Correctional Nursing and the Ethic of Social Justice

Have you ever been asked what you do as a nurse and found yourself launching into a discussion of sick call and medication passes? It is easy to get lost in the weeds on our professional journey. That’s why it can be refreshing to periodically return to the defining qualities of the nursing profession to see the big picture.

The definition of nursing as found in the ANA Scope and Standards of Practice is

  • The protection, promotion, and optimization of health and abilities
  • Prevention of illness and injury
  • Facilitation of healing
  • Alleviation of suffering

We do this through the diagnosis and treatment of human response and we advocate in the care of

  • Individuals
  • Families
  • Groups
  • Communities
  • Populations

As correctional nurses, we fulfill this definition in the criminal justice system. The location of nursing care delivery establishes our unique patient population, environment of care, and ethical dilemmas of practice.

It is invigorating to be reminded that nursing care goes beyond the post duties and task list for the shift. Certainly caring for patients in a one-on-one situation is the majority of many of our job descriptions. However, I was recently struck by the inclusion of communities and populations in the nursing definition. How do we advocate for care and alleviate the suffering of communities and populations as a correctional nurse?

What is Social Justice?

Social justice is a broad term used to describe equity in the distribution of resources and responsibilities among members of society. According to the Canadian Nurses Association social justice in health care involves “working to prevent negative effects of oppressive practices such as discrimination against individuals on the basis of gender, sexual orientation, age or any other social factor that might affect health and well-being. In correctional nursing, social justice would include reducing dehumanizing practices within the criminal justice system and extend toward improving the health and well-being of the homeless, impoverished, and under-educated communities from which our patients and their families enter into the criminal system.

Social Justice in the Criminal Justice System

You would think that a system with justice in its title would be just but there is a lot of social injustice in the criminal justice system. You don’t have to look very far to see oppression in the power structure of many correctional settings. The need to maintain discipline and provide for personal and public safety can lead to severe punishment and even brutality in the organizational culture in some settings. As correctional nurses, we may not ascribe to the incivility but are often required to view or even participate in the culture in order to delivery necessary health care. For example, have you ever had to witness a violent inmate take-down during an emergency man-down that resulted in the use of a severe restraint device? Did you feel there might have been a more humane way to deal with the safety issue but were afraid to speak up or felt you had no voice in the matter? How might a nursing response to restraint practices across the criminal justice system embody advocacy for the alleviation of suffering among our patient community and population?

But This isn’t a Patient Health Care Situation

As nurses in the criminal justice system we can easily get tunnel-vision about our role within the system. Certainly we are helped in this narrow focus by those criminal justice professionals who clearly see nursing as attending to the direct health needs of specific patients. Yet, our definition of nursing practice speaks otherwise. Our patients are the entire community of inmates within our facility and our role, among other things, is to promote their health, prevent their injury, and alleviate their suffering. Correctional nursing, then, is more than serial one-on-one patient care situations.

We Are All in This Together

Correctional nurses, as a group, can be a significant force in the criminal justice system. Our definition and Code of Ethics calls us to consider the human dignity of our patient population and the significant suffering that our patient community bears up under. Working together we have an opportunity to bring about social justice in an institution, a correctional system, and the entire criminal justice system.

 

Job, Career, or Calling? It’s Up to You

“It’s not what you look at that matters, it’s what you see” – Henry David Thoreau

Your CallingCorrectional nursing can be a job, a career, or a calling based on your perspective – what do you see?

  • If you see your work life as an endless string of shiftwork passing pills and triaging sick call slips then you may have a job perspective
  • If you see your work life as a stepping stone to an advanced position then you may have a career focus
  • If you see your work life as meaningful to the lives of others and personally fulfilling then you may have a calling focus

Those who research job satisfaction have found that those who see their work as a calling do work they care about. They consider their work to be more than a means to an end, but an opportunity to find meaning and do something important. These researchers also found that those who viewed their work as a calling were healthier, had greater satisfaction with their life and missed less work than those in either the Job or Career categories.

Knowing your work orientation can help you find ways to motivate yourself and craft a better work situation without having to change jobs. Job crafting, in fact, is a primary way correctional nurses can move from a Job perspective to a Calling perspective regarding their work life.

Dimensions of Meaning

Experts have determined five dimensions of meaning that can be found in work.

