Competent and appropriately credentialed healthcare staff, including ancillary staff, nurses, mental health staff, and providers,  are the mainstay of a safe health care program, inside and outside the walls. An essential element is the confirmation of credentials at the start of employment, followed by an initial evaluation of competence; an appropriate orientation, including  those areas identified as needing support; and an ongoing program to develop the competencies of all staff in the program.

Credentialing

Credentialing to evaluate the licensure and certification status of a potential staff member should be done prior to hiring. Licensing acts as a safety net for the patient, and is a legal requirement for many healthcare positions. Thus, procedures  must be in place to ensure that practitioners have a free and unencumbered license to practice in the position and in the geographic location of the facility (usually the state).

Professional boundaries of licensure differ among states, but not among health care settings within jurisdictions; therefore, a physician unable to practice in a traditional setting would also be unqualified to practice in a correctional setting. Indeed, the National Commission on Correctional Health Care  and the American Correctional Association accreditation standards require that the credential verification process includes inquiry regarding sanctions or disciplinary actions of state boards, employers, and the National Practitioner Data Bank.  Perhaps, the variability in scope of practice between states is most apparent in LPN/LVN licensure.  It is vitally important that both the individual nurse and the healthcare program know their state’s current Nurse Practice Act and Scope of Practice, and ensure that the expectations for the role of the LPN/LVN in their program stay within those boundaries.  These expectations (for all staff) should be articulated in a job description document that is acknowledged by both the staff member and the correctional healthcare program.

Initial Competency

Employers have a responsibility to ensure that new staff members are competent to practice; therefore, thorough and timely employee orientation practices are essential.  In addition, an on-boarding process that addresses the knowledge, skill, and attitude necessary for successful job performance ensures practice consistency and increases safety in healthcare delivery.  The orientation program should include elements of personal safety in the correctional environment, especially since many new staff members are also new to the correctional environment.

Ongoing Competency

In addition to the initial competency, the correctional healthcare program should have a process for evaluation, including peer review, and ongoing competency development. Peer review may be challenging for programs that have one provider or one nurse, but because it is so important, suggestions for implementation include working reciprocally with other programs of similar size. It is very helpful to do a needs assessment which will help determine the content areas for ongoing competency activities. Further, any policy and procedure or clinical system change requires that staff be educated, including the reason for the change, the components of the new process, and their role in its implementation.

Correctional healthcare programs that engage in credentialing, orientation, and ensuring initial and ongoing staff competency reduce their risk of clinical errors and protect their patients’ health.

Tell us about the orientation in your correctional healthcare program. What do you think about the correlation between staff training and patient safety?  Share your thoughts in the Comments section below.