Providing health care to incarcerated patients is different than other types of nursing practice; yet nursing principles remain the same. Nurses entering the world of correctional practice can have apprehensions and misconceptions about the patient population and expectations of their practice. Here is an overview of the similarities and differences of correctional nursing practice as compared to a traditional practice setting.

A Different Patient Profile

The incarcerated patient population has several distinct characteristics to keep in mind when providing care. While each patient is an individual, the population, as a whole, is likely to have these characteristics that should be taken into consideration when providing care.

• Incarcerated persons have a biological age older than their chronological ages. Many experts consider the incarcerated patient to be ten years older than their chronologic age when it comes to the effects of age and illness. So, many correctional settings consider elderly inmates to be 55 years and older.
• Less educated and less health-literate than the general population, incarcerated persons are more likely to have learning disabilities and have difficulty understanding basic health information.
• More infectious disease, especially HIV, Hepatitis C, sexually transmitted disease, and tuberculosis are found in this patient population.
• Incarcerated persons have higher rates of mental illness than the general public, especially depression, mania, and psychotic disorders. Mental illness can contribute to criminality. Borderline personality disorders that lead to poor impulse control, self-injury, and aggression are also often present.
• This patient population has higher rates of traumatic brain injury and post-traumatic stress disorder that can also lead to poor impulse control, erratic behavior, and inability to concentrate or understand health instruction.
• High levels of drug, alcohol, and tobacco use in this population increase the likelihood of withdrawal issues, liver toxicity, and respiratory conditions.
• Increased risk of suicide is found in this patient population as compared to the general population. This is a concern in any stage of the incarceration, but especially of concern at admission to the jail, after a court appearance, and after sentencing, when hopelessness, shame, and guilt are at their highest.

The Same Nursing Care

Nurses working at a correctional facility as a licensed professional are expected to provide safe patient care in accordance with that license. This can be challenging in settings where the boundaries of their nursing scope of practice are not clearly defined. Many traditional practice settings are focused only on providing health care and have a strong nursing leadership structure that defines nursing practice within the boundaries of the nurse practice act. Correctional Nurses, however, may need to establish their own boundaries of practice, possibly for the first time in their professional career. Three important documents provide resources for establishing practice boundaries.

• The Nurse Practice Act: Established by the nurse licensing board for the practice jurisdiction (mainly the state of licensure)
• Code of Ethics for Nurses: Established and periodically revised by the American Nurses Association and the International Council of Nurses
• The Correctional Nurse: Scope and Standards of Practice: Established by the ANA and periodically revised by a Correctional Nurse expert workgroup under the auspices of the American Nurses Association. The third edition was published in 2020.

Nurses are ethically and legally bound to practice within the framework of the profession in every setting. Nurses working in corrections must be fully aware of these boundaries as there are fewer safeguards present in our setting and they must advocate for themselves and their colleagues if presented with a situation where the actions requested exceed their scope of practice.

A Re-Focused Nursing Perspective

While correctional nurses must practice within the boundaries and responsibilities of licensure, the nursing perspective must be refocused to accommodate a secure setting and an incarcerated patient population. That means a re-focus of care provision to prioritize personal and professional safety.

The first area of refocus is the nurse-patient relationship. Although this relationship continues to be based on the health and well-being of the patient, the relationship in the correctional setting must include stronger physical, emotional, and mental boundaries. Caring behaviors cannot include physical touch, as may have been the case in prior nursing positions. Words and actions establish a caring relationship in this setting, not hand-holding, touch, or a shoulder squeeze. The presence of narcissistic and manipulative personalities within the incarcerated population means that nurses must be especially careful to avoid being drawn into an inappropriate patient relationship.

Personal safety is the next area of refocus for correctional nurses. Personal harm from patients is of concern when practicing in the criminal justice system, although this is now true of our nursing colleagues in other areas, like the emergency department. Always be alert when in the work environment. This means being aware of the location of officers and following all facility safety policies and procedures. In a correctional setting, personal safety is of higher priority than immediate emergency care. Thus, correctional nurses must be sure the environment is cleared by officers before entering the area to provide treatment in an emergency situation, such as an unconscious patient in a housing unit.

The final area of practice re-focus is professional safety. As described earlier, it can be tempting to practice beyond licensure in an isolated and resource-challenged setting such as a jail or prison. It can also be easy to slide into a cynical and jaded attitude toward patient requests when some may be manipulating the system for their own benefit. Yet overstepping the bounds of licensure or disregarding patient health requests can jeopardize your career and create significant legal risk.

What is your advice for nurses new to the specialty of correctional nursing? Do you have tips to share about caring for incarcerated persons? Use the comments section to add your advice.