Best of the Blog #3 – New Scope and Standards of Practice for Correctional Nursing

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired June 14, 2013.

On May 27, 2013 the American Nurses Association (ANA) published the new edition of Correctional Nursing: Scope and Standards of Practice (2013).  These are broad parameters defining our specialty area of practice that transcend geographic location (south, east, west, midwest), type of employer (public/private, jail, prison, detention center), and the various populations served in correctional health care (sentenced, unsentenced, juvenile, female etc.).  The standards define who, what, where, when, why and how of nursing practice (ANA, 2010, p.2). The ANA standards are used to:

  • inform nurses and others about correctional nursing practice
  • guide nurse’s day- to- day practice and resolve conflicts
  • develop policy and procedure and other governance of  professional practice
  • reflect on professional practice and plan improvement

Correctional nursing was first acknowledged as a specialty practice by the ANA in 1985. At that time, the first standards for the specialty were published as: Standards of Nursing Practice in Correctional Facilities. Since 1985 the standards for correctional nursing have been revised four times.  This revision was the result of collaboration among seventeen correctional nursing leaders representing various settings and organizations. Input from correctional nurses was sought at various conferences, by survey, and during a public comment period over a period of eighteen months. The input from practicing nurses was incorporated into the description of the scope of correctional nursing practice.

Patricia Voermans MS, RN, APN, CCHP-RN, chairperson of the task force described this edition as “expanding the description of the patient population and addressing the challenges of delivering evidenced based care in the correctional setting.  It also discusses the evolving role of nurses in coordinating care, developing policy and continuing leadership in correctional health care” (April 22, 2013).

Correctional nursing is defined as… “the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, advocacy, and delivery of health care to individuals, families, communities, and populations under the jurisdiction of the criminal justice system” (ANA, 2013).  It is the location of nursing care, with its unique population demographics, environmental constraints and ethical dilemmas that defines our specialty practice (Voermans, Schoenly & Knox, April 22, 2013).

There are sixteen standards of correctional nursing practice in the new edition. The first six standards delineate the steps used in the nursing process. The next ten standards define the professional role of nurses in the correctional setting. This edition emphasizes the importance of communication and collaboration in the delivery of safe and effective patient care. The areas covered by the standards are listed in the table below.

Table 1: Scope & Standards of Practice for Correctional Nurses
     Practice      Professional   Performance
1. Assessment 7. Ethics
2. Diagnosis 8. Education
3. Outcomes Identification 9. Evidence-Based Practice and Research
4. Planning 10. Quality of Practice
5. Implementation 11. Communication
6. Evaluation 12. Leadership
13. Collaboration
14. Professional Practice Evaluation
15. Resource Utilization
16. Environmental Health

Correctional nursing: Scope and standards of practice. (2013). 2nd Edition. Silver Spring, MD: American Nurses Association.

Each standard is further defined by the competencies registered nurses and graduate-level prepared or advanced practice registered nurses (APRN) are expected to demonstrate in meeting the standard. Competency is defined as the integration of knowledge, skills, abilities and judgment needed to achieve an expected level of performance (White & O’Sullivan 2012). The registered nurse is responsible for maintaining professional competence and accountable for each of the decisions made in their nursing practice.

Standard 16 on Environmental Health is a new standard and requires the correctional registered nurse to practice in an environmentally safe and healthy manner. Environmental health is the assessment and control of factors in the environment that can potentially affect health.  Two of the competencies of the correctional registered nurse in this area of practice are:

  • Knowledge of environmental health concepts, with implementation of environmental health strategies.
  • Reducing environmental health risks for workers, patients, and others in the correctional setting.

To experience how the ANA standards are applied in day to day practice they have been interwoven into every chapter of the Essentials of Correctional Nursing which can be ordered directly from the publisher. If you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

Copies of Correctional Nursing: Scope and Standards of Practice, 2nd Edition (2013) can be ordered from the ANA at When you receive your copy of the new edition of the ANA standards one suggestion is to assess your competency to practice in conformance with each of the standards.  Select one or more areas that you would like to improve and develop a plan to do so.

We will share more about how to use the standards in correctional nursing practice in future posts.  In the meantime what experiences have you had applying the ANA Correctional Nursing: Scope and standards in your daily practice?  What tools or resources did you find most helpful? Please share your experience and advice in the comments section of this post.


American Nurses Association. (1985). Standards of nursing practice in correctional facilities. Washington, DC: American Nurses Association.

American Nurses Association. (2013). Correctional nursing scope and standards of practice. Silver Spring, MD: American Nurses Association.

Schoenly, L. (2013). Overview of Correctional Nursing. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. New York: Springer.

Voermans, P., Knox, C., Schoenly, L. (April 22, 2013). Correctional Nursing: Applying the New Scope and Standards of Practice. NCCHC Spring Conference 2013, Denver, Co. Accessed May 8, 2013 at

White, K., O’Sullivan, A. (2012). The Essential Guide to Nursing Practice: Applying ANAs Scope and Standards in Practice and Education. American Nurses Association. Silver Springs, MD.