  • Money: Although correctional nursing salaries can be competitive, it is not the one of the highest paying nursing specialties
  • Status: Correctional nursing practice has made advances of the last decade but nurses working in jails and prisons can still be stigmatized by their patient population and work setting.
  • Making a difference: Correctional nurses can make a significant contribution to the health and well-being of a marginalized and disadvantaged patient group.
  • Following your passions: What motivated you to become a nurse? How would that align with correctional nursing practice?
  • Using your talents: Many passions also end up being talents. What nursing talents do you have that are applied in a correctional nursing position?

What is Job Crafting?

Job crafting is a way to redesign work perspective, relationships, and tasks to improve job satisfaction. Job boundaries can expand or contract over time based on the individual in the position and the aspects that are emphasized or de-emphasized. It starts with determining the areas of a role that are the most meaningful, provide the most satisfaction, and are aligned with gifts and talents. While in many situations other areas of the role cannot be neglected; focusing on extending time and effort toward gaining experience and expertise in areas of fulfillment craft the position.

Ways to Job Craft

Even in the most structured of job descriptions, there is room for modifications to make work life more satisfying and meaningful. Researchers found that successful job crafters took action in three areas: perspective, relationships, and tasks. Here are some suggestions specific to a correctional nursing role.

  • Perspective: It all starts in the mind. Mentally seeing your work as affecting the lives and health of your patients is more helpful than seeing your work as a list of nursing tasks that must be completed by the end of the shift. Thus, correctional nursing is not medication administration, sick call, emergency response, and intake screening but “the protection of health, prevention of illness and injury, and alleviation of suffering” (definition from the Correctional Nursing Scope and Standards of Practice, 2013). Successful job crafters reframe the social purpose of their positions to align with their values and concerns. What parts of the definition of correctional nursing do you highly value? Be mindful of those themes during your day-to-day activities.
  • Relationships: The type and extent of relationship with various workmates can be a way to craft a more positive work experience. Hang around unhappy, stressed, and cynical people and you will find yourself mirroring their moods and emotions. The reverse is also true. Honestly evaluate the perspective of each member of your work team and develop deeper relationship with those who will encourage and facilitate your highly valued role components.
  • Tasks: Evaluate which elements of the correctional nursing role give you the most pleasure and fulfillment. Ponder the specific themes of these elements. For example, if you enjoy sick call, which parts? Is it the assessment, the patient interaction, the teaching component? Find ways to do more of the satisfying component. That might not mean the original job task. For example, if assessment is the satisfying part of the sick call process then intake screening is also a task that would provide opportunity for more assessment. If patient teaching is the driving satisfier than chronic care tasks may be an additional option. Once determined, seek ways to increase satisfying tasks while decreasing or streamlining less-valued tasks to accommodate the change.

Just a Job? Just a Step in the Ladder? Just a Way to Make a Difference?

So, what will it be for you? Is correctional nursing just a job that meets your monthly bills and is available until you find something better? Is your position just a step on the career path to a position of more power and prestige? Or, is correctional nursing a way that you make a difference in the lives of others, creating a meaningful professional life of compassion and service? In the end, it is up to you.

“We don’t see things the way they are, we see things the way we are.” – Anais Nin

Four Ways to Jumpstart Patient Safety Efforts

Runner is starting on the running trackPatient safety is an important core value of nursing practice so efforts to overcome barriers to preventing patient harm (like those discussed in a prior post) are worth our energy and attention. Sometimes getting quick results can reduce resistance to the changes needed to decrease clinical error. I’d like to suggest four ways to quickly move forward on improving patient safety in any setting.

Communication Systems

Communication breakdown has been the most frequently cited cause of clinical error so this is an excellent place to start.  If you are a leader, evaluate the various hand-off points in your primary care systems and work to tighten them up. Also take a good look at communication among disciplines, including your staff and officers. For example, are there conflicts and poor relationships that are getting in the way of smooth operations.

Human Factors Engineering

Human factors engineering (HFE) may be an unfamiliar term. It refers to developing systems that take into account human error by implementing safeguards or barriers to common human error points. HFE has reduced errors in other high-risk industries like nuclear power and space travel. Here are a few examples for health care:

  • Reducing reliance on memory with whiteboards or checklists for important care processes
  • Improving information access at the point of care such as easy availability of treatment protocols and drug information where care is delivered
  • Standardizing tasks so that all members of the team perform the task in the same way.

