I was recently asked to validate that I was a “guest” in the correctional facility, and as such, no matter what, security had the final say in nursing practice.  I did not agree.  The integration of healthcare and security is vitally important to the provision of healthcare in correctional facilities, but there must be policies and procedures (and common practices) that mandate discussion of the healthcare need in question and how it will be best addressed in that facility.  Sometimes, there are general circumstances that can be directly addressed in the policies and procedures, but most often issues arise with the care of a particular patient, and so it is vitally important that the mechanism is set for discussion and resolution of the issue.  The National Commission on Correctional Health Care and the American Correctional Association have very straightforward standards stating that medical decisions are made by medical, and security does not override them.  In practice, communication and collaboration is key to providing appropriate healthcare to all patients.

The following guest post was written a few years ago by my good friend, Sue Smith, MSN, RN, CCHP-RN, who worked many years in the Ohio Department of Rehabilitation and Correction.  Her words continue to be applicable to correctional nursing today!

Maintaining a safe and secure environment is the primary mission of correctional facilities – not healthcare.  This means that the persons who hold nearly all of the power in correctional facilities are the security officers and administrators.  Practicing within the correctional environment means that correctional nurses must learn to cooperate and collaborate with the security staff.  Philosophical differences between the two disciplines can be very significant, especially with regard to treatment of incarcerated persons.  One of the most difficult practice adjustments correctional nurses must make is learning to work with security staff without sacrificing the nursing perspective. Making the adjustment in collaboration with security staff is often difficult, but it can be done. Correctional nurses need to be mindful of a few things:

• Security personnel are like most people – they have preconceived notions about how nurses behave and think.  Sometimes, correctional staff can be critical of nursing concepts like compassion and patient advocacy when displayed in the correctional setting, but they still do not like it when the nurse does not act “like a nurse” (as expected).  Role modeling expected nurse behavior may invite some teasing, but generally the security staff will have greater respect for the nurses.
• Mutual respect will go a long way to facilitate collaboration with security staff.  Correctional officers and administrators have a hard job.  Correctional nurses must recognize this and refrain from being overly critical or judgmental about security perspectives about incarcerated individuals – without sacrificing their nursing perspective.  Simply put – the words “please” and “thank you”, professional courtesy and consideration will help nurses collaborate with their security colleagues.
• Nurses must remember that the correctional environment is different than the hospital environment and can be inherently dangerous.  Thus, they must remember and be concerned with safety principles at all times so that they do not place themselves and their security colleagues in unnecessary danger.

What are your experiences with collaboration with our correctional officer colleagues? Share your insights in the comments section of this post.