I am trying to remember the first time I came across the advice to be firm, fair, and consistent with inmate patients. It may have been during my orientation for my first position in corrections. While the terms are used in correctional officer, manager, and education literature, I have not seen these golden principles in the nursing literature on patient interactions. More often, nurses come to the correctional setting with communication training based on principles of respect, empathy, and unconditional positive regard. While these principles should also be engaged in a correctional setting, they need to be tempered with “tough love” to be successful with a patient population living in an environment that can require cunning and deception for survival.
If you are new to correctional nursing, you may need to develop application skills for the three golden principles of dealing with inmates. If you are an ‘old hand’ at working in a correctional setting, these principles may have become a cliché. Either way, here are some reminders of just what firm, fair, and consistent really mean.
Firm
Being firm does not necessarily mean being rigid or stern. Instead, being firm with inmate patients means being resolute to follow the rules and expect your patient to do the same. It also means not being persuaded or intimidated by a patient to disregard standard procedure or do favors for them. Some incarcerated patients pursue staff who are people pleasers and seek to sway them to do their bidding. These patients typically back off when staff members are firm in their presentation, demeanor, and conversation. In addition, in the long run, staff who are firm gain the respect of both patients and officers they work with.
Fair
Just as being firm does not mean being rigid, being fair does not mean treating every patient exactly the same. Instead, being fair means not making assumptions about a patient because he or she is a prisoner. Each patient should be treated with the same objectivity when they arrive in the medical unit. Fairness also means treating inmates with civility and respect no matter their crime, security level, behavior, or other characteristics. While fairly treating patients is required in every nursing specialty, it can be a challenge when your patient is incarcerated for particularly heinous crimes such as murder, rape, or child abuse.
Consistent
The final principle in this trio is consistency. Depending on your personality, consistency can be easy or tough. Unlike an acute care setting where patients move in and out of our work lives, a jail or prison can be more like a residential setting where our patients are a continual part of day-to-day activities. Inconsistent staff behavior can cause anxiety and uncertainty among patients. Predatory patients see labile staff emotions or behaviors as an opportunity to engineer a situation to their advantage. Too much drama in a medical unit can have repercussions throughout the facility.
Being firm, fair, and consistent has been described by one correctional expert as basically living out the Golden Rule; that is, treat others as you would like to be treated. That is probably why the phrase firm, fair, and consistent has stood the test of time as golden principles for dealing with incarcerated patients.
So, how about you? Have you heard of the three golden principles? Do you have a story about how you use them in your correctional nursing practice? Please share in the comments section of this post.
Cheralee says
We work in a small jail in a small town. Many of our patients know us personally outside of the jail (went to school with them, parent was their teacher, neighbors, friends, and family). This can be very difficult knowing we must keep a professional attitude with them knowing we are always being watched. We are watched on camera as well as the inmates phone calls and letters monitored. There have been investigations where an inmate referred to an officer several times and therefore causing admin to be concerned. It can be very challenging treating these inmates with constant concern that any actions could be deemed “special”.
Lorry Schoenly says
I have always thought that the toughest correctional gig was small jail small town. Thanks for your comment, Cheralee!
Laura MacQueen says
About a month ago we had an inmate (young and healthy looking) come in as a walk-in with vague complaints of headache, dizziness, nausea, and vomiting. Some of our staff make it known they thought he was a faker right off the bat, but a couple of us, including our nurse trainee who was assigned to him, sensed something was wrong. Thankfully she stood her ground and kept him in the treatment room for several hours. His vital and neuro signs had been normal all morning but abruptly and dramatically, his speech became very slow and slurred, and he could no longer perform the simple “touch your finger to your nose” test. He was sent to a local ER immediately. The diagnosis was Cerebellar Stroke. It is not an exaggeration to say that firm, fair, and consistent saved his life. Many of our staff would have sent him back to his cell house.
Lorry Schoenly says
Thanks for sharing this important story, Laura!
cmk2016 says
As a nursing student in the 1980’s, I recall hearing “Firm, fair, and consistent in my Mental Health rotation. I was a single Mom at the time and applied the principles to my teenage daughters with great success! There is a book “Psychiatric and Mental Health Nursing” By Ruth Elder, Katie Evans, Debra Nizette that goes into more detail about F,F,& C. It is a very good reference and supports the principles Lorry discussed. I personally apply them in just about ever situation I find myself stressed over like contractors, aging parents, and recidivism inmates.