The most recent issue of CorrectCare, a quarterly publication by the National Commission on Correctional Health Care (NCCHC) included an article by Sue Smith MSN, RN, CCHP-RN reporting the results of a recent survey of nursing leaders about the educational and skill needs of correctional nurses. I have reprinted it here so that you can consider the results in light of your own experience and educational needs. Please take a minute to think about your own answers to each of the five survey questions that were used and compare your opinions to those of others who responded.
Nurse Leader Survey Sheds Light on Nurses’ Top Educational and Skill Needs
by Sue Smith, MSN, RN, CCHP-RN
The Nursing Advisory Council is a stakeholder group that advises the NCCHC multidisciplinary education committee on the continuing education needs of correctional nurses and assists the NCCHC lead nurse planner in assessing continuing education for correctional nurses and evaluating the quality and effectiveness of the continuing education. The council consists of nine nurse members who represent a wide variety of roles and settings, including staff nurses, nurse managers/administrators, nurse educators and advanced practice nurses who work in jails, prisons, governmental agencies and private correctional health care agencies.
In 2015, the Nursing Advisory Council developed a needs assessment survey directed at nursing leaders, including nurse managers and nurse administrators. The survey questions were determined by consensus and consisted of five primary questions:
- How much time should be allotted for training a first-time correctional nurse before working independently?
- What are the three most important topics for orientation/training of correctional nurses?
- What is the single most important piece of knowledge for a correctional nurse to have?
- What is the single most important skill for a correctional nurse to have?
- What RN/LPN-LVN ratio are you using at your facility? What is the rationale for this ratio?
The survey questions were distributed via SurveyMonkey to nurses who self-identified as nurse managers or nurse administrators at NCCHC educational conferences. The survey was available to the target audience for two weeks. In total, 273 responses were received; a small number of responses were discarded that did not address one or more of the questions. The collected results were analyzed by the lead nurse planner using simple data reduction techniques.
1. How much time should be allotted for training a first-time correctional nurse before the nurse is allowed to work independently? (233 responses)
Less than 2 weeks 18%
2-4 weeks 14%
5-8 weeks 49%
9-12 weeks 8%
3-5 months 8%
6-12 months 3%
2. What are the three most important topics for orientation/training of correctional nurses?
Inmate manipulation, Safety of self and others
Security issues and procedures, Collaboration with security staff, Contraband
Nursing Practice (129)
Health/physical assessment skills, Emergency response, Sick call procedures, Documentation
Medication issues including administration, verification, pharmacology and competence
Triage/screening, Mental health, including assessment, referrals, suicide prevention, substance abuse
Special needs, Discharge planning
Professional Practice (52)
Neutrality, Firm, fair and consistent
Compassion; patient advocacy; balance of advocacy vs. safety
Emphasis on patient care, Autonomy
Legal/Constitutional Issues (37)
Access to care, Deliberate indifference, Policies and procedures, Licensure/scope of practice
Standing orders, Patient confidentiality, Standards/guidelines
Time management, Critical thinking, Ethics, Electronic medical records
Unique practice environment, Clinic operations, Limitations and restrictions on care provision
3. What is the single most important piece of knowledge for a correctional nurse to have?
Professional Nursing Practice Skills (108)
Assessment skill, Professional boundaries
Able to see inmates as patients, quality care, respect, patient advocacy, compassion, nonjudgmental attitude, uses nursing process, appropriate follow-up
Critical thinking skills, previous clinical experience, good judgment, know where to find the answer
Emergency skills including recognition of critical patients, proper CPR, trauma evaluation, emergent care
Safety/Security (74): Don’t let guard down, how to get help, staying calm, situational awareness, infection control
Correctional Nursing Practice (16): Unique practice, understand population served, understand environment and facility culture, how to navigate security/medical issues, role of health care in corrections, concept of firm, fair and consistent
Legal Issues (16): Policies and procedures, inmate rights, scope of practice
Communication/Collaboration (15): Manner, effective communication, with advanced providers and DON/HSA, with security, knowledge of chain of command, SBAR technique, professional communication, who and when to call for help
Clinical Nursing Knowledge (9): Pathophysiology, medications, current on clinical guidelines, proficiency on treatments
Mental Health (9): Inmates, staff
Manipulation (7): Inmate-patient behavior
Miscellaneous (2): Computer skills, preventive health care
4. What is the single most important skill for a correctional nurse to have?
Assessment Skills (111)
Physical, mental health, health, rapid
Interpersonal Skills (46): Good listener, nonjudgmental, honest, able to handle manipulation, objectivity, professional behavior, boundary setting, able to get along with others, assertiveness, respect, conflict resolution skills, ethics, flexibility, diligence
Critical Thinking Skills (33): Accuracy, think and perform under pressure, good judgment, confidence, problem-solving
Communication (33): Written (including documentation), verbal with staff and inmates, therapeutic.
Clinical Skills (25)
Evidence-based medicine, clinical knowledge, nursing process, CPR, codes, first responder
Triage/prioritization of care
Personal Skills/Attributes (21)
Observational skills, including awareness of surroundings
Autonomy, Self-motivated learner
5. What is the ratio of RNs to LPNs/LVNs at your facility? (268 responses)
Overall average – 3 (RNs) : 4 (LPN/LVNs)
Most frequently occurring ratio – 1 : 1
27 respondents reported all RN staff.
A few respondents reported use of nursing assistants, medical assistants, medication aides and paramedics in addition to or instead of licensed nurses.
103 (38%) did not give information or a ratio could not be determined from the information given.
6. Which of the following best describes the correctional setting where you work? (236 responses)
Prison facility 19%
State DOC/agency 17%
Federal agency 8%
Juvenile detention/confinement facility 6%
Private corporation 5%
* immigration facility, inpatient acute correctional facility, consultants, tribal jails
Total responses were 273. However, not all respondents answered every question and it was necessary to discard a number of unusable responses. Simple arithmetic averages were calculated for questions 1, 5 and 6. Qualitative data received in response to questions 2, 3 and 4 were analyzed and separated into broad categories. The number in parentheses beside each category indicates the number of responses in that category.
There is some overlap in the information requested by questions 2, 3 and 4. This was anticipated by the Nurse Advisory Council, but we felt that there would be enough variation in the responses and/or response rates to ensure that the information gleaned from the survey would be useful. The data analysis does indicate that the weight, or importance, of the topics listed varies between each question. Additionally, there was some variation in the specific topics suggested by respondents.
The information gleaned from this survey is consistent with the results of the general needs assessment survey completed in 2014. The Nurse Advisory Council has been using, and will continue to use, the information collected by these two needs assessment surveys to plan continuing education for correctional nurses who attend NCCHC educational conferences.
Sue Smith, MSN, RN, CCHP-RN, is a correctional nurse educator. She serves as lead nurse planner for NCCHC educational activities and directs the NCCHC Nursing Advisory Council. Contact her at firstname.lastname@example.org.
How similar were your answers to the survey results? Do the results confirm your priorities for correctional nurses’ professional development and continuing education? Please share your comments with others who follow this blog by responding in the comments section of this post.
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