Who’s Minding Your Patients? Scopes of Practice Issues in Corrections

Fran Tompkins, RN, MS, CCHP, CCN/M, is Nurse Training and Education Supervisor for Correct Care Solutions in Nashville, TN. This post is based on the session “Who’s Minding Your Patients? Understanding Licensed and Unlicensed Scopes of Practice” that she is presenting at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Scope of practice can be described as those activities health care staff are permitted to legally perform based on licensure and training. All nurses need to understand their scope of practice to be able to stay within the boundaries of licensure. Correctional nurses, though, can encounter significant challenges to keep within the bounds. First of all, correctional nurses can have significant autonomy in make care decisions based on the setting. There may be few other health care providers onsite. In addition, officer colleagues may expect nurses to deliver health care beyond licensure limits, unaware that a request is inappropriate.

Nurses have a responsibility to dissect scope of practice as it applies to their particular state of licensure, understand it, and ensure that they are practicing within the boundaries of their license and fulfilling the requirements and conditions of the applicable regulations for the state.

Scope of Practice and Delegation

When using unlicensed assistive personnel (UAP) such as nurses’ aides, medication techs, or emergency medical technicians, it can be difficult to determine what they can legally do. The American Nurses Association and Council of State Boards of Nursing provide some guidance for determining delegated activities within a scope of practice for these individuals. In particular, registered nurses need to uses critical thinking and professional judgment while considering the 5 rights of delegation:

  1. The right task
  2. Under the right circumstances
  3. To the right person
  4. With the right directions and communication; and
  5. Under the right supervision and evaluation

Considerations when deciding to delegate a task include the potential for patient harm, the task complexity, amount of problem-solving needed in the situation, and the predictability of the outcome.

When Delegation is Not a Good Idea

Based on the above considerations, delegation is not always the best decision; especially when the patient situation is acute. For example, first responder events in corrections, like man downs, require nurses to think critically about patients who are acutely injured or become acutely ill. Other nursing processes also require complex evaluation and intervention. Besides emergency response, highly developed assessment skills are needed for intake screening and nursing sick call. In these examples, staff must often make autonomous decisions and intervene based on clinical judgment. Delegation to lesser-licensed staff can be risky.

Nursing staff must be prepared to offer the best care to all patients, recognize those individuals who are critically ill, and determine the best interventions for them; all within the boundaries of their scope of practice.

How do you handle scope of practice issues and delegation in your setting? Share some insights in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.


Lateral Violence in Nursing (Podcast Episode 107)


Tara Taylor, BSN, RN, CCHP, Regional Director of Nursing, and Mariann Burnetti-Atwell, PsyD, Director of Operations, Behavior Health Services, for the Missouri State Department of Corrections through Corizon Health, join Lorry to discuss lateral violence and bullying in nursing. They are presenting the session Lateral Violence in Nursing: How to Prevent Bullying and Create a Healthy Work Environment at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Lateral violence is also called horizontal violence or workplace bullying. It can happen in any profession but is especially troubling in nursing. This summer the American Nurses Association published a position statement on Incivility, Bullying, and Workplace Violence. The ANA sees these as ethical issues and the statement quotes the Code of Ethics for Nurses with Interpretive Statements that nurses are required to “create an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees, students, and others with dignity and respect” (ANA, 2015a, p. 4).

Affects Staff and Patients

An unhealthy work environment affects both staff and patients. Here are just a few of the effects of bullying on staff morale and patient care.

  • Medication errors: 40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague.
  • Staff health issues: Unmanaged anger contributes to hypertension, coronary artery disease, depression, psychological problems or other health problems.
  • Staffing issues: Low staff morale, increased absenteeism, attrition of staff, deterioration in the quality of patient care.
  • High staff turnover: Nurses leave the profession due to lateral violence and bullying contributing to the nursing shortage.

Preventing Lateral Violence

Both employers and staff have opportunities to intervene to prevent lateral violence. Employers can make it clear that bullying will not be tolerated through policy enforcement. Education about and role-modeling of respectful interactions is also important. Poor behavior needs to be addressed rather than ignored. The ANA provides posters graphically representing various prevention mechanisms for use in the clinical setting.

Is lateral violence an issue in your setting? How do you handle it? Share your tips in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Nursing Assessment of Dental Problems

Julia Buttermore, DMD, is Chief Dental Officer, Federal Medical Center, Carswell, Fort Worth, TX. This post is based on her session “Nurses’ Assessment of Dental Problems” taking place at the 2015 National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015. Learn more about the conference and register HERE.

