Self-Assured Nurses Thrive in Correctional Institution Practice
Tuesday October 9, 2001
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The Cook County Department of Cor-
rections houses more than 10,000 people on a daily basis. Since they have not been convicted, these people are considered pretrial detainees, and they maintain the right to receive healthcare.
When I tell people where I work, they look at me with surprise and empathy. Often they say, "That must be tough," or "How do you do that?" Working in corrections may seem frightening, but people don't realize nurses are accompanied by officers while delivering care and when walking from building to building or within the jail's divisions. On the living unit, detainees may be in the day room or in their cells, but officers are still present.
Correctional patients generally greet nurses with a level of respect and appreciation. I have found when you conduct yourself as a professional, show genuine interest in the health needs of patients, and treat them with respect, respect is returned. Most correctional patients are grateful for the healthcare they receive.
Many people believe if a person commits a crime, society should lock that person up and throw away the keys. I have learned it's not that simple. Many incarcerated people come from underserved communities with limited resources, education, and support. Many are incarcerated as a result of substance abuse or homelessness. Some have committed murder or other crimes, but many have mental illness and have nowhere to go besides jail. Jailed women are often victims of domestic violence, have a history of drug use, enter jail pregnant, or have sexually transmitted diseases due to prostitution and unprotected sex.
The clinically competent nurse is pivotal to patient care in correctional healthcare. Nurses are involved in patient assessment, triage, intervention, evaluation, medication administration, and patient education. The role of the nurse administrator in correctional healthcare is one of leadership and patient advocacy.
Flourish on Both Sides of the Bars
The challenges of leading in a correctional environment include meeting the needs of a vulnerable population, building relationships, working effectively with correctional staff, and working collaboratively with multiple health disciplines. Another equally important challenge is to provide healthcare without being judgmental. Correctional nurses treat people who are at the most vulnerable points in their lives. Our interventions have a significant impact on patients' lives and community health.
Despite my affiliation with the National Commission on Correctional Health and my certification as a correctional health professional, it is difficult to stay connected to the nursing profession while working behind bars. As nurse administrators build skills in correctional healthcare, they must stay abreast of trends and issues in nursing practice and the nursing community. They can do so by -
· participating in local, state, and national professional organizations for nurse leaders, such as the Association of Nurse Executives and the Illinois Organization of Nurse Leaders
· participating in public health organizations and associations
· reading business and healthcare publications
· developing and seeking opportunities for networking
The key is to not get lost behind bars while working behind bars. Correctional nurse administrators must build and monitor systems that will enhance nurses' roles as professionals and not allow nurses to confuse caring for patients with managing the correctional environment. Nurse administrators must share positive experiences within correctional healthcare and promote correctional healthcare as a legitimate specialty within nursing (currently, it is not considered a specialty). Nurse administrators must -
· publicize the connection between public health, community health, and healthcare delivered in correctional environments
· report the positive effects of healthcare on the correctional patient population
· diffuse public perceptions, myths, and disinterest
Education Aids Recruitment, Retention
All nurse administrators - including those who work in corrections - have certain roles in common. Nurse administrators are always accountable for providing nursing services. They are responsible for setting and enforcing standards of care, developing policy, and ensuring nurses practice according to state licensure and acceptable practice standards. They must establish an effective leadership team, evaluate care rendered by nurses, comply with regulatory standards, and manage a fiscally responsive budget.
Recruitment and retention also are key concerns for all nurse administrators. In corrections, however, recruitment and retention are larger challenges than in other healthcare environments. Many nurses are afraid to work in corrections due to misconceptions, particularly regarding safety. Correctional nurse administrators must address these concerns and foster an atmosphere of professional opportunity, growth, and recognition among staff.
Try these strategies to recruit correctional nurses:
· Make connections with local universities and colleges. If you are a nurse administrator, seek opportunities to participate within schools of nursing.
· Prepare informational materials that explain the roles and benefits of correctional nursing.
· Encourage correctional nursing staff to participate in career days at local high schools or colleges.
· Increase the visibility of correctional nurses at career-related events, leadership conferences, and other venues.
· Promote and discuss the value of nursing in corrections.
Use these strategies to retain correctional nurses:
· Establish ongoing communication between nurse leaders and staff nurses.
· Encourage staff feedback.
· Be sensitive to nurses' safety needs.
· Manage stress - things are not always calm in a correctional environment.
· Encourage nurses to share positive experiences.
· Recognize nursing staff contributions.
· Encourage continuing education, and assist staff in their efforts to obtain it.
Nurse administrators must ensure nurses receive both a clinical orientation and an orientation to working in a correctional environment. The orientation must help nurses understand the differences pertaining to practicing with patients who are part of the criminal justice system. Nurses also must learn how to establish relationships with the correctional staff and administrators.
Correctional nursing requires good physical assessment skills, critical thinking, the ability to make decisions, and solid negotiation and problem-solving skills. The correctional nurse must be confident, self-disciplined, and not easily influenced, while simultaneously being empathetic and flexible.
More Special Considerations
Nurse administrators are challenged to ensure they have sufficient staff to meet patient care needs. Many patients come to jail with chronic health problems, such as diabetes, asthma, sickle cell anemia, TB, and seizures. A significant percentage of the population has been or will be diagnosed with cancer; many receive hemodialysis. The Cook County Jail sees many patients who have sexually transmitted diseases and HIV.
Corrections can be a highly litigious environment, and correctional nurse administrators must deal with litigation issues. Nurse administrators may also be called upon to address the nurse's role in working with assistive personnel. Appropriate and timely documentation is a priority.
Correctional nurse administrators must respond to court-ordered subpoenas for care and calls from attorneys and concerned family members. In a traditional hospital setting, bed assignments are generally based on patients' healthcare needs. In corrections, detainee housing is generally determined by an individual's charge (the crime committed); however, healthcare needs take precedence.
It is both humbling and rewarding to lead in corrections. Correctional healthcare is a complex environment with many challenges. Nurses who choose corrections as a career will develop new skills and continually test their commitment to caring for others. Correctional nurses often practice autonomously, and patient interactions and interventions are based on self-assessment.
Corrections offers nurses the opportunity to address public and community health issues while providing healthcare services to those who have likely been underserved in their communities. The nurse who is caring, committed, and self-directed will find correctional healthcare an ideal role.
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