Photo Credit:  American Nurses Association NSPS’10_Fig 4  Nursing Process  Stds

Best of the Blog #4 – Barriers to Effective Delegation

Human Intelligence and CreativityWe searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired February 11, 2014.

If delegation is a fundamental aspect of nursing practice why do nurses find it difficult? Part of the reason is that as the resources to provide care shrink and the environment for care becomes more complex the importance of delegation has become more apparent. Nursing care today is delivered in correctional settings by a wide variety of personnel (registered nurses, practical or vocational nurses, unlicensed assistive personnel, etc.) each with different educational preparation and scope of allowable practice. Correctional nurses also work in a very restrictive and challenging environment with a very diverse patient population which has complicated health care needs. The National Council of State Boards of Nursing (NCSBN) identifies delegation as a “complex process of professional practice requiring sophisticated clinical judgment” (2005) and yet many nurses received little formal training in delegation during their education and employers rarely evaluate and develop nurses’ delegation skills as they do other clinical competencies (Weydt, 2010). Well no wonder nurses find delegation challenging!

The American Nurses Association (ANA) recently asked nurses what barriers to delegation they were experiencing as part of the process of updating the Principles for Delegation (2012). Three major barriers were identified and each is discussed below:

Poor partnerships: It is difficult to delegate when the nurse does not know the staff or their capabilities. It is also not practical to assess each of the staffs’ skills in all areas before making a delegation decision. Participating in the orientation of new staff is one way to get to know what skills are evaluated and to become familiar with the capabilities of individual staff.  Nurses should also periodically review staff competency records. Working together is an opportunity to build partnerships with each of the staff.  Good quality partnerships are correlated with improved patient safety (McCoy & Duffy, 2013).

Attitudes: Nurses express concern that delegation results in loss of control over patient outcomes. Another way of saying this is …“If I am held accountable for the patient, why should I delegate?”  This was discussed in last week’s post on the principles of delegation. The staff person accepting delegation is responsible for performing the assignment and accountable for accomplishing it safely and correctly. Therefore the nurse’s accountability is for the patient, not the staff’s performance. This is because the nurse retains authority to direct the patient’s ongoing care. Knowing how to identify and evaluate patient outcomes are critical aspects of accountability and delegation of patient care. These competencies are described in Standard 3 of the ANA’s publication Correctional Nursing:  Scope and Standards of Professional Practice and can be used by nurses as a resource in developing delegation skill (2013).

Sometimes the nurse goes on to say “…especially someone I either don’t know or don’t trust?” Trust comes from concentrating on building good interpersonal relationships while working together.  Delegation is an invitation to participate in the delivery of care and when delivered in a respectful and conscientious manner it promotes communication. When meaningful two-way communication is increased the quality of patient care improves (Corazini et al. 2013).

RN Leadership: The third barrier identified was lack of sufficient registered nurses to support effective delegation. Contributing factors were nurses’ lack of experience with delegation, insufficient ratio of registered nurses in the staff mix, and administrative work that supersedes clinical care.    Many correctional facilities do not have a strong structure to support professional nursing practice with policies, procedures, job descriptions and other directives or guidelines that are consistent with state laws and regulations. Uninformed or ill-advised managers may not fully support a healthy workplace that includes developing the delegation potential of registered nurses. Traditionally, little focus has been placed on developing the leadership responsibilities of nurses to ensure delivery of patient care by delegating and supervising care provided by other members of the nursing staff (Weydt 2010).

The ANA articulates the expectation that correctional registered nurses are competent to delegate care in Standard 15: Resource Utilization (2013).  Nurses can develop delegation skills by, first, becoming familiar with the laws and regulations concerning scope of practice, reviewing job descriptions and other workplace guidance that defines the roles and responsibilities of staff. The next step is to understand how the principles of delegation can be applied to patient care in the correctional setting. The use of a decision tool such the one included in the Joint Statement on Delegation (2006) helps guide nurses through the critical thinking that results in a delegation decision. As experience using structured critical thinking  increases delegation decisions are accomplished with speed and confidence. Using simulation or case review and reflection are also effective ways to build delegation skill (Weydt, 2010). Nurses can do this on their own or with a proctor or mentor at the worksite.

Your thoughts about this subject are important to us. Do these three barriers resonate with your experience as a correctional nurse?  Does your communication contribute to good interpersonal relationships? Are registered nurses sufficiently involved in clinical care to effectively delegate? Please share your experience and advice in the comments section of this post. For more information and discussion about correctional nursing order your copy of the Essentials of Correctional Nursing directly from the publisher. Use Promo Code AF1209 for $15 off and free shipping.


