None of us likes to receive complaints and yet receiving and responding to grievances from inmates is a daily part of our work as correctional nurses. Health care is among the most frequently grieved areas in the operation of a correctional facility. There are many reasons for this. Inmates do not get to select their health care providers and if dissatisfied with the service have nowhere else to go. Aspects of care that an inmate may have been able to address themselves in the community are governed by institutional rules and may require assistance or supervision from health care staff. The grievance procedure is usually the only way available for inmates to raise concerns constructively.
Every correctional nurse should expect to be grieved about health care they have provided. Many nurses express negative perceptions about grievances as an allegation of wrongdoing or a waste of time or a nuisance. Here are some ways to look at grievances more positively especially since they must be dealt with as daily aspect of our practice. 1. Submitting a grievance is an attempt to identify and resolve problems verbally; a pro-social behavior which should be supported. 2. Having a concern, complaint or even disagreement about care is not a negative statement about a nurse’s integrity, motivation or competency; it may reflect lack of understanding or anxiety about a condition. 3. Responding to a grievance is an opportunity to clarify misunderstandings and can avoid future problems; it also lays a legal record for the future.
The following is an example of a grievance a nurse might receive…“I show up at Medical to take the medication. The nurse asked lots of questions. I cannot speak English so was not able to take the medication. I was sent back to housing with no medication. I need this problem solved with time it has grown.”
The first step is to be diligent in looking into the problem. There is not much detail provided in the complaint but a quick look at the medication administration record would indicate if he was missing prescribed medication. It would also be a good idea to look at the current orders to see if there are any prescribed medications not yet started and any recent progress note indicating that medication was not being given for some reason. Meeting with the inmate is often recommended and in this example would be especially valuable to find out more specifically what happened and when.
Even if the health record shows that the patient is receiving treatment as prescribed there are two things we still want to find out from the inmate: 1. What medication does the patient think they should receive and are not. 2. What problem does the patient have that has grown worse? It is very likely that the patient does not understand the treatment plan or an aspect of prescribed treatment. We may be able to clarify or explain the plan of care and alleviate the patient’s concern or if there is a new or worsening problem have the patient seen by a provider. Either of these would be positive outcomes for the patient.
Now that we have the facts as well as the inmate’s perception of the problem we can respond to the grievance. Our response is a legal document that may be reviewed by others on appeal or eventually by the legal system so it should be to the point and professional. Here are other tips to consider in writing responses to grievances:
- Responses should be conversational and easily understood by the reader. Use simple language and avoid the use of medical terminology.
- Regardless of what was written in the grievance, responses should be professional and polite.
- The response is written to the writer. The response is not to a third party such as the grievance coordinator or ombusdman; it is an explanation in writing to the patient.
- Address each of the specific issues being grieved; do not add material that is not relevant to the patient’s complaint.
- Offer some resolution or responsive action when possible. Let the writer know what steps were taken or what action will be taken in the future.
- If a problem is identified that needs some kind of intervention let the inmate know the information was appreciated, e.g., “Thank you for bringing this problem to my attention…” If an apology is due include it in the response.
- Keep the response informative and avoid abrupt or legalistic answers.
- Respond in a timely manner. Failure to respond timely results in a cascade of grievances and may result in automatic appeal to the next level.
With these tips here is our response to the inmate in the example above: “I investigated your grievance and met with you on 5/22/2014 to discuss the problem with your medication. There was a misunderstanding between the pharmacy and nursing about your prescription. This has been corrected and as of 5/24/2014 you are getting all of the right medications. I am sorry for the delay and appreciate that you wrote to tell us about it.” Suggested criteria for evaluating the quality of grievance responses include:
1. Appropriateness – Responsive to the concern and avoids blaming the writer.
2. Informational – Provides information that thoroughly addresses each of the issues.
3. Professional – Acknowledges the importance of the writer’s concern; avoids defensive or argumentative language.
At your facility do the nurses see grievances as a burdensome chore or an opportunity to address inmate concerns? Have you developed any tips or tools that can help nurses respond to inmate grievances? Please share your opinions and experience by responding in the comments section of this post.
Two nursing colleagues, Heather Villanueva, Oregon Department of Corrections Health Services and Mary Raines, Correct Care Solutions provided information for this post. Here is an excellent policy and procedure on grievances. For more on correctional nursing read our book, the Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.
Photo credit: © OlegD – Fotolia.com