In a prior post, we suggested a Correctional Nurse Manifesto with seven propositions. This post discusses the meaning and importance of the sixth proposition:

Correctional nurses speak up when they see degrading treatment of their patient population

Nurses working in jails and prisons can be witness to brutality and indecencies in the course of providing health care. The nature of the correctional environment and the natural adversarial roles of incarcerated individuals and correctional staff can lead to a pervasive culture of disrespect and indignity which is foreign to professional nursing practice. Over time, nurses can develop feelings of frustration, isolation, and disempowerment. Or, even worse, correctional nurses can be socialized toward a negative (punitive) orientation rather than maintaining a professional nursing orientation. Survival in a harsh environment can involve desensitization to harsh and impersonal treatment or even a culture of cruelty. Recent news stories highlight the result of nurses who have identified with and become socialized to a dysfunctional culture to the detriment of their patients and their own professional practice.

Crimes against Patients

In a California jail a patient died after being left alone after a nurse and an officer witnessed a head injury during a seizure.  In Ohio, a woman suffered a fatal brain hemorrhage and died after the nurse failed to contact a provider or send her to the emergency department when she blacked out, struck her head and had multiple episodes of seizures. Instead, she was sent back to her cell. In Oklahoma, a man died from pneumonia and sepsis. The allegations include that the nurse accused him of faking and threatened to have him restrained.

Nurses are called to make the health needs of their patients primary. Our professional code requires compassionate and respectful treatment of all patients without consideration of social standing or personal attributes. The Code of Ethics for Nurses also calls us to promote, advocate for and strive to protect the health, safety, and rights of our patients. How can we accomplish this in the correctional setting? We must speak up when we see ill treatment of our patient population in the course of our work in the correctional setting.

Silence is Not Golden

Avoiding conflict is common in the nursing profession. We are easily intimidated by those in power, whether they be the physician from whom we take patient care orders or the correctional officer in charge of a housing unit. We may be working in an unhealthy or even hostile work environment due to conflicting values among the various disciplines.

Yet, silence is deadly. In landmark work on the need to speak up in the traditional setting, less than 5% of surveyed staff were willing to confront a team member about abuse, disrespect, poor teamwork, or incompetence. How can we garner the courage to speak out when we see degrading treatment of our patients?

The Courage to Speak

Moral courage is the willingness to stand up for and act according to our professional values when they are being threatened. It is a skill that can be developed through intentional practice. Moral courage is necessary for successful correctional nursing practice. Often we are working in environments with a history of tolerance and indifference to the degrading treatment of others. Speaking up in the face of this work culture can be terrifying.

The following actions can help gather the courage needed to speak out against wrong treatment:

• Develop relationships within your work setting that allow you to speak up about how you are feeling about a difficult situation. It will be much easier to be heard in a critical situation if you have already developed a voice.
• Start small to develop your courage muscle. Speak up about small situations to practice for big ones. For example, mention rude behavior or harsh words immediately.
• Deal with the individual directly, and privately, before moving to engage management. Keep things local, when possible.
• If possible, have a suggestion for an alternative action to replace the ill treatment.
• Know the proper process for reporting unethical treatment before it happens. How do you activate the chain of command on your shift? Who do you call or what is your first step?
• Talk about important nursing values with like-minded colleagues. Be allies in supporting each other to ‘do the right thing’ in the face of a moral issue.

Correctional nurses have an opportunity to encourage an ethical culture by intervening when degrading treatment is witnessed. Each of us can be an instrument for good in the position we have within an organization. A single action can change a situation; can even save a life. We know this in the physiologic work we do every day. It is also true for the moral actions we take.

As a correctional nurse, you may be placed in a position requiring moral courage to respond. Will you be ready?

Have you seen degrading treatment of an inmate in your correctional nursing practice? Were you happy with your response? Would you do anything differently? Share your story in the comments section of this post.