American Nurses Association (2012) Principles for Delegation by Registered Nurses to Unlicensed Assistive Personnel (UAP). Silver Spring, Maryland. Accessed on 1/29/2013 at 

American Nurses Association (2005) Principles for Delegation. Silver Spring, Maryland. Accessed on 1/29/2013 at

Corazzini, K.N.; Anderson, R.A.; Mueller, C.; Hunt-McKinney, S.; Day, L.; Porter, K. (2013). Understanding RN and LPN Patterns of Practice in Nursing Homes. Journal of Nursing Regulation. 4(1); 14-18.

Correctional Nursing: Scope and Standards of Professional Practice (2013). American Nurses Association. Silver Spring, Maryland:

McCoy, S.F. & Duffy, M. (2013, March 20). Navigating the Complex World of Delegation [Audio podcast]. Retrieved from

National Council of State Boards of Nursing and the American Nurses Association. (2006). Joint Statement on Delegation. Retrieved December 31, 2013 at

Weydt, A. (2010). Developing delegation skills. Online Journal of Issues in Nursing 2 (1)

Photo Credit:   © freshidea –

Best of the Blog: #5 – Spiritual Distress

We searched through the stacks of almost 200 blog posts to pull out the most popular ones for this series. If you are new to the Essentials of Correctional Nursing Blog you may have missed some good reads. Enjoy!

This post, written by Catherine Knox, originally aired September 3, 2013.

Mr. M. is 52 years old and in the infirmary for treatment of dehydration resulting from diarrhea that occurred after receiving chemotherapy for colon cancer.  The physician recently discussed with Mr. M. permanent assignment to the infirmary for end-of-life care. Mr. M. is listless and unengaged while in the infirmary. He expresses loneliness and frustration that he has no visitors especially now that he has cancer. He is estranged from family because he was physically abusive to his wife and daughter. Mr. M. was convicted of child sexual abuse and has been incarcerated for 10 years. As you leave the room Mr. M. says to you “God must be punishing me for all the bad that I have done in my life. How am I ever going to make amends?”

This is a patient in spiritual distress. Spiritual distress is defined by the North American Nursing Diagnosis Association (NANDA) as “the disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature” (2001). A patient in spiritual distress loses hope, questions their belief system, or feels separated from personal sources of comfort and strength (Gulanick et al., 2003). Assisting patients to address spiritual distress is one of the competencies for nursing care of patients at the end of life established by the American Association of Colleges of Nursing (2004). Chapter 8 in the Essentials of Correctional Nursing discusses spiritual distress in the correctional population, provides cues to identify the condition and recommends nursing interventions to address spiritual distress.

To summarize nursing care for a patient in spiritual distress involves four components:

  1. A nurse-patient relationship. Patients report that their distress was relieved when the nurse cared for them as a person, not as a number; gave patients freedom of choice when possible and when the nurse listened and gave the patient a chance to talk (Creel, 2007; Sellers, 2001).
  2. Spirituality is a coping mechanism and can be used by patients to transcend illness and suffering (Emblem & Halstead, 1993).
  3. Active listening and facilitating the patient’s verbalization of concerns are skills vital to provision of spiritual care. Nurses do not need to know about specific beliefs, religions or spiritual practices to provide effective spiritual care (Martin, Burrows and Pomillo, 1983).
  4. Spiritual care resembles psychosocial care in that it involves demonstration of respect for the patient, listening and appropriate self-disclosure (Sellers, 2001; Taylor, 2003).

Nursing interventions for a patient with symptoms of spiritual distress include:

  • Developing an ongoing relationship with the patient that demonstrates trust to reinforce the patient’s connectedness to others.
  • Respect and support the patient’s faith and religious belief system by making appropriate referrals.
  • Assist the patient to sort out ethical dilemmas in health care decision making.
  • Be aware of the patient’s suffering and act to ease suffering by showing compassion.
  • Encourage reflective prayer as a means to transcend immediate experiences of pain and suffering.
  • Allow the patient to verbalize anger and fear.
  • Help the patient deal with feelings of guilt and instill hope (Villagomeza, 2005).

Pitfalls to avoid in addressing issues of spiritual distress include:

  • Trying to solve the patient’s problems or resolve unanswerable questions.
  • Going beyond the nurse’s role or expertise or imposing personal spiritual beliefs on the patient.
  • Providing premature reassurance to the patient (Lo, B. et al., 2002).

What do you think would be the best response to the questions posed by Mr. M. in the case example at the beginning of this post? How would you address his distress? For more on spiritual distress in End-of Life Care see Chapter 8 of the Essentials of Correctional Nursing which can be ordered directly from the publisher. If you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

References and Resources:

American Association of Colleges of Nursing. (2004) Peaceful death: Recommended competencies and curricular guidelines for end-of-life nursing care. Retrieved My 16, 2011 from

American Psychosocial Oncology Society. Distress Management Training for Oncology Nurses. Retieved September 1, 2013 t

Creel, E. (2007). The meaning of spiritual nursing acre for ill individuals with no religious affiliation. International Journal for Human Caring 11(3): 14-21.