Dental conditions can be a great concern for correctional nurses, yet, most received little or no training about dental conditions in nursing school. Most traditional nursing positions don’t involve dental assessments so many nurses enter the correctional specialty unprepared.

What’s the Big Deal?

First of all, a nurse is most often the first person an inmate sees about a dental concern. This is usually at a receiving screening or through the nursing sick call process. So, nurses must be able to determine the nature of the issue and make a decision about urgency of treatment. A dental episode might be remedied with instruction on self-treatment, may need assignment to the next available dental appointment, may need urgent evaluation by a dentist, or may need emergency treatment in the acute care setting. It requires significant clinical judgment abilities to appropriately manage dental issues.

Another reason dental conditions are a concern for correctional nurses is because there are so many of them in our patient population. Our patients are less likely to have received dental care in the past and many have a lifestyle that does not include high levels of dental hygiene. Therefore dental decay and periodontal disease are seen frequently. Our patients come from violent backgrounds that can result in tooth trauma. They also indulge in high levels of alcohol, tobacco, and drug use. All these substances have a negative effect on dental health.  Methamphetamine use, in particular, can cause severe dental erosion and decay. Self-medicating with alcohol and drugs can mask tooth pain. Once incarcerated and withdrawn from these substances, inmates feel increasing mouth pain that leads to dental requests for evaluation and treatment.

Finally, systemic chronic conditions and infections affect dental health. Nurses who understand the relationship of dental conditions to systemic disease can often activate medical evaluation when a dental manifestation is observed. For example, canker sores or herpes can appear on the mouth of an immunosuppressed individual and periodontal infection might exacerbate blood glucose levels in diabetics.

Where to Start

A good assessment starts with an evaluation of the patient’s mouth pain. Here are some important questions to ask.

  • How long has it been hurting? (Just now? 24 hours? 3 months? Years?)
  • Does it hurt spontaneously or when eating, drinking?
  • Does the pain wake you up at night?
  • Describe the pain quality: aching, throbbing, pressure, tingling
  • How long does it hurt? (<1 minute? 30 minutes to 1 hour? all day?)
  • Does anything help the pain?
  • Use the pain scale of 0-10 to determine a baseline level of discomfort

Dental conditions can affect the ability to breathe and swallow. These are two immediate concerns in evaluating any dental condition. Ability to breathe and swallow is affected by infection, traumatic injury, persistent bleeding in the oral cavity, or swelling. Impairment of breathing or swallowing needs immediate emergency treatment. Inspect the mouth for swelling. Take the patient’s temperature.

If this is a traumatic injury, check for a broken jaw. Mandibular fracture is a common injury due to assault or falling. Malocclusion (teeth not fitting together normally) is an indication of a mandibular fracture.

A New Skill

Since most correctional nurses come to the specialty with little training or experience with dental assessment, you may need to develop your own dental training program to develop skill in this important area of nursing practice behind bars. This can involve encouraging your facility dentist to provide in-services and hands-on practice assessing patients under their direction. You may also be able to discuss dental assessments and findings as a debrief of urgent or emergent evaluations. Dental trauma and infections tend to be the most common conditions requiring nursing assessment so these are good places to start.

Do you assess dental conditions in your practice? Share your experience in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2015 National Conference on Correctional Health Care. All posts in this series can be found HERE.

Med Math Help for Correctional Nurses (Podcast Episode 104)


Ep104Jamie Davis, a registered nurse and paramedic, discusses medication math and the help provided by his book – Med Math Simplified: Dosing Math Tricks for Students, Nurses and Paramedics. Jaime podcasts on the ProMed Network hosting shows like the Medicast podcast and the Nursing Show podcast. Jaime is open about his own struggles with math concepts as a nursing student and how that helped him to develop an easy-to-read guide for other students, nurses, and paramedics.

We talk about the challenges of medication calculation and apply it to the correctional setting. Correctional nurses don’t always have the luxury of unit dosing or pharmacy calculation. In fact, some settings are still providing a lot of medication from a stock supply. There are plenty of opportunities for error. So brushing up on math is important when moving into a new position in a jail or prison. Even seasoned nurses can use some help when the rare IV is started in the infirmary and a drip rate needs calculated.

Do you find med math challenging? How do you manage math calculations in your setting? Share your thoughts in the comments section of this post.

