Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.

Having a primary commitment to the patient means stepping up to collaborate with the healthcare team and other professionals to solve unmet health needs. This can be a dangerous minefield for nurses working in corrections. Consider this situation I discussed in a prior post on pregnant patients.

In Staten v. Lackawanna County (2008) a 6 months pregnant inmate complained of pressure in her pelvis. She was evaluated in the jail medical unit. The nurse determined she was not in active labor yet and the patient was relocated to a camera cell. Correctional officers did not respond to information from the patient that her water had broken and that the baby was crowning. The nurse did not continue to monitor the patient once she had left the jail medical unit. The baby was born in the cell.

Not Just Cooperation

In the case above, it appears that officers and nursing staff cooperated with each other. Collaboration, however, includes much more. As this HuffPost article points out, cooperation keeps us in our divided and defined areas of practice while collaboration weaves our work together toward a common goal. In a critical health situation like high-risk active labor, both disciplines need to work as a team to accomplish a positive outcome.

Collaboration includes the following components:

• Problem-focused: Solving problems goes beyond sharing information. It involves listening, negotiating, and coming to agreement on a course of action.
• Sharing: Collaboration involves sharing thoughts and actions toward solving a problem or issue. It also involves sharing power in the relationship; a concept that may be foreign in some correctional settings.
• Working together: By working together, nurses and officers can bring their own perspectives to an issue and come to a better solution than working separately. This requires cooperation and shared responsibility.

Mutuality a Necessity

Mutual goals among nurses and officers must be encouraged and nurtured. While each profession has a different role and perspective, officers and nurses have a common goal of safety. Officers keep inmates safe from themselves and others. Nurses also seek safety from harm, injury, and illness. The officers and nurses in the situation above were not working together toward keeping the mother and unborn baby safe.

Avoiding Fragmentation

Fragmentation of care, whether the lack of coordinated officer/nurse efforts or the disconnected communication among healthcare disciplines, is a huge issue in the correctional setting. Developing collaborative relationships in both these areas reduces fragmentation and improves patient outcomes.

Improving Collaboration

Improving collaboration takes deliberate action and willingness among participants to be successful. Sometimes an organization can leverage a catastrophic situation like the one described above to make improvements in communication, collaboration, and teamwork. Here are a few ways to do this.

• Role Awareness: Many officers misunderstand the nurse’s role and many nurses misunderstand the officer’s role. Usually, this results in simplification of the complexities of professional practice. While officers may think nurses are mere ‘pill vending machines’; nurses may see officers as merely ‘watchers’ or ‘enforcers’. These labels underestimate the professional nature of the other.
• Skill Development: Interpersonal relationships require mutual respect and trust. They also require good communication skills. These skills may need to be developed in key participants.
• Administrative Support: The hard work of improving collaboration will not happen without continual administrative support from all levels of leadership. Old patterns and attitudes quickly return without constant reinforcement of new behaviors.
• Action Projects: Once a foundation is created for collaborative relationships, skills can be developed through collaborative projects among the targeted disciplines. Quality improvement activities are a good way to facilitate the continued development of collaborative skills.

How about you? Share a story about a successful or challenging collaboration situation you have experienced in your correctional nursing practice.

Read other posts about the Code of Ethics here.