Emblem, J. D. & Halstead, L. (1993). Spiritual needs and interventions: Comparing the views of patients, nurses and chaplains. Clinical Nurse Specialist 7(4): 175-182.

Gulanick, M. , Myers, J., Klopp, A., et al. (2003) Nursing Care Plans: Nursing Diagnosis and Intervention. 5th ed. St. Louis: Mosby

Lo, B., Ruston, D., Kates, L.W. et al. (2002). Discussing religious and spiritual issues at the end of life: A practical guide for physicians. Journal of the American Medical Association. 287(6): 749-754.

Marie Curie Cancer Care (2003). Spiritual and religious care competencies for specialist palliative care. Retrieved September 1, 2013 at

Martin, C., Burrows, C., & Pomilio, J. (1983). Spiritual needs of patients study. In Fish, S. & Shelly J. (Eds) Spiritual care: The nurse’s role.  Downer’s Grove, IL: Intervarsity Press.

North American Nursing Diagnosis Association. (2001) Nursing Diagnosis: Definitions and Classification. 2001-2002. Philadelphia.

Sellers, S. (2001). The spiritual care meanings of adults residing in the Midwest. Nursing Science Quarterly 14 (3): 239-249.

Taylor, E.J. (2007) What Do I Say? Talking with Patients about Spirituality. Templeton Press: Philadelphia.

Taylor, E.J. (2003). Nurses caring for the spirit: Patients with cancer and family caregiver expectations. Oncology Nursing Forum 30(4): 585-590.

Villagomeza, L. R. (2005). Spiritual distress in adult cancer patients. Holistic Nursing Practice. November/December: 285-294.

Photo Credit: © eugenesergeev –

Explaining what is it like to be a correctional nurse?

Tonia FaustAll correctional nurses have the experience of explaining to another nurse what it is like to be a nurse who practices in a prison, jail, juvenile detention facility, police lock up, or customs enforcement facility. Many of our fellow nurses respond to our answer with comments or questions like…”I had no idea nurses could be found in there.” “How can you provide care for a murderer or a rapist?” or “Do you feel safe?”

I am having the same experience now as I get ready to give a presentation at the Arizona Nurses Association later this month about the cultural challenges in correctional nursing. This audience will be nurses but very few of them will be correctional nurses. The three cultural challenges for correctional nurses that I am going to describe are:

  1. Balancing the security imperative with the constitutional right to care.
  2. Diversity and disparity of the patient population.
  3. Developing a practice that embraces caring and remains true to professional principles.

In preparing, I went back to The American Nurse which I discussed in an earlier post. This book is a collection of seventy-five interviews with nurses in the United States. It was published in 2012 as part of The American Nurse Project. There were five nurses in this group who talked about their work as correctional nurses. I thought I could use their stories as a starting point to describe the tremendous opportunities in correctional nursing.

While searching through the book I found another resource, a documentary film by the same name that was produced about two years after the book was published. A correctional nurse, Tonia Faust, is one of five nurses portrayed in the film; she is responsible for the hospice program at Louisiana State Penitentiary. She is pictured at the top of this column. It turns out the film will be shown at the conference the night before my presentation, so by the time I talk about correctional nursing every nurse in attendance will have been introduced to at least one already!

In the film Ms. Faust gives a tremendous interview and we are right there with her as she dresses a wound and talks with the offenders in the infirmary. We meet one of the inmate hospice workers and observe the caring he expresses as he helps to shower an inmate. I would think any nurse could identify with the intimacy and humanity of care so apparent in the film taken from inside the penitentiary. Next time you have someone ask what you are doing as a nurse working in a correctional facility have them watch the film, An American Nurse directed by Carolyn Jones.

The best news is the website for The American Nurse Project is fabulous and this post is written to suggest that every correctional nurse visit it. You don’t have to wait because the film can be downloaded for only $9.99 and watched multiple times thereafter or it can be rented and viewed for a period of five days for only $3.99. The other four nurses portrayed in the film work in labor and delivery, home health, a nursing home and for the military. Two of the five nurses are men. The film really does a great job confronting many of the stereotypes there are about nurses and their careers. An hour and a half of CE is also available after watching the film. Finally there is also a blog that that provides more details about filming of each of these fabulous nurses.

Nurses responsible for new employee orientation or professional development should consider using the film to generate discussion about the expression of caring in the correctional environment, what it means to be non-judgmental as a nurse and what it is like to feel purposeful as a correctional nurse. There are two study guides available without cost on the website; one for the general community and one for nurses. Both provide good material for discussion and reflection on correctional nursing practice.