A Pre-Flight Checklist Before Rolling Out of the Med Room

A Pre-Flight Checklist Before Rolling OutMedication administration is a common and frequent nursing task in most settings. There are plenty of opportunities to get things wrong….even when surrounded by fantastic resources like an onsite pharmacy and electronic information sources. Correctional nurses don’t often have these advantages, though, and medication administration can take on some interesting configurations. I’ve been in quite a few jails and prisons in my correctional consulting career and have seen many a method for medication delivery to overcome environmental and security challenges. Here are just a few of the ways medication may be delivered behind bars.

  • A window in the med room. Patients may line up outside the room in a hallway or in an outdoor area
  • A medication cart rolled to the housing unit and stationed in the common area or a small room in the housing unit
  • A cart, room, or even table near the dining hall
  • A larege utility shed in the recreation yard

In most of these cases (except the first one, maybe) the nurse must take all the medications and supplies out away from the medical unit and must be prepared for any situation. There is little opportunity to ‘run back to the unit’ for something forgotten or unexpectedly needed. This made me think of airplane pilots who need to know they have everything checked out and ready to go before they take to the air. As a passenger on these flights, I am glad the captain doesn’t rely on memory to be sure everything is in order. Cruising altitude is not a good place to be finding out the gas tank is low.

Here are my suggestions for a pre-flight checklist before you take-off on your medication flight.

  1. Check that the cart is properly stocked.
  • Patient medications
  • Medication administration record
  • Pen, highlighter, notepad
  • Current drug book
  • Pill crusher
  • Calculator
  • Pill cups
  • Water/drinking cups
  • Waste receptacles
  • Any access keys needed such as access to the narcotics box
  1. Perform the following activities while in the Medication Room.
  • Scan MARs for
    • Any new medication orders since last administration.
    • Any new patients
    • That all patients have drug allergies listed or NKA (no known allergies) identified
  • Check to see that new medications are available or, if being processed, are added to the cart before starting administration
  • Check a drug reference book on any new medications that are unfamiliar
  • Perform any calculations for odd dose orders
  • Perform hand hygiene
  1. Each single episode of medication administration should follow the same path in order to habituate safety principles. Here is an example of a workable medication line episode path that includes the safety mechanisms of checking the medication three times and involving the patient in medication verification.
  • Ask the patient to recite their full name while checking ID band or card.
  • Locate correct MAR page
  • Scan page for medications due at this administration time
  • Locate patient medication group in medication cart drawer
  • Take first card and check against MAR while popping pills into medication cup
  • Take next card and check against Mar while popping pills into medication cup
  • Continue in like manner until all pills for this administration time are in the medication cup
  • Recite medications to the patient while preparing them
  • Recheck cup of pills against MAR before handing to the patient
  • Ask patient if he/she has any questions about their medications while pouring water
  • Watch patient take medication. Perform oral check or confirm officer is doing oral check
  • Observe that cups are deposited in waste receptacle and not taken by the patient
  • Move to the next patient
  1. Additional steps in the process might be needed depending on the patient or situation.
  • Crushing some or all medications.
  • Responding to a patient question or confirming a medication if questioned.
  • Unlocking and signing out any narcotics.
  • Obtaining a double-check on high risk medications and complex calculations.

Do you have a mental checklist you use when preparing for and administering medications? Share your tips in the comments section of this post.

July 2015 Correctional Health Care News Round Up (Podcast Episode 103)


Ep103Gail Normandin-Carpio and Denise Rahaman join Lorry to talk about top correctional health care news items for July, 2015.

Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons

Our first story is a report out of Human Rights Watch about the use of force against inmates with mental disabilities in US Jails and Prisons. We have been discussing the plight of the mentally ill in the criminal justice system for some time. Our jails and prisons are not organized to effectively treat mental illness, yet growing numbers of inmates have serious mental illness such as schizophrenia and bipolar disorder. The mentally ill are less likely to adjust to conditions of confinement and have difficulty following all the rules that must govern life behind bars. That puts them into confrontational situations with officers who must keep order and control. This report paints a grim picture but also provides some hopeful recommendations.

Bill would give inmates’ families access to prison medical records

New York has passed a bill that would require the State Department of Correction and Community Supervision to provide medical information disclosure forms as a routine procedure for all incoming or transferring inmates. This would give inmates the option of appointing a family member or other person to receive their medical information.

Dating a prisoner: What attracts people on the outside to fall in love with convicted criminals?

