This month continues our discussion of Correctional Nursing Practice and the Code of Ethics with Provision 5 – The nurse owes the same duty to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. Our discussion is based upon the latest ANA Code of Ethics with Interpretive statements.

Ray was an emergency trauma nurse before he started in a minimum security prison a week ago. This morning he is assigned to respond to man-down emergencies along with his preceptor, a registered nurse with 8 years of experience at the facility. When a man-down is called early in the shift, they head out to the yard with the emergency bag and a stretcher. When they arrive Ray sees officers lining up inmates along the fence and two men on the ground, not moving. He starts into the yard to assess and treat the injured but his preceptor holds him back. “We have to wait until the ‘All Clear’ is called before we can go in,” she told him. Ray cannot believe that he must wait for a non-medical person to determine whether he can go in and treat his patients, who clearly need assessment and perhaps even CPR. Isn’t his responsibility to the patients – to treat them as soon as possible? What if they stop breathing or bleed out while he stands by?

One of the earliest principles nurses learn when starting in correctional health care practice is that of ‘Safety First’. Unlike other settings, a correctional facility holds personal danger that must be considered at all times. Although the Code of Ethics for Nurses is patient-centered, since 2001 the Code has included Provision 5, an explicit statement about a nurse’s duty to self.

Although the provision is unchanged in the latest revision to the Code, our duty to self is more fully explained in the interpretive statements of this newest version. Here are the key areas of expanded information.

Nurses are Persons of Worth and Dignity

Nursing is intensively other-focused. It is easy to lose sight of our need to preserve our own self-identity as a person of worth and dignity. In order to most effectively care for others, we must attend to our own psychological and emotional well-being. For correctional nurses, this can mean being aware of personal boundaries with patients; guarding against secondary traumatization and compassion fatigue; and avoiding unhealthy work relationships.

Personal Health, Safety, and Well-Being is an Ethical Mandate

Physical safety is as ethically important as psychological and emotional safety in nursing practice. Nurses in all settings routinely pause to don protective gear or wait for help when having to lift equipment to prevent physical injury. These same moral principles apply in a situation where correctional nurses must wait for indication from officers that an emergency scene is secure before initiating care.

Conscientious Objection to Remain Whole

The Code of Ethics further articulates and expands the need for preservation of moral integrity by describing the concept of conscientious objection as a refusal to participate in morally distressing activities. This could include actions that jeopardize a specific patient, family, community or population. Conscientious objection may be necessary when nurses are asked to take part in morally problematic activities such as force-feeding prisoners on hunger strike or participating in the collection of forensic evidence. Deeper discussion of this concept in the Code provides nurses with a better understanding of how to preserve their moral integrity in the face of a clinical situation for which they have strong moral grounds for objection.

Personal Growth is More than Professional Growth

A refreshing inclusion to the interpretive statement for Provision 5 is the addition of continuation of personal growth. Professional growth has always been a moral requirement for nurses, since advances in healthcare and the changing work environment make continuing professional development a necessity. But in addition, the Code encourages nurses to grow personally through life-long learning, reading broadly, pursuing leisure and recreational activities, and engaging in civic activities and social advocacy. A well-rounded nurse is more able to meet the continuing stresses of professional life.

The unique patient population and unusual practice environment of correctional nursing calls for specialized interpretation and application of the Code for Nurses. Ray needs to reflect on the Code as it relates to practice in the criminal justice system. A thoughtful review of Provision 5 will help him come to terms with the necessary personal safety perspective needed in a secure setting. Discussion of the man-down situation and applicable ethical principles with his preceptor might also generate meaningful dialog among other nursing team members as the situation is shared with them.

Do you think self-care is an important ethical principle for correctional nurses? Share your thoughts in the comments section of this post.