I watched The American Nurse last night and cried. I was so proud of the nurses portrayed in the film, but especially Tonia. I don’t think that others will ever think correctional nurses aren’t among the best the profession has after watching this film. As one commenter said “My eyes were really opened by the nurse who worked in prison. You could see how much she cared about the patients. I learned that there are more opportunities in nursing than just the traditional settings.”

Take time at least to see the film (79 minutes) and get an hour and a half of CE. Does watching the film help you answer the question when others ask you “What is it like to be a correctional nurse?” Tonia Faust talks about having a purpose for being at the Louisiana State Penitentiary and it has made me think about my purpose as a correctional nurse. What is yours? Share your thoughts about the film as well as the questions posed here by responding in the comments section of this post.

For more about the opportunities and challenges in correctional nursing order a copy of our book, Essentials of Correctional Nursing directly from the publisher or from Amazon today!


Photo credit:

Knowledge Resources for Medication Management

ReadingThe American Nurses Association statement on the scope of practice for correctional nurses requires that nurses be knowledgeable of the medications administered, including dosages, side effects, contraindications and allergies. Nurses also must be able to teach and coach patients so that they know what medications they are taking, the correct dose and frequency (2013). Many more drugs have been developed to effectively treat a wider variety of conditions in the last several decades and new drug formulations established which reduce treatment time, improve adherence and reduce the burden of side effects. With the proliferation of treatment choices available to prescribers today, the scope of knowledge required of nurses has expanded as well.

The types of health problems presented by our patients during incarceration is very broad therefore correctional nurses must maintain more expansive knowledge about the drugs likely to be prescribed than nurses who specialize their practice to a certain acuity (e.g., critical care) or particular health problem (e.g., kidney dialysis). It is impossible to memorize all this information so what references should a nurse use to aid their knowledge about medications these days? What are the drug references that you use?

A couple years ago another nurse and I were talking about a patient and one of the drugs that had been prescribed. I went in search of the big red text from the American Hospital Formulary Service. He turned to the computer and typed the drug’s name into Wikipedia and before I left the room he had the information we were looking for.  The problem is that anyone can contribute information to Wikipedia and so the accuracy and completeness of drug information on this site has been examined. Drug information on Wikipedia relies most heavily on news articles and commercial websites rather than evidence-based material and the information, especially that which is safety related is not reliably updated (Koppen, Phillips & Papageorgiou 2015).

Nurses in one survey in the U.S. favored using the Physician’s Drug Reference (PDR) or a text written especially for nurses like Lippincott’s Nursing Drug Handbook (Gettig 2007). In another survey nurses reported that, other than the PDR, they relied most on other colleagues in the workplace. The problem with relying on co-workers for information about drugs is that the individual may not be available or authoritative on the subject. Access to information and ease of use were the most important factors in nurses’ choice of drug information resources so that quick and concise answers could be obtained (Ndosi & Newell 2010). As drug information has become more available in electronic format it can be more quickly accessed and is becoming a more reliable reference for busy correctional nurses.

The following is a list of drug references and applications that are available on line and can be obtained for free:

National Library of Medicine has three databases that are useful for nurses in medication management. The first is the Drug Information Portal which provides information on 53,000 drugs from government agencies and scientific journals. The second is Drugs, Herbs and Supplements providing information for patients about the purpose of drugs, correct dosages, side effects and potential interactions with dietary supplements and herbal remedies. Last is a database designed for use in emergencies and developed to help identify unlabeled pills called Pillbox.

Epocrates is one of the most widely used and highly recommended drug references. In addition to drug information the basic package which is free has a dose calculator, drug-drug interaction checker which includes OTC medication and a pill identification program. For an annual fee the program can be upgraded to access medical information, diagnostic information, a medical dictionary and infectious disease guidelines.

Medscape Mobile is a combination medical reference and drug database. In addition to clinical reference for 8,000 drugs, herbals and supplements it includes a robust drug-drug interaction checker and a dosage calculator.

A final resource that should be available at every correctional facility is the telephone number for the poison control center. This is a national hotline number (1 800 222-1212) which connects to the nearest poison control center. Most poison exposures can be treated locally if contact is made with a poison control center because they are staffed 24 hours seven days a week by health care professionals with special training. The facility should also stock a supply of antidotes for various types of poison. A consensus guideline published in the Annals of Emergency Medicine (2009) recommended stocking 12 antidotes available for immediate use in treatment (2009). Since then several poison control centers have lists on-line of recommended antidotes to have on hand.

Availability of antidotes is a decision that should be made by the facility medical director in consultation with the supplying pharmacy. Usually they are stored with other emergency medications. Nurses should be familiar with each antidote stocked at the facility for use in medical emergency care. Here is a link to a list of common drugs and antidotes that nurses should know about.

Are there any knowledge resources for nurses in managing medications that are not described here and should be? Please let us know about them by responding in the comments section of this post. For more about the opportunities and challenges in correctional nursing order a copy of our book, Essentials of Correctional Nursing directly from the publisher or from Amazon today!


