All nurses need to be concerned about legal risk in their nursing career no matter the specialty. Correctional nurses, however, have some specific areas of concern based on our unique setting and patient population.

Because correctional nurses work in a custody environment designed to maintain security and order rather than for providing healthcare, conflict can occur between the goals of custody and the therapeutic goals of nursing care. When issues arise, correctional nurses must advocate for necessary care and seek higher authority if barriers to delivering care emerge. Patient advocacy, a prime professional nursing role, is of particular importance in corrections.

In addition, working in a custody environment can lead to a jaded or cynical view of the health concerns of incarcerated persons. Correctional nurses can begin to assume that all patients are looking for a secondary gain from any health care encounter. This attitude can lead to the ignoring of significant signs and symptoms with potentially adverse outcomes. Thus, it is vitally important that correctional nurses self-reflect, identify any such attitudes, and remediate.

Situations involving forced medication administration, suicide assessments, substance withdrawal, evaluation post use of force and body cavity searches can also put nurses into legal jeopardy. What should a correctional nurse do to reduce legal risks?

Reducing Legal Risk

• Know Your Nurse Practice Act: Nurses working in corrections, especially smaller facilities, may be asked to perform functions outside the scope of practice for their license. This can be due to a lack of understanding of healthcare licensure by custody staff or administration making the request. Be sure YOU know what you can and can’t do by virtue of your licensure and always adhere to your scope of practice.
• Follow Policy and Procedure: Know your role in the various situations that you encounter, especially for the risky situations listed above. For example, if you are asked to review a medical record to clear a patient for the use of pepper spray, do you know what Health conditions are contraindicated? Does your policy and procedure indicate this is an appropriate role for you?
• Document Effectively: All important actions and assessments must be documented in the health record. In the pepper spray example above, the nurse should document the review of record and his/her/their findings. Be aware of all standard forms for various assessments and watches. Initiate forms as appropriate and use them correctly. If a form requires sign-off by another care provider (RN or Provider), make sure that individual is alerted to sign the form.
• Use the Chain of Command: If you are asked to perform an assessment or intervention beyond your licensure, know the chain of command to follow. Communicate your concerns immediately to your supervisor.

By following these recommendations, you can significantly reduce your legal risk in your correctional nursing practice.

What recommendations do you have to protect your practice from legal risk? Use the comments section to share your advice with your colleagues.