One reason correctional nursing is a specialty is that we deal with a unique patient population. We need to know how to work with inmate patients. Many of our inmate patients have lived much of their lives on the margins of society. These individuals have learned to deal with life, many times, through manipulation and deceit. Like an illusionist, they can distract and divert attention while accomplishing their goal. This is the first of a series of post explaining some common inmate tactics to obtain secondary gain in their interactions with healthcare staff. The challenge is to be ever alert to the potential for manipulation in the nurse-patient relationship without becoming jaded or cynical in dealing with our patient population. For more on maintaining a good nursing perspective in corrections, check out this Correctional Nursing Today podcast.
How to Work with Inmate-Patients Part 1: Be Alert for the Con
Tactics used by inmates to gain an advantage with correctional nursing staff:
- Flattery – Simple statements like “You look good today” or “You are the only nurse who knows what to do around here” flatter the nurse and create a relationship.
- Empathy/Sympathy– The patient seeks to establish an identity that is ‘just like you’ by making empathetic comments about the work experience like “I know what you are going through. I used to have a very stressful job.”
- Helplessness – Once a relationship is established, a request for help, other than appropriate healthcare, may result. Examples could include mailing a letter, gaining access to other resources, or bringing in information about a community program. These requests sound innocent, but are intended to have the nurse break some type of facility rule.
- Sensitivity – A patient can begin to show personal sensitivity to the nurse’s condition. This may also be a ploy to create a wedge between the nurse and other staff members. “I can see how the other nurses are treating you. You deserve better.”
- Confidentially – The patient shares a secret with a nurse that may be inconsequential or even inaccurate but moves further into an intimate relationship and creates a bond. An example might be, “I overheard Officer Jones ask Nurse Smith for a date.”
- Isolation and Protection – Rumor and innuendo could be shared that can lead to isolation, such as sharing that the other staff members are talking about the nurse. The patient might indicate they ‘stood up for you’ and protected the nurse. “I told them you were the best nurse ever and they shouldn’t talk about you like that.”
- Touching – If the verbal relationship moves along well, physical contact can start. An innocent-appearing brush of hands, tap on shoulder or body bump, if not immediately addressed, will progress to further and more frequent physical contact.
- Sexual Innuendo – If touching is not addressed immediately it gives the impression that it is ‘OK’ and sexual innuendo will follow. At this point, the nurse may be pressed for sexual favors.
- Coercion and Intimidation – Once a nurse has bent rules with or for an inmate-patient, coercion and intimidation can follow quickly. A nurse might be told to bring in contraband or break security rules. If refused, the inmate will threaten to reveal to the authorities the prior, more innocent actions taken. At this point the nurse has been ‘hooked’ by the con game and can feel trapped.
As can be seen from this list, a progression of action can take place over multiple interactions and leads to a nurse falling into the power and influence of an inmate-patient. If you see this happening to yourself or a fellow staff member, act immediately to break the progress. Stop before it gets worse. An inmate is not your friend; an inmate is your patient.
Have you seen this happen to you or a colleague? Share your inmate experiences in the comments section of this post.
Information in this series comes from a presentation given by Lori Roscoe, DNP, APRN, CCHP-RN at the Nursing Forum of the 2012 National Conference of the American Correctional Health Services Association (ACHSA). Dr. Roscoe is the principal of Correctional HealthCare Consultants LLC and The Correctional Nurse, LLC and offers accredited continuing education for correctional nurses at her website The Correctional Nurse Educator.
Photo Credit: © kikkerdirk – Fotolia.com
If you like this post, you might like
How to Work with Inmate-Patients Part 2: Are You A Target?
How to Work with Inmate-Patients Part 3: Watch for These Techniques
How to Work with Inmate-Patients Part 4: Protecting Yourself
Tracy Higginboth says
Although I have never worked in the correctional setting, I see this type of behavior occur in the psychiatric setting. I’m a novice nurse but it did not take me long at all to identify staff manipulations. I never ever treat any client different than another. It will ALWAYS be misconstrued, and it’s never therapeutic.
Lorry Schoenly says
Great advice, Tracy! Yes, this information can apply to other patient populations. Lots of intersects between corrections and mental health.
I’ve seen these behaviors over and over. Many lead to the classic overfamiliarization on the nurse’s side of the formula and many fall for it. One time (at band camp…LOL!), I saw a nurse sitting on an inmate’s bed speaking to him. When I arrived to the inmates cell, the nurse switched from speaking English to Spanish and continued talking to the inmate knowing that I don’t speak Spanish. The inmate was the shot-caller for that specific unit, so the nurse and I had a very serious talk about it. A few weeks later the very same nurse was terminated for several instances of overfamiliarization. I found out later that her boyfriend was a parolee.
Inmates have made so many attempts to manipulate the nurses, we just made a game of it. We would pick a topic to talk about for our shift knowing that inmate workers would be listening; like our football team for today will be the Washington Redskins. The next day, the inmate workers would be saying how great the Washington Redskins are and that is their favorite team.
Soooo many nurses fall for the, “You’re the best nurse here routine”, or ,”You’re the only one that cares” routine. If one take their job seriously, an inmate’s opinion of how one does their job is of little consequence, although; it is the very first sign of the manipulation red flag if you find yourself being flattered by an inmate.
If you’ve been in corrections, even for a short time, you know that when an inmate says, “HI! How are you?”, etc, that it’s a good time to put your head on a swivel because they are most likely just trying to distract you so they can meet some other goal. It’s just classic, but we all know that something is up.
I continue to advocate for inmate patients, but I don’t fall prey to the manipulation. It can wear you down some days, but you have to keep on your toes.
These days, I work with juveniles in a correctional setting. I like to say that in juvenile hall the only problems we have are “minor” problems. LOL! (minor’s = juveniles….get it.)
Take care and be safe!
Lorry Schoenly says
Awesome insights, Ray! Thanks for sharing your experiences. We all need regular reminders about these things.
I have only just come foward to my work yesterday. after reading this stuff it all makes sense and i feel sickened that this has happened to me. I have always been friendly in nature and treat my prisoners with respect I am empathetic and listen to their stories. However, this one prisoner asked me “do you want to take it further if i am on the outside” i infomed him NO and he felt by ass and grabbed him towards me and told me that if i said anything “my job would be a gonner” i have had sleepless nights over it and job performance is at an all time low. I finally told someone yesterday and even though they were thankful i was ended up to feel guilty that i didn’t report it sooner. worse feeling ever…
I was meant to say in that comment he grabbed me towards him….
Lorry Schoenly says
Thank you for sharing your difficult journey, Jenna. You must feel violated and victimized. It will be hard not to be jaded and cynical in your outlook toward other inmates. You did the right thing in reporting the situation. Focus on your inner strength to overcome this. Don’t let the actions of one person mar your beauty or your nursing practice. If possible, have the inmate brought up on charges and have your assignment changed, although that isn’t always possible in a small facility.
I am so glad I found this site. I am not a nurse but a Social Worker in a facility. I can see how things progress. I am going to share your tips with coworkers who are new to corrections. Its sad how inmates run these games up on people who work there to try and help them.
Lorry Schoenly says
Welcome, Beth! Yes, please do share any information you find here. Much applies to your work, as well. It is a difficult field but can be quite rewarding. Hope you stop by and share your experiences often…
Thank you for these articles in the series. I am also not a nurse, but am a physical therapist and just accepted a position at a prison. I’m trying to prep myself for the best protection. I was under the impression that as a PT, we would have a c.o. present in the room or just outside–could be wrong there. But are there ever incidents where the c.o. is in on the game and causes issues for the health professional?