This next story is about dating prisoners and comes from a British news source. The recent NY Prison Escape story and follow-on investigation as brought to light something we see in practice all too often – staff getting intimately involved with criminals. Hybristophilia is described as a condition whereby women are sexually aroused by and responsive to men who commit heinous crimes. Often referred to as the ‘Bonnie & Clyde Syndrome’, the person who is the focus of the sexual desire can be someone who is in prison. In some cases, the hybristophile may urge and coerce their partner to commit a crime. This may somewhat explain staff attraction to our patient population.

Florida prisoners train therapy dogs to help veterans

In our final story, a group of Florida prisoners are training therapy dogs for veterans suffering from Post-Traumatic Stress Disorder as part of a new program. Prisoners from the Blackwater River Correctional Facility will train three puppies for America’s Vet Dogs Veteran’s K-9 Corps with plans to expand to 10 dogs by the end of the year. The training program will teach the K-9s to do everything from retrieving medication, to turning lights on and off, to waking veterans from nightmares. Sounds like a nice idea for both the veterans and the inmates.

What is your take on these news items? Share your thoughts in the comments section of this post.

Scope and Standards: Five Tenets of Correctional Nursing

This post is part of an ongoing series discussing key components of the Correctional Nursing Scope and Standard of Practice, 2nd Ed. Review prior posts in this series here. Purchase your own copy of this highly recommended book through Amazon.

Correctional nurses practice in a unique setting with a unique patient population, however, the way we practice is based on tenets common to nursing across all settings. These five tenets of nursing practice are identified in all nursing specialties and here applied to our practice in the criminal justice system.


In the end, correctional nursing is providing care to one patient at a time. Yet, we are careful to understand the demographics of our particular patient population when providing that care. For example, when working in a maximum security setting every patient is considered a high safety concern. However, correctional nurses constantly struggle with the challenge of balancing objectivity with cynicism due to the potential for manipulation of some in the patient population. Actively focusing on the individual needs of the current patient while keeping in mind the patient population characteristics can help maintain individualized care.


Nursing care in all settings requires collaboration with other disciplines, the patient, and family members to reach health goals. In the correctional setting, nurses also coordinate and negotiate with officers and non-healthcare administrative leadership to reach these goals. Correctional nurses, in particular, need skill in communication, collaboration, and persuasion to be successful.


Correctional nurses struggle with the definition and application of caring in a secure setting. Professional boundaries, safety issues, and security rules are ever-present concerns that alter caring practices from those of a traditional care setting. Defining caring in our practice is an important professional goal.


The nursing process is foundational to nursing practice. Correctional nurses use the nursing process to plan, deliver, and evaluate care in such activities as nursing sick call, emergency treatment, and infirmary care. The autonomous nature of nursing practice in jails and prisons requires excellent assessment and critical thinking skills.


Our practice environment affects our practice, no way around it. Although many correctional nurses work in positive environments, the nature of the corrections culture is punishment and control. These twin goals can facilitate an oppressive work environment where care and caring are difficult. Correctional nurses must strive to overcome a negative work culture that can discourage and demoralize our practice.

Do you have a favorite tenet of correctional nursing? Share your thoughts in the comments section of this post.

Keep Your Cool: Heat Injury Alert

keep your coolIt’s that time of year again-Summertime. Time to be hot and bothered at work if you are one of many correctional nurses working in a setting that lacks air conditioning. Jails and prisons were not built for comfort and many older ones are without air conditioning or even good ventilation. Heat injuries such as heat exhaustion and heat stroke should be on our minds when evaluating vague patient symptoms during the summer months; especially when the weather is both hot and humid, like many of our southern states. For example, as identified in a recent lawsuit, most of the Texas state prisons are without air conditioning, although some have climate control in the medical unit. So, what should you do to identify and treat heat injuries?

Vulnerable Conditions

Although anyone can succumb to heat and humidity, the young and old have fewer reserves to overcome heat stress. If possible, move patients with the following conditions to special housing or provide with additional monitoring and fluids during high heat alerts.

  • Elderly
  • Heart disease
  • Pulmonary disease
  • Mental illness

A main reason those with the above conditions are prone to heat-related illness is the medication they are likely prescribed. The following medications or substances increase heat injury risk.