Patient Involvement

Involving patients in their care is not always a popular concept in the criminal justice system. However, if you are returning to your health care roots and centering on the patient, it makes sense to involve them in their care. Patients are able to assist in reaching an accurate diagnosis. Certainly the more  you are able to have an open and honest dialogue with your patient the more likely you will get accurate information to make a diagnosis. Patients can also provide feedback on effects and side effects of treatment. If your patient is engaged as an active member in the care team, he can speak up when something is amiss such as identifying when a treatment or medication is missing or different than expected.

You can also engage some members of your patient population in program improvement activities. For example, trusted patients or inmate councils can provide input into system changes that affect them. The inmate grievance process can also be used to improve patient safety if used to evaluate trends in complaints.

Mindfulness

The final recommendation is simple, yet difficult at the same time. Be continually mindful of patient safety when going about care tasks. Mindfulness is the increasing ability to experience being present with acceptance, attention and awareness. Attention and awareness to the potential for patient harm in everyday clinical situations can go a long way toward averting errors in practice. Just reading about patient safety is likely to increase your awareness but that can fade quickly if patient safety does not become part of the fabric of how health care is delivered in your setting.

Have you overcome barriers to implementing patient safety processes? Share your experiences in the comments section of this post.

Patient Safety – What’s Holding You Back?

Patient safety is a core concept to professional nursing practice. Indeed, we have an ethical responsibility to keep our patients from harm and to always seek their good. I discuss this in an earlier post. Wouldn’t it be nice if we could just say – OK, patient safety is a great model – Let’s do it! Unfortunately, changing a mindset is difficult in any setting; maybe even more so in an entrenched correctional culture.

There are many reasons it can be challenging to embark on a serious journey toward a patient safety culture in a correctional setting. Here are the three frequent barriers to advancing a patient safety model that I found while working with health care leaders in jails and prisons. Would these be barriers in your facility?

Organizational Culture

An organization’s culture is the collection of norms of behaviors that are approved, allowed, or ignored. Culture determines what behaviors are rewarded and what behaviors are punished. Many work cultures in the criminal justice system are built on incivility and disrespect. These cultures are more likely to reward conforming and ‘by the book’ behaviors that rely on administrative controls rather than innovation and initiative. Leaders in this type of environment do not want to hear the ‘bad news’ of a possible safety issue and may marginalize those who try to make them aware of concerns that need addressed to avoid harm.

On the other hand, a patient safety culture builds on a culture of respect and is non-punitive in nature; valuing accountability, honesty, and mutual respect. This has been described as “allowing the boss to hear bad news”. A patient safety culture, then, requires open communication based on trust and positive regard, not always present in our hierarchical and para-military settings.

Broken Systems

Another common barrier to implementing a patient safety mindset is broken or absent systems. Health care, in and of itself, is a complex system of interactions of care providers, patients, diagnostics, equipment and environment. Correctional health care is all of that with an overlay of the criminal justice system and security structure. Not only is health care a complex system but also one that is constantly adapting to changing context and outcomes.

We are in a high-stakes profession where broken systems can mean loss – injury and death – as this case in a prior post illustrates.  Human error is inevitable. We must admit that and embrace it to move forward in designing our health care processes and systems to limit and avoid human error potential.

Nobody Cares

There are many more barriers to a patient safety perspective in corrections but I will close with just one more – Nobody Cares. Granted, there is good reason for developing an uncaring attitude toward our work and our patients. After all, it only takes being manipulated or duped by a patient to be on guard against that happening again. No one wants to be on the other end of deception or exploitation.

Even as healers, we can absorb a pervading “us against them” mentality in many of our settings. If cynicism does not harden our souls, maybe compassion fatigue or secondary traumatization from working with patients in such distressing life situations can zap energy and leave us focusing on merely performing tasks without really considering the people we care for. Layered upon this can be the challenges of dealing with uncivil or bullying peers. All of this can lead to a ‘why bother’ attitude toward our role in patient care and patient safety.

Yet, only clinicians thoughtfully considering their practice and environment will actually see and respond to potentially harmful situations. Only engaged practitioners will reflect on a patient situation to improve the care they provide.

Does this paint a hopeless picture regarding patient safety? I hope not! No matter what your position, you have an opportunity to make a difference and move the organization forward toward patient safety.

Great things are done by a series of small things brought together. – Vincent Van Gogh

What is a small step you could take toward a patient safety culture in your setting? Share your thoughts in the comