“It’s not what you look at that matters, it’s what you see” – Thoreau
I have been practicing in correctional healthcare for the last 25 years, and the issue of whether correctional nurses care for patients or inmates has been around for at least that long! I have heard nurses say that their correctional officer colleagues get “upset” when they hear the inmates being called patients. I have seen nurses documenting their care of the “inmate,” “client,” “resident,” “inmate-patient,” and “patient” in the health records that I audit. This topic was also debated for quite some time during both the 2013 workgroup meetings that edited our Correctional Nurse: Scope and Standards of Practice, 2nd edition and our third edition workgroup meetings in 2019 (which should be available on October 1, 2020). In the workgroups, there were individuals who represented all types of correctional healthcare programs (jail, prison, community, juvenile; county, state and federal; self-op, public partnerships and private contractors….) and academia, and it was very enlightening to consider the topic from the different perspectives. I learned through that process that correctional nurses do have support for our patient advocacy role from many of our correctional colleagues, but definitely not all, and we must continue to educate them and advocate for our patients. [We ultimately decided to use the term “patient” when discussing correctional nursing practice and use the term “inmate” when discussing the population (in general) with whom we work.]
I have heard comments in meetings and at national conferences stating that what we call the individuals for whom we provide nursing care is unimportant, and even irrelevant, as long as we are abiding by our scope of practice and are providing appropriate care. However, please consider this: When you look at your patient in a health care encounter, which do you see?
A criminal who happens to need health care?
A patient who happens to have broken the law?
I would suggest that your perspective about the person for whom you are caring has everything to do with your professional nursing practice in the correctional setting.
Focus of Nursing Practice
Nursing practice in inherently patient-centered, and as such, our professional values call us to seek the health and well-being of our patients. Our primary commitment, in fact, is to our patients. A patient perspective in correctional nursing practice, then, sets us squarely on a solid foundation clinically, ethically, and legally. The right to health care is universal and transcends all individual differences (Code of Ethics 1.1). In particular, a patient’s social status and lifestyle choices cannot be considered in our provision of nursing care.
On the other hand, seeing the person receiving nursing care as an inmate is inherently custody-centric. Rather than focusing our intentions to seek health and well-being for the individual, as our professional values demand, this inmate perspective can leave us in a defensive position or in an exchange relationship that can be both dehumanizing and depersonalizing. An inmate perspective does take into consideration the social status and lifestyle choices of our patients, which then become factors in our care decisions. Doing so makes our practice in conflict with nursing standards and nursing ethics.
The Nurse-Patient Relationship
The basis of every nurse-patient relationship is therapeutic. Our patient’s needs are primary in this relationship. In a correctional setting, a patient’s health needs can be overshadowed and even ignored by the correctional system. Nurses must engage in collaborative dialog to advocate for a patient’s health and well-being, especially when the correctional culture may not always consider the incarcerated individual’s health needs.
While a patient perspective is likely to lead to necessary patient advocacy, an inmate perspective blurs this focus and can align nurses with a punitive or merely disinterested perspective toward an individual patient and the patient population as a whole. In addition, mutual respect within the nurse-patient relationship is threatened when the patient is viewed as having less societal value, human rights, or inherent dignity.
Correctional nurses dealing with pressure to call their patients inmates have an opportunity to inform and educate their correctional colleagues about professional nursing practice. While our practice setting is a unique environment with a unique patient population, the foundational principles of nursing practice and nursing values remain unchanged in the correctional setting and for correctional nursing practice.
SO, DO WE CARE FOR PATIENTS OR INMATES?
What do you think? Regardless of the correctional setting in which you work, as part of your professional practice it is very important that you think about this, and make your decision from your nursing and personal standards and ethics. Then, if challenged about the term you use for the individuals for whom you care (whether you choose patient or inmate, or something else), you will be prepared to answer as a correctional nurse, with confidence and forethought.
I would love to hear your thoughts about this topic – Please use the comments section of this post to share them.
Patti Henning, RN says
When I entered correctional nursing recently, I followed suit of previous nurses when documenting by referring to the ones I provided care for as “inmates”. I found myself, however, occasionally writing “patient”, probably more out of habit than for any other reason. “Inmate” just sounds so uncaring and uncompassionate, not how I view myself or the care that I give.
Thank you for this article and letting me know that it is alright to write or say “patient”.
Deborah Shelton, PhD, RN, NE-BC, CCHP, FAAN says
Thank you for the great discussion. The individual I care for and advocate for is a patient and a person.
Jaime Shimkus says
Thank you for your well-reasoned perspective on an important topic, Dr. Roscoe. I too have closely followed this issue since entering the field 20 years ago. The evolution has been slow, but moving in the right direction.
Charles Lee says
The issue is not how the officers react when you call them patients, the issue is that they ARE patients. Keep calling them patients; the officers will “get over it”
jailaid says
Most prisoners are exposed to little to no healthcare treatment in most correctional facilities. If they have a correctional nurse within the premise, they realize its importance and appreciate the attention and care they get from them. Correctional nurses are heroes!
Sue Smith says
I had similar issues with COs when I first started working in the Ohio prison system. I also had the privilege of being the primary nurse to deliver inservice education to our facility staff. I started including education about how nurses function and what their standards of care include. Between this annual educational opportunity and my day to day interactions with COs, they gradually accepted my way of doing things – some of them even respected it. COs are intelligent enough and flexible enough to understand differing perspectives.
Lori Roscoe says
Thanks Sue for your shared experience and insight!
Alison O Jordan, LCSW says
Thank you for this. I’m a champion of Person first language. Patient, person incarcerated. I’d suggest one cannot have a fully productive therapeutic relationship as a health care provider if you adopt the language of corrections. That said it is challenging when all you hear all day is “inmate”. Definitely worth asking.
Tim Thomas says
As a correctional nurse, my role is not to punish the inmate. My role is to care for my patients. Person first language is so important here, and unfortunately I have seen the negative impact of viewing our patients as inmates. This has to stop now. We need to adopt the Mandela Principles.
Cheryl P says
I pride myself in “Treating the patient, NOT the prisoner!” My concern is not why this person is in law enforcement’s custody, it is to render medical care.
Lori Roscoe says
Tim – Thank you so much for your comments. I admit that I was not familiar with the name “Mandela Principles” and did look them up today. I think they will make a great blog post for the future! Thank you for sharing your knowledge, and increasing mine!
Stacy says
This was a very interesting read & a topic that needs reform on a much deeper scale. I found myself in a local county jail on a probation violation for 11 days. The power went out the day before Thanksgiving & the jail was put on lockdown so I wasn’t able to see a judge until Monday. I was housed in the infirmary for severe dehydration, I was vomiting black liquid, & I didn’t eat for the 11 day stay. I have never been treated so poorly. I actually had a nurse tell me I would lay there & die before they sent me out to the hospital. The entire nursing staff was horrible to not just me but to everyone. I imagine they lose their sense of compassion, their ability to care, or just get burned out. I feel there is no excuse or any reason to treat “inmates” with such a poor standard of care. I’m not exaggerating, I have never seen anything like the hatred I seen from nursing staff leveled at inmates. My point is not everyone in jail is a hardened criminal & at a very minimum “inmates” are human beings first and should be treated as such.