if inmate came over because his blood glucose was high. While there I talk about education, jobs on the street. But we are nurses and that is our job
Lorry Schoenly says
Thanks for your input, Laura. It can seem like an alternative universe to be asking the questions, right?
Laura Mish says
Yes, lol. I understand why it’s asked, but I don’t want people to lose sight of the reason why we are nurses, even if we work in a prison.
T. THOMAS says
I found this blog after speaking to a corrections nurse regarding my son. I called because I felt he needed immediate medical attention. The nurse was very rude to me for no apparent reason. She eventually hung up on me. Again I gave her no reason to respond to my request like this. If this is the tone, lack of professionalism, and lack of compassion that she showed towards me, I would hate to see how the inmates are treated. This disgusts me to see this type of behavior towards people in any setting, especially when you’ve taken a vow as nurses and doctors take. I have read a lot of the comments and can understand both sides. I agree that you can and should show compassion without getting emotionally attached or involved. I also commend those of you who dedicate your time and gift to the incarcerated. I know the environment is not the safest or most ideal. May God bless and protect you as you do your jobs with the care and compassion we should all have for any human being. Thank you also to the writer of this blog.