  • Anticholinergics (Atrovent, Chlor-Trimeton, Cogentin, Spiriva)
  • Antihistamines (Allegra, Benadryl, Zyrtec)
  • Benzodiazepines (Klonopin, Librium, Valium, Xanax)
  • Beta blockers (Atenolol, Corgard, Lopressor)
  • Calcium channel blockers (Cardizem, Norvasc, Procardia)
  • Diuretics (Chlorothalidone, Diuril, Lasix)
  • Neuroleptics/Phenothiazines (Haldol, Mellaril, Prolixin)
  • Tricyclic antidepressants (Pamelor, Tofranil, Vivactil)

Rapid Cooling and Hydration for Heat Injury

Heat exhaustion and heat stroke are the two most common heat injuries, although sunburn and heat cramps are also often listed.  In heat exhaustion, the body is decompensating having difficulty maintaining normal body temperature in an extended high heat situation. Heat stroke begins when the body becomes unable to keep internal temperatures in a livable range. Without intervention, heat exhaustion can progress to life-threatening heat stroke. Here is a quick comparison of the presentation and treatment of heat exhaustion and stroke.

Heat Exhaustion Presentation

  • Body temperature under 104 degrees F
  • Heavy sweating
  • Muscle and stomach cramps
  • Headache
  • Nausea or vomiting
  • Tiredness, weakness
  • Dizziness and fainting

Heat Stroke Presentation

  • Body temperature above 104 degrees F
  • Hot, dry skin
  • Confusion, strange behavior, seizures, or unconsciousness
  • Rapid pulse
  • Throbbing headache
  • Nausea

As you can see, many of the symptoms are similar as heat stroke is an intensification of heat exhaustion. A differentiating factor is the change from heavy sweating to hot, dry skin. In both cases, treatment focuses on rapidly cooling and hydrating the body. Heat stoke definitely requires hospitalization while heat exhaustion, if mild, can be treated at the facility and may require infirmary monitoring.

Heat Exhaustion Treatment

  • Move to a cool area (Shade, AC)
  • Remove or loosen restrictive clothing
  • Rehydrate with fluids
  • Use evaporation methods
    • Spraying water on the body and fan the air
    • Sponge body with cool water
  • Rest
  • Monitor until body temperature returns to normal

Heat Stroke Treatment

  • Move to a cool area (shade, AC)
  • Removal of restrictive clothing
  • Use evaporation methods
    • Spraying water on the body and fan the air
    • Sponge body with cool water
    • Covering the patient with cold water–soaked sheets
    • Place ice packs in the axillae and groin
  • Supplemental oxygen, if available
  • Prepare for possible initiation of IV therapy
  • Prepare for transfer to acute care

Patient Education for Prevention

Helping patients to manage heat and humidity can prevent heat injury. These reminders are important for officer staff, as well.

  • Keep hydrated. This can be difficult where bad-tasting water and fruit-flavored Kool-Aid are the only options. Advocate for healthy fluid options for your patients when possible. Ask about fluid intake during your subjective assessments.
  • Reducing physical exertion. Now is not the time for basketball competitions or lifting challenges. Many inmates are on outdoor work duty with many hours in the sun. Be mindful of the work status of inmates coming to sick call with symptoms of dizziness, weakness, headache, and general body tiredness. Instruct patients to take frequent rest breaks and seek out shaded areas at work and recreation sites.
  • Use available cooling methods. Teach patients evaporation heat reduction methods to stay cool such as sponging body areas with cool water and body fanning.

Personal Safety in the Heat

Don’t forget yourself in your summer heat preparations. You are also vulnerable to heat injury. Even if the medical unit is air conditioned, many health care activities take place outdoors or in housing units. Be sure to follow all the instructions provided to patients. Stay hydrated and monitor your mental and physical status regularly. Urine output and characteristics can be a good indication of adequate hydration. If you are basically healthy, pale urine is an indication of appropriate bodily fluid volume and generally good kidney function. Concentrated darker urine or decreased urine output can indicate a need to increased fluids. Double up on the fluids you bring on shift. Water is always a better option than sweet or caffeinated drinks.

Do you work in a high-heat setting? How do you keep your cool and manage your patient’s heat regulation during the summer? Share your thoughts in the comments section of this post.

Photo Credit: © OlegDoroshin

June 2015 Correctional Health Care News Round Up (Podcast Episode 101)


Ep101Lorry is joined by Mari Knight and Catherine Knox to discuss the latest correctional health care news items.

New study examines health factors influence on ex-prisoners’ chances of returning to jail

The first news item is a study out of Australia that links health factors to recidivism. In this exploratory study of prisoners from seven institutions in Queensland, those inmates with a history of risky drug use and mental illness were more likely to return to prison while those who were obese or had a chronic disease were less likely to be incarcerated again.