ANA (2013). Correctional Nursing: Scope and Standards of Practice. Silver Springs: American Nurses Association.

Dart, R.C., Borron, S.W., Caravati, E. M., (2009) Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Annals of Emergency Medicine 54 (3): 386-394.

Gettig, J.P. (2007). Drug information availability and preferences of health care professionals in Illinois: A pilot survey study. Drug Information Journal 42, 263-272.

Koppen, L., Phillips, J., Papageorgiou, R. (2015) Analysis of reference sources used in drug-related Wikipedia articles. Journal of the Medical Library Association 103 (3), 140- 144.

Ndosi, M. & Newell, R. (2010). Medicine information sources used by nurses at the point of care. Journal of Clinical Nursing 19, 2659-2661.

Photo credit: © Xuejun li –

Communication and medication management

man talking on the phone but does not listen

This week’s post explores the language of medication management. The correct use of terminology enables nurses to communicate accurately and prevents misunderstanding with other nurses, providers and pharmacy staff in the delivery of patient care. Continuing the analogy that working is corrections is like foreign travel it is helpful to speak and understand enough of the local language to find the train station, grocery and rest room and not get these mixed up along the way. The same is true when dealing with medications in correctional health care.


Using the correct terminology

The terminology used to describe who does what in the medication delivery system is subtle and often misused. One of the most commonly misused terms I hear used in correctional settings are dispense and administer. Only pharmacists and prescribers (physician, advanced practice nurse, physicians assistant) can dispense medication. To dispense is to remove medication from a stock bottle or container, label and package it for a patient according to a written prescription (the sig). Important steps in this process are to verify that the order is safe (right drug for the problem, correct dosage and route) and to review other medications the patient may be taking to ensure that the new medication does not cause an adverse interaction. Administration of medication is to give medication to a patient as prescribed and then to evaluate or monitor the patient for intended and unintended effects. Medication administration involves correctly carrying out the order as well as assessment of the patient’s response which are fundamental steps of nursing process. Most states allow administration of medication to be delegated by a nurse to unlicensed personnel if they have been trained and are supervised.  Sometimes medication is given to inmates in correctional facilities by other types of personnel including clerical staff, medical technicians, paramedics and correctional officers. The proper term for this is distribution of medication because there is no evaluation that the medication is being given as prescribed and no evaluation of the medication’s effect.

An adequate number and variety of medications must be available at any time at a correctional facility to treat inmate/patients in a timely manner. To accomplish this a correctional facility will have an arrangement with a wholesale drug supplier or pharmacy to dispense and deliver patient specific medications that are prescribed and will keep some medication on hand to use in an emergency or to start treatment immediately. Procurement is the term used when ordering or receiving medication at a correctional facility to be available for use, as prescribed, in the treatment of patients. Medication accountability is a similar term, but broader in scope.  Both state law and the accreditation standards require that there is a system to track, document and account for all medication from the time it is received at the facility until it is administered or delivered to the patient, returned or destroyed. Nurses may be responsible for procurement and accountability of medication at the facility, especially if no pharmacy staff are on site. This is not a role nurses have in traditional health care settings but is common in corrections.

Knowing how and where patients get medication

There are a handful of terms used in correctional settings to describe how inmates receive medication. When inmates receive medication administered directly by a nurse is referred to as directly observed therapy or DOT.  When a package of medication (an envelope, blister card or bottle) is given to an inmate and they are expected to take the medication on their own is referred to as keep on person or KOP medication. Another term is self-administered medication. When inmates receive medication it may be at a “pill call” or “pill line”.  Medication may be delivered “cell side”, through the “cuff port”, at the “pill cart” or “pill window”. Sometimes the vernacular used to describe an activity or place within a correctional facility can be unprofessional or demeaning. Nurses should know what local terms are used as well as their meaning, then make a deliberate decision to use the local language or not.

Selection and availability of drugs

As mentioned in last week’s post, correctional facilities should have a formulary which is a list of the medications that providers can order. The formulary can be “open” meaning virtually any brand of drug is available. A correctional facility that uses a local retail pharmacy to supply medications is more likely to have an open formulary. A “closed” formulary narrows the choices of drugs available in each class (antibiotics, analgesics etc.).  Accreditation standards require that if a particular medication is not on the formulary that there must be a way to request it for a particular patient if needed-this is a “non-formulary” request. Correctional nurses are often involved in helping to fill out and track responses to non-formulary requests so that the medication is received by the patient in a timely manner. It also pays for nurses to be familiar with what drugs are on the formulary so that they can help providers remember what is available when writing orders.

