Scope and Standards: Prevalence of Correctional Nurses

By Lorry Schoenly, PhD, RN Leave a Comment

Before I accidentally became a correctional nurse, I didn’t even know the specialty existed. However, I soon learned that, although we work in a hidden practice setting, there are many correctional nurses. Unfortunately, we are almost invisible to the larger profession. Take any nursing survey that asks for your specialty area and you will see what I mean. I have never seen a place to check for correctional nursing. Most often we are filling in the open space next to ‘other’.

The taskforce revising the Correctional Nursing Scope and Standards of Practice had quite a time searching for verifiable information on the number of correctional nurses working in American jails and prisons. We finally settled on reporting numbers from the Health Resources and Services Administration (HRSA) data from the National Sample Survey of Registered Nurses. This survey estimated a total of 20,772 registered nurses working in correctional settings. That is almost 1% of all nurses working in the US (0.08%).

To those of us active in the profession, however, this seems a low number. Could it be that more nurses work in criminal justice? The way nurses are employed to work in a correctional setting may skew survey findings. For example, correctional nurses may be employed by a university medical system (like those working in Connecticut and New Jersey prison systems. Many jails are staffed by nurses working for the public health department. Nurses may provide care to inmates but work for private companies such as those who manage dialysis units within prison systems.

Maddie LaMarre, in a chapter on nursing practice for Clinical Practice in Correctional Medicine (2006), cited an estimated 2-3% of US nurses work in corrections. With Bureau of Labor Statistics of over 2.6 million employed registered nurses in 2008, this would suggest between 52,374 and 78,561 correctional nurses. The figure does not include the many LPN/LVN nurses practicing in the specialty.

Also not reflected in the National Sample Survey are nurses who work in correctional settings in a part time or per diem capacity. Some prison settings in remote areas must rely on traveling nurses to meet healthcare needs. Many settings regularly employ agency nurses to fill gaps in the schedule.

Without a professional association specifically dedicated to correctional nursing practice, there is no reliable collection on information on the number and characteristics of correctional nurses. More the pity. Correctional nursing might be more visible with an accurate idea of the number and strength of the specialty.

How many correctional nurses do you think there are in the country? Share your thoughts in the comments section of this post.

The full Correctional Nursing Scope and Standards of Practice, 2^nd Ed. Is available through Amazon.

Photo Credit: © piccaya – Fotolia.com

Nurse Perceptions of Correctional Health Care (podcast)

By Lorry Schoenly, PhD, RN 1 Comment

Podcast: Play in new window | Download

In this episode of Correctional Nursing Today Karen Marchand-Singleton discusses her research involving nurse perceptions of correctional healthcare. Karen performed this research as part of her master’s degree program and hopes to expand her sample in future research. Karen’s entry into correctional practice started when her son, who has hemophilia, was detained at a local jail. She had not been exposed to correctional nursing before and was unsure of the medical treatment her son would be receiving. She took a position at a nearby jail to find out and discovered she loved the specialty.

As a nurse manager at that same facility, Karen found it difficult to recruit nurses into the correctional setting. This led her to pursue this research topic to find out what the perception was of correctional nursing in the healthcare community. Her research sample was based on her South Carolina locale where she did live interviews with 20 nurses. These nurses had backgrounds in acute care, home care, hospice, and corrections. Her structured interview involved 10 questions about their understanding and exposure to correctional nursing.

Her results indicate that we have a ways to go to improve the awareness and image of correctional nursing. Few study participants had a clear understanding of the specialty and only one had been exposed to the field during initial schooling. Her findings indicate a need for more dialog in the general nursing community about correctional nursing practice. Correctional nurses need to interact with nurses outside the specialty at general conferences and become a part of the larger nursing community.

Do you think the correctional nursing specialty is invisible? Share your thoughts in the comments section of this post.

What’s Bugging You? Lice Identification and Treatment

By Lorry Schoenly, PhD, RN 6 Comments

During a jail intake for a homeless man brought in for vagrancy, a nurse sees some tiny insects flying about his clothing and he is scratching at them as she interviews him. She is concerned that an infestation may result and initiates a protocol for lice which involves shampooing and showering with the insecticide permethrin and a special laundering process for all clothing. Was this the right action?

Correctional nurses need to be aware of various infestations as a high percentage of inmates in some locales are prone to head, body, and pubic lice. Once these little hitchhikers enter a facility they can spread by direct physical contact or through sharing of personal items like clothing, bedding, or towels. Was this patient infected with lice? Let’s look at some information about these little critters.

Do lice fly?

Lice remain on a person’s hair or clothing and wander to the skin to blood feed once or more often each day. They have tiny straw-like mouthparts – similar to those of mosquitoes – that they use to suck blood from skin capillaries. They’re unable to burrow into the skin. Lice never develop wings, so they cannot fly. They’re also incapable of jumping. So, this patient did not have lice.

Lice cause itching

Lice may cause an allergic reaction that can cause itching. For head lice, the itching tends to be mild and temporary. Body lice tend to cause far more itching, and even make the infested person feel ‘lousy’. Public lice tend to cause much itching in the affected area. This patient’s itching may be caused by the insect in question but further investigation is needed.

Lice are not very common

Lice are not nearly as prevalent as is generally believed, and other creatures and objects on a person are frequently mistaken for lice. Other insects include fleas, ticks, mites and bedbugs. None of these insects have wings, though. The homeless man in our case may merely have gnats or fruit flies about his person.

Lice are relatively tiny – as small as a poppy seed and as large as a sesame seed. A screener must have good eyesight, be close enough to see the creature, use a magnifying lens, and some expertise to identify lice; distinguishing them from other insects. In fact, other kinds of insects and even bits of debris are frequently mistaken to be lice. As in this case, misdiagnosis and unnecessary treatment can be frequent.

When in doubt – don’t treat

Treating everyone who enters a facility is not a good idea; nor is it cost effective. Treatment focused just on those infested is consistent with sound medical practice. It can also dramatically save time and precious funds; while reducing the risk of lawsuit. The standard medications used in prisons for delousing contain the insecticides permethrin and pyrethrins. These have become less effective as resistance is becoming widespread.

When positive lice identification is confirmed, treatment can be ordered as follows:

Head lice can be treated with one or two 10-minute applications of a pediculicide.
Body lice usually require no treatment to the person. Instead, a person with body lice should bathe and change into prison-issued clothing. The infested clothing should be disinsected by proper laundering, or disposed of. If body lice are detected on the body hairs of a person, a full-body treatment with a pediculicide is needed.
Pubic lice would necessitate treatment to the affected area only.

Ongoing prevention measures for lice include frequent (at least weekly) laundering of clothing and linens, and early recognition and treatment of genuine infestations. The Federal Bureau of Prisons Lice and Scabies Protocol of March 2011 recommends the following actions:

Be sure laundry temperatures are set to at least 130 degrees Fahrenheit to kill lice and their eggs on linens and clothing. Use a hot cycle for drying, as well.
Educate inmates about lice and how to get treatment if they observe lice. The FBOP Protocol includes inmate education handouts that might be helpful.
Inmates should not be transferred to other facilities until 24 hours after initiation of treatment. If moved before the 2^nd treatment application (7 days), communication and continuation of treatment should be provided.

How are you managing lice, bedbugs, fleas, and ticks in your facility? Share your thoughts in the comments section of this post.

Photo Credit: © Sascha Burkard – Fotolia.com

Scope and Standards: New Definition of Correctional Nursing

By Lorry Schoenly, PhD, RN 2 Comments

How has professional nursing practice in the correctional setting changed and evolved over the last decade? When discussing any concept, the first place to start is with a definition. How has the definition of correctional nursing changed over the years?

To start with, the very name of our specialty has moved from corrections nursing to correctional nursing. This name change indicates a movement away from purely defining nursing practice based on location. Similar evolutions have taken place in such specialties as emergency nursing (no longer Emergency Room Nursing) and Perioperative Nursing (no longer Operating Room Nursing).

Definition of Corrections Nursing in 2007

Corrections nursing is the practice of nursing and the delivery of patient care within the unique and distinct environment of the criminal justice system.

As the general definition of nursing has progressed, so has the definition of correctional nursing. This edition of the Correctional Nursing Scope and Standards of Correctional Nursing unveils an expanded definition of correctional nursing which mirrors the 2010 ANA definition of nursing.

Definition of Correctional Nursing in 2013

Correctional nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, advocacy, and delivery of health care to individuals, families, communities, and populations under the jurisdiction of the criminal justice system.

Nurses practice professionally in every setting. Therefore, the core components of correctional nursing include protecting, promoting, and optimizing the health and abilities of patients. Nurses in all practice settings, including corrections, prevent illness and injury while alleviating suffering. Correctional nurses, as those in other settings, diagnose and treat the human response to illness and injury. They advocate for their patient’s health and deliver health care to individuals, families, communities, and populations.

The location of care – under the jurisdiction of the criminal justice system – does give context to the practice of nursing. The criminal justice system presents the unique environmental constraints and ethical dilemmas of our specialty. In addition, the criminal justice system creates a unique patient population for nursing care. This patient population has demographic characteristics and illness patterns that require specialized nursing knowledge. The combination of environment and patient can lead to specific patient advocacy situations for correctional nurses.

What do you think of the new definition of correctional nursing? Share your thoughts in the comment section of this post.

The full Correctional Nursing Scope and Standards of Practice, 2^nd Ed. Is available through amazon.com.

A New Year Reading List

By Lorry Schoenly, PhD, RN 7 Comments

Do you plan to do some reading in 2014? It can be hard to find good books in our specialty. Here are some books I recommend for both professional and recreational reading. By purchasing through these Amazon affiliate links, you can give back to CorrectionalNurse.Net and help cover the cost of keeping this blog running (web hosting, podcasting streaming, and graphics fees).

Professional Reading

Essentials of Correctional Nursing

No surprise that my first recommendation is our book on the basics of nursing care behind bars. This book provides essential informaiton for any nurse to get up and running in the specialty. It also includes plenty of information for seasoned correctional nurses about professional practice issues. But, don’t take my word for it. Here are a couple reviews to help you decide:

“I have been searching for a resource like this for the entire 11 years I have worked in correctional health care. As a Nurse Educator, I am constantly searching for current research-based information to share with the correctional nurses I instruct. Lorry has definitely hit the mark with this book.The information is complete and well-organized, and covers issues all correctional nurses enounter daily. Every correctional nurse should own this book.”

“This is THE resource for correctional nurses. As a nurse manager, it sits on my desk. This is the definitive book of nursing in jails and prisons. The authors and editors have done a great job of capturing the essentials that nurses need to know to practice. Read this and you will be grounded in your practice, knowing why things are important as well as what needs to be done.
If you are preparing for certification, this should be the first book in your reading list. If you are new to corrections, this is your guide and starting point. If you are a seasoned nurse, this book will help fill in the gaps and let you know what the best practices and national thought is, moving you beyond your experiences and into the world of expert opinions. If you are a manager, use this to help orient your nurses.”

Correctional Nursing Scope and Standards of Practice, 2^nd Edition

It was my pleasure to be a part of the ANA Correctional Nursing Scope and Standards Workgroup that produced this latest edition. I wrote the ethics section on pages 18-21, by the way. This book is an incredible resource no matter what your position. As a staff nurse you can see the full scope of correctional nursing practice and use the standards to evaluate your own competency or create a personal development plan. As a nurse manager you can create job descriptions, policies, competency and orientation programs from the material. This book should be on every correctional nurse’s bookshelf right next to the Essentials of Correctional Nursing!

Games Criminals Play: How You Can Profit from Knowing Them

I used this book as background for writing my chapter on staff safety in the Essentials of Correctional Nursing. It is an older book (1981) but manipulation techniques are classic. This book is practical and definitely not a scholarly work. You can find some good principles for avoiding harm in your nurse-patient relationships. Here are a couple reviews that tell it all:

“Games Criminals Play is a very easy to read, straight-forward account of the manipulations inmates are so skilled in often as a means of survival, and how easily susceptible the correctional employee can be. Accounts given demonstrate how easily the manipulations can begin; how difficult they can be to terminate, and how to proactively and professionally ward off the inmates’ manipulative games. The book would serve anyone new to the corrections environment very well.”

“I think that this book should be an annual training requirement for EVERY correctional employee! It reminds us that even a ‘veteran’ can be manipulated, and or set up by convicts. The game never changes, Only the players”

The Art of the Con: Avoiding Offender Manipulation

Like the book above, this one is written from the officer perspective but has good information to help correctional nurses. If you like a lot of examples of ways our patients might be manipulative, you can find them here. The difficulty with both these books for nurses is balancing the caring/custody dichotomy. You need to keep that in mind when reading books from the criminal justice perspective. Comments from readers:

“This book really helped me realize how NOT to be a victim of manipulation. I’m usually very trusting and want to believe in the best of people. This book helped me to remember that I am in the criminal’s environment when I am there. They are not in mine.”

“A must have for any or all corrections personnel. I am a nurse working at a state prison and this book gives me the life saving tools needed to avoid any situations that a inmate will place you in without your having the slightest notion what is happening to you. It is a must have to avoid the master manipulation that goes on in the corrections system with the inmates.”

Recreational Reading

Orange Is the New Black: My Year in a Women’s Prison

I read this book before it was picked up as a series on Netflix and also interviewed author Piper Kerman on women’s healthcare in prison several years ago on the Correctional Nursing Today podcast. The book is engaging and provides an inmate perspective on life in a women’s prison. Comments from other readers:

“It is difficult for many people to have compassion for people who are in prison or to care about their living conditions since they “made their bed”, but I think books that remind us of our common humanity with “others” are important and worth reading.”

“It is an interesting read about how an educated woman was thrown into a world in which she was unaccustomed and how she survived a year in prison. As expected the Netflix series takes quite a bit of poetic license with the story, but that need to be reviewed on its own merits. It is an enjoyable read with an interesting and well-thought-out reasoning for why the war on drugs is a failure and why our nation’s mandatory minimum laws need reform (with suggestions about how to reform the laws without letting the guilty get away with their crimes unpunished).”

These next two books are on my reading list for 2014 as they were recommended by other correctional health professionals. Want to read them with me this year?

The Prison Angel: Mother Antonia’s Journey from Beverly Hills to a Life of Service in a Mexican Jail

Mother Antonia recently passed on and her work was the topic of the December 2013 News Round-Up Podcast. Her work and sacrifice sound amazing. Here is a description from Amazon:

“The winners of the 2003 Pulitzer Prize for international reporting tell the astonishing story of Mary Clarke. At the age of fifty, Clarke left her comfortable life in suburban Los Angeles to follow a spiritual calling to care for the prisoners in one of Mexico’s most notorious jails. She actually moved into a cell to live among drug king pins and petty thieves. She has led many of them through profound spiritual transformations in which they turned away from their lives of crime, and has deeply touched the lives of all who have witnessed the depth of her compassion.”

Maximum Insecurity

This books sounds like an insider view of what we do. Here is the Amazon description:

“After three decades as a successful ear surgeon, William Wright, MD is bored beyond belief. He dabbles with retirement, but finds idleness infuriating. He has to do something.

Then he sees an ad for a doctor’s position from the Colorado Department of Corrections at a supermax prison. Now that, he thinks, would be different. His wife has some thoughts on the matter too. She thinks her husband just lost his mind and is on a collision course with a prison shiv.

Told with self-depreciating humor and scathing wit, Maximum Insecurity describes Dr. Wright’s adventures practicing medicine in a supermax correctional facility without, he’s glad to say, getting killed even once.”

So, what are you reading for fun and profit this year? Share your picks in the comments section of this post.

Planning for the New Year: December 2013 Reader Survey Results

By Lorry Schoenly, PhD, RN 5 Comments

Thanks to everyone who participated in last month’s first-ever reader’s survey. The results are in and they will help us plan a fantastic 2014.

Who is Reading CorrectionalNurse.Net?

The majority of readers participating in this survey have been working in corrections for over 5 years and are either a staff nurse or a nurse manager.

Most of you visit the site weekly and you expect to continue to read the blog in 2014. You mostly read the weekly postings but the resources are also highly valued.

Most Surprising Finding

As an educator, it was delightful to see comments from several respondents about using the blog material and podcasts for staff meetings and monthly education. I hadn’t considered that use and want to encourage more of it. Corrections specific nursing content is scarce so providing content for educational purposes is a great value add.

What You Want More Of

Participants were asked to suggest topics for future posts. Here are the topics most often suggested:

Current legal challenges and cases
Ethical cases
Relationships with custody staff
Staying safe in a dangerous environment
Drug abuse and withdrawal
Documentation Pitfalls

Changes and Updates in the Year Ahead

To make this blog more useful and a good investment of your time, I am planning on the following changes and updates in 2014.

Brand New Look with More Functionality: It has been almost 2 years since the blog had a face lift. We will be upgrading the site in early 2014 with added functionality and easier mobile access.

Encourage More Interaction: One thing I learned from this survey is how much wisdom we have in our regular readers. Besides being an information source, CorrectionalNurse.Net needs to also be a place where nurses from jails and prisons around the country can come together as a community for mutual support. With this in mind, a members-only section will be started later this year with forums and additional information so we can interact and exchange information.

The CorrectionalNurse.Net CE Store: CorrectionalNurse.Net recently became accredited to provide Nursing CE through the California Board of Registered Nursing. Stay tuned for corrections-specific continuing education offerings available this year in text, audio, and video formats.

Monthly Newsletter: CorrectionalNurse.Net will offer a free monthly newsletter starting this spring. The newsletter will highlight recent blog posts and news items, while offering exclusive information not posted on the blog.

So, what do you think of the results of our first reader’s survey and the direction we are going in 2014? Share your ideas in the comments section of this post.

December 2013 News Round-Up (podcast)

By Lorry Schoenly, PhD, RN Leave a Comment

Podcast: Play in new window | Download

Regular panelists Johnnie Lambert, Mari Knight, and Margaret Collatt help us close out the year with discussion of December 2013 correctional healthcare news. Let’s roll……

Story #1: Eye Care Rare Among Low Income Diabetics – Implications for Correctional Nursing?

Our first story, while not specifically about correctional healthcare has a very real connection for our consideration. A Reuter’s news story reports on a study finding that young low-income diabetics are not attending to their eyes. Our inmate population fits this profile – young, low-income and often diabetic. Are their implications for our patient care here?

Story #2: Psychiatrist Shortages in Corrections?

Our next story is from the California Prison System. California Healthline reports that the state prison hospital has had to cut services and reduce admissions due to a psychiatrist shortage.

Story #3: Orange is the New Black and Women’s Prisons Portrayal

Story #3 from the Washington Post lauds the Netflix series ‘Orange is the New Black’ as a fairly accurate portrayal of a women’s prison. Do you think having a program based on a women’s prison might be helpful in raising awareness of incarcerated women and their plight?

Story #4: Mother Antonia Passes

Our final news item is the sad report that Mother Antonia Brenner has passed on. She was dubbed the Prison Angel for her work with the poor and imprisoned in Tijuana, Mexico. She has an amazing story. Her prison worked grew from her charity work among the poor in California where she was a twice divorced mother of eight children. Eventually she moved into a cell in the Tijuana Prison to more fully experience the lives of those she served. Hers is an inspiring story of kindness and sacrifice.

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

Christmas is About the Children

By Lorry Schoenly, PhD, RN 3 Comments

With my grandson nearly 3 years old, our Christmas this year is full of toys and wonder and a reminder of the Babe long ago who brought hope to the world; whose birth we are celebrating. Christmas is definitely a time for children and a reminder of how many children have parents behind bars in our country. These young victims of their parent’s crimes suffer grave consequences, including separation from their parents during the holiday season.

According to the Bureau of Justice, 1.75 million children have a parent in a state or federal prison this Christmas. Many inmates have multiple children and the Sentencing Project estimates that 1 in every 50 children in this country has a parent behind bars. These are sobering numbers amid the lights and glitter of our holiday celebrating.