Prison break casts spotlight on staff-inmate relationships

The New York Prison Break has been prominent in the news and in this last week of June the two escaped inmates from a maximum security prison in upstate New York have been apprehended. As more information emerges about the planning and implementation of the elaborate escape, light is being focused on staff-inmate relationships and how staff can be manipulated. Resource links on the issue of nurse-patient relationships can be found in this recent post.

Top doc blasts California prison health care

A prison psychiatrist at San Quentin State Prison in the California Prison System circulated a memo about constitutionally inadequate mental health treatment in the prison and seems to have suffered retaliation for doing so. Correctional nurses have felt a need to speak out about inadequate care or conditions of their inmate patient population and have also suffered negative consequences.

Caring for the dying, behind bars

Our final story is about caring for dying patient behind bars. This is an opinion piece written by Dr. Jaime Mayer, an infectious disease physician, and published in the Boston Globe. She basically askes the question – is it possible to have a good death in prison? It is a struggle to balance compassion and correction …or, care and custody in many areas of healthcare behind bars. This essay provides a good example.

How about you, do you have some input or experiences to share related to our news items? Share your thoughts in the comments section of this post.

Could You Be the Next Joyce Mitchell? 4 Prevention Tips

Could You Be the Next Joyce Michell- (1)Many of us have been closely watching the unfolding events surrounding the NY Prison Break over the last month. Here is a timeline of events, concluding with the death of convicted killer Matt and the shooting and capture of convicted killer Sweat in upstate New York. Early in the story Joyce Mitchell, a prison worker who managed the tailor shop with her husband, was taken into custody for her part is assisting the prisoners.

Those unfamiliar with our patient population find it hard to believe that someone would develop an intimate relationship with a murderer and assist them in this way. Yet, unhealthy inmate relationships are a constant threat and should be a continual concern for anyone working in the criminal justice system. No one is immune to this work hazard. Here are my four prevention tips along with some links to prior posts and podcasts on the topic.

Know Your Patients

Prisoners are ten times more likely than the general population to have an antisocial personality disorder (ASPD). That means many of our patients are sociopaths or psychopaths; individuals who use others to gain what they want without remorse, guilt, or conscience. Among other things, that means that they may appear charming and charismatic in their interactions with you. Unfortunately, that charm is often ‘turned on’ in order to manipulate and deceive. Always be aware that things may not be what they seem in the words and actions of patients. Click here for more information about dealing with lying and manipulative patients.

Know Yourself

Most of us became nurses in order to help people in distress – the injured, ill, and suffering. This motivation can make us prey to antisocial patients. Empathetic people are natural targets for sociopaths. We are even more vulnerable when our emotional lives are in turmoil such as when we are having relationship issues (divorce or break-up), work stress (new job, discipline, understaffed), health issues (illness, pregnancy, new baby) or are under financial stress (foreclosure, credit card debt). Be aware of your emotional and psychological state when dealing with this patient population.

Remember Where You Are

Many of us spend the majority of our time at work. What is unusual for most people (working behind bars) becomes normal and common place for correctional nurses. It can become so normal that you forget where you are and who is nearby. This can result in ‘letting down your guard’ and becoming too familiar with your patients. Talking about your personal life around workmates and patients alike can make you vulnerable to those interested in gaining rapport and influence. Small breaches of professional boundaries can lead to great harm. It is unlikely that Joyce Mitchell woke up one morning determined to help two murderers escape prison. But, she is reported to have been very chummy with at least one of them including bringing in meals.

Help Each Other

Manipulative patients will note any friction among staff members and use that to advantage. One of the best ways to avoid being drawn into an inappropriate patient relationship is to have good working relationships with your team mates. Present a united front before the patient population and keep any friction or personality differences for behind the staff-room doors. Talk openly in staff meetings about professional boundary challenges and be willing to confront team mates who may be slipping into danger. It seems hard to believe that no staff member noticed Joyce Mitchell’s over familiarity with Matt and Sweat. Would life be different for her right now if someone had intervened?

Learn from this News Event

Could you be the next Joyce Mitchell? It is easy to become accustomed to your surroundings and lose sight of the relationship goals of some of your patients. We can all learn from the recent events at Clinton Correctional Facility. Take this opportunity to double down on your professional boundaries with patients and have a conversation with your workmates about how to prevent inappropriate relationships from starting.

Resources to Keep You Safe

Working with Inmate-Patients Series

Podcast Episodes

What tips do you have for avoiding unhealthy patient relationships? Share your thoughts in the comments section on this post.

Photo Credit: © boule1301 – Fotolia.com