Having a voice in drug selection

Nurses sometimes have representation on the Pharmacy and Therapeutics Committee (P & T) where decisions about what drugs are on the formulary are made. Nursing input is very important in drug selection especially to avoid decisions that result consume unnecessary time during pill line (such as pill splitting or crushing) or present safety issues in the correctional setting (potential misuse or error). If you have a chance to serve on this committee I hope you will jump on the invitation. Even if you do not have a spot on the committee be sure to voice your opinion about the selection of drugs available for treatment at your facility.

Use of generic vs. brand names

One of the most important decisions and practices in medication delivery is how particular medications are referred to. At your facility is the brand or trade name of the drug used or is the generic or chemical name used? In a comment on last week’s post a nurse said that some nurses organize medications in the cart by using the generic name and other nurses put the medication in by brand name. That means that you have to look in at least two places on the cart for a particular medication! Deciding on and then using one or the other saves a lot of time.  It really is preferable to use the generic name since the brand or trade name changes.

How medication is packaged

Various terms are used to describe how medication is packaged. Some nurses came into the profession when most medication was administered out of “bulk stock”. This refers to taking one dose for a particular patient out of a bulk container of the drug. Some correctional systems prefer to use bulk stock for psychotropic drugs because of cost, frequent prescription change and high patient turnover. To improve patient safety most state pharmacy laws prohibit medication administration systems that rely solely on “bulk stock” and have developed “patient specific packaging” that is in “unit dose”.  Patient specific packaging is a medication that has been prepared and dispensed by a pharmacist in a container or package that is labeled with the patient’s name, start and stop date, the medication dose, route and frequency, as well as prescriber and pharmacy names. Many correctional systems will provide discharge medication packaged in this way with a child proof cap. When medication is packaged in unit dose each dose of medication is packaged individually. An example of unit dose are the plastic or paper packets or aspirin or acetaminophen. Unit dose packaging may be labeled with the individual patient name as described in patient specific packaging above or it may not be labeled and used like “bulk stock” with single doses provided to multiple patients. An example of the later would be single doses of medication used for immediate treatment such as an antihistamine. Finally some correctional facilities allow inmates or their families to bring in an inmate’s medication that they were taking in the community. This is referred to as patient owned or personal medications. The medication and prescription must be verified before accepting it into the facility and accountability for proper use must be assured. Usually several types of packaging is used in correctional facilities. How many different kinds of packaging and what terms are used at your facility?

Preventing miscommunication

Even when we speak the same language communication can be misunderstood. Errors in communication occur in oral and written communication about medications sometimes resulting in adverse consequences for the patient. The Joint Commission, U.S. Food and Drug Administration (FDA) and the Institute for Safe Medication Practices (ISMP) have each promoted practices that reduce errors in medication management. One example is that QD is often misunderstood as QID resulting in four times the intended daily dose. The opposite is also true but the patient would receive a much lower dose than was intended therapeutically.   Either can have disastrous consequences. The IMSP and FDA have listed medication abbreviations that are frequently misunderstood and have developed brochures, posters, a slide set and a video about how to avoid these errors. The health care program at your facility should have a list of approved abbreviations and may also have adopted a list of error prone abbreviations to avoid using. If not the IMSP website is a recommended resource.

Have you had a funny or sobering experience with the language used in medication management at your facility? Do you have any terms unique to medication delivery in the correctional setting you would like to contribute to our glossary? Do you favor use of generic or brand names and why? Please comment by responding in the comments section of this post.

For more about the opportunities and challenges in correctional nursing order a copy of our book, Essentials of Correctional Nursing directly from the publisher or from Amazon today!


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An overview of medication management in correctional settings

Isolated, whitespace, copyspace.

The roles and responsibilities of correctional nurses for medication management are broader in scope than other practice settings. In health care settings many other professional and support personnel contribute to delivery of patient care.  However in correctional facilities nurses are relied upon to deliver care without the availability of these other types of personnel. The result is that correctional nurses often work in professional isolation and may feel like they are in a foreign country (Muse, 2012). I think traveling in a foreign country is a good analogy for correctional nursing. Doing this well involves preparation by learning something about the sights to see, building skill using a little of the language, familiarizing yourself with the rules, particularly which side of the road people drive on and finding out how to avoid being robbed or harmed in some way. The thrill of correctional nursing, like the thrill of foreign travel, comes when you realize how much you are enjoying it, especially the independence of professional nursing practice in this field. This post is the first part of a guidebook for your journey managing medication in correctional settings.

State law, rule and regulation

State law serves as the basis for nearly all of the practices and procedures involved in medication management. Most nurses are familiar with the nurse practice act in their state. If not, this is the place to start by reviewing it for definitions and references to medication. The nurse practice act will be especially helpful in describing the training and supervision requirements if non-licensed personnel, such as nursing assistants, administer medication at the correctional facility.

The pharmacy practice act is the most important resource to review. These laws will define how to obtain, store, dispense and account for medication which are often the responsibility of nurses when there is no pharmacist on site.  Even if there is a pharmacist at the facility, being familiar with the law that governs their practice is helpful in understanding the recommendations pharmacists make about drug storage, packaging of medications and accountability.