Children in this situation may be lonely and feel alienated from the season’s festivities. Even if able, visiting a parent in prison during this time of year can bring more sadness than cheer; emphasizing the obvious separation. Distance and lack of financial resources may make visiting impossible and incarcerated parents may be unable to afford providing even a token gift for a child.

If the incarcerated parent is also the primary care provider, the child may be living in foster care. More fortunate children may have a loving extended family member willing to provide support and supervision during this period. According to an economic study of incarcerated families, children with incarcerated parents are more likely to have difficulty in school with more aggressive behavior noted among boys and an increased chance of being expelled or suspended.

Most of us will not be able to make as great an impact as 2012 Miss America, Lauren Kaeppeler, who is using her platform to bring more attention to the plight of kids of incarcerated parents. Her father was incarcerated when she was a teenager and she has first-hand experience of the effects of a parent behind bars. However, every one of us can do something. Here are just a few of the organizations that are helping our patient’s children cope with the impact of prison on their lives. This Christmas season, consider contributing to one of these charities, or another you may be aware of in your community:

Prison Fellowship: Angel Tree

Camp Spaulding – New Hampshire

Children of Promise – New York City

New Hope – Oklahoma

Does your facility do anything for inmates and their children on Christmas? Could they? Share your thoughts in the comments section of this post.

Vicarious Traumatization in Correctional Nursing (podcast)

By Lorry Schoenly, PhD, RN Leave a Comment

Podcast: Play in new window | Download

Have you ever felt traumatized at the end of your work day? Maybe you have gone through periods of feeling very burned out in your nursing practice. In this episode I talk with Tanya Munger about her research into vicarious traumatization of correctional nurses. She surveyed correctional nurses from around the country about their experiences with this phenomenon. Tanya Munger, MSN, FNP-BC, CNOR, CCHP, is Clinical Instructor, Department of Health Systems Science, UI College of Nursing at Rockford, IL. She worked as a nurse practitioner with UIC College of Medicine inside of the Winnebago County Jail, the second largest county jail in the state of Illinois.

What is vicarious trauma?

Vicarious trauma is the result of taking on and absorbing disturbing aspects of the traumatic experiences of others, such as our patients. As correctional nurses we work in a harsh system among patients who often have very painful background full of violence and abuse. Regular contact can result in integration of this post-traumatic stress into our own functioning resulting in a variety of alarming symptoms such as flashbacks, nightmares, intrusive thoughts, depression, and sleeplessness.

What can you do about vicarious trauma?

What should you do if you think you are absorbing the traumatic experiences of others? First, be aware of this possibility and monitor yourself. Be sure to take care of yourself, getting enough rest, health food and activity. Traumatic stress can get you off balance and it might take conscious effort to return to a balanced lifestyle. Find ways to separate yourself from your patient. Remind yourself that this is not your pain. You may be holding it or helping with it, but it is not you. Look for small and large ways to renew yourself. Do what works – which can be different for everyone. Meditation, deep breathing, yoga, creative arts are some small regular options. Larger ways might be taking a real vacation away from your worksite to totally unplug, drain your stress, and re-center yourself. Certainly, if you are experiencing serious or debilitating symptoms, it is time to seek help through counseling or healthcare services. Read more about this condition from the resource links below.

Resources

Burnout, vicarious traumatization and its prevention

For Professionals: Vicarious Trauma

Announcements – Reader Survey

Did you know CorrectionalNurse.Net is running a first-ever reader survey for the month of December? Take the survey and give your input on what you want more of in posts and resources for 2014.

Correctional Nurse . Net

Inspiring Professional Correctional Nursing Practice

Scope and Standards: Prevalence of Correctional Nurses

Nurse Perceptions of Correctional Health Care (podcast)

What’s Bugging You? Lice Identification and Treatment

Scope and Standards: New Definition of Correctional Nursing

A New Year Reading List

Planning for the New Year: December 2013 Reader Survey Results

Top Six Posts of 2013

December 2013 News Round-Up (podcast)

Christmas is About the Children

Vicarious Traumatization in Correctional Nursing (podcast)

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