The medical practice act provides important information about how a physician’s order for medication is lawfully carried out. The medical practice act also has information about how medical assistants and paramedics work as well as the requirements for training and supervision which need to be followed if these personnel are involved in medication management.

This is not interesting reading but it does provide information that nurses can use in determining the responsibilities of personnel for medication management. It also provides definitions and terminology to accurately communicate with the pharmacy that provides medication to the facility and with providers about implementation of orders. Finally it provides nurses a basis to knowledgably resist inappropriate requests from custody and other personnel not familiar with health care laws to carry out tasks that are inconsistent with state law.

Accreditation standards

The National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA) are organizations which accredit correctional facilities for providing services and programs consistent with national standards. The standards are also used by most correctional facilities in developing policy and practices even if accreditation is not sought. Both organizations have standards related to medication management which are summarized in Figure 1. This list is a handy description of all the moving parts and pieces of medication management in correctional settings and nurses are involved in all of these components. This list can be used to review how medication management is handled at a facility and identify areas that may need attention.

Figure 1:   Standards for medication management in correctional facilities
Applicable standards C-05, D-01, D-02 4-4378, 4-4379
1. Facility operates in compliance with state and federal laws regarding medications. Similar
2. There is a formulary and method to obtain non-formulary medication. Similar
3. Policy and procedures address how to procure, receive and account, dispense, distribute, store, administer and dispose medication. Similar
4. Medications are under control of appropriate staff and accounted for. Secure storage and perpetual inventory of controlled substances, syringes and needles.
5. Medication is only prescribed as clinically indicated after provider evaluation. Similar
6. Providers are notified of medication needing renewal prior to expiration. Similar
7. Staff are properly trained to administer or distribute medication. Similar
8. Inmates do not prepare, dispense, or administer medications. Self-carry medication programs are allowed.
9. There are no outdated, discontinued, or recalled medications at the facility.
10. If there is no on-site pharmacist, a consulting pharmacist is available for advice and makes inspections of the facility’s medication program at least quarterly.

Nursing standards

The American Nurses Association (ANA) has recognized correctional nursing as a specialized field of practice since 1995. The ANA publishes a reference that describes the scope and sets standards for the practice of correctional nurses. With regard to medication management the role and responsibility of correctional nurses is as follows:

  1. To be knowledgeable of medications administered, including dosages, side effects, contraindications and food and drug allergies.
  2. Practices with regard to medication management in the correctional setting meet the same standards as in the community. To do so nurses must be knowledgeable about state practice acts (as suggested earlier in this chapter).
  3. Ensure that patients know what medications they are taking, the correct dosage and potential side effects.
  4. If patients are expected to take medications without supervision the nurse evaluates the patient’s competence to self-manage and takes steps to protect those who are not competent to do so.
  5. Work with custody staff so that patients receive medication in a timely and safe manner (ANA, 2013).

This overview makes me reflect on my first experience with medication management in correctional nursing. I was being oriented to administer medications on the evening shift at a maximum custody men’s prison. A technician rolled a grocery cart filled with stock bottles of all kinds of medication out to me. The cart was full. In giving me the cart he said “You roll this along the tier and stop at every cell. Ask the inmates what meds they want. When you give them the medication then you record it on one of these index cards that has the medication listed at the top.” I remember being shocked and asked the technician why they did it that way. He shrugged his shoulders and went on with his tasks. While this experience is pretty extreme you might use it to review against the ANA nursing standards of practice, the accreditation standards and state law that were reviewed in this post and identify the inconsistencies. Being knowledgeable about the standards and requirements for medication management prevents erosion of professional practice and ultimately protects patients from harm.

Going back to the travel analogy, knowing state law, the national standards for correctional facilities as well as the standards of practice for correctional nurses is like having a guidebook to review the sights to see in place you have selected to travel to. These become a reference point to plan so you can make the most of your time as well as an expectation for what will take place while on your journey.

Is medication management a troublesome area where you practice correctional nursing? Have you looked at the problem through the lens of applicable state law, corrections standards and the nursing practice standards? If so, what have you identified as the problem areas? Please comment by responding in the comments section of this post.

For more about the opportunities and challenges in correctional nursing order a copy of our book, Essentials of Correctional Nursing directly from the publisher or from Amazon today!



ANA (2013). Correctional Nursing: Scope and Standards of Practice. Silver Springs: American Nurses Association.

Muse, M. (2012). Professional role and responsibility. In C. Schoenly L. & Knox, Essentials of Correctional Nursing (pp. 364-377). New York: Springer.

National Commission on Correctional Health Care. (2014). Standards for Health Services. Chicago: National Commission on Correctional Health Care.

American Correctional Association. Performance Based Standards for Correctional Health Care. Retrieved August 19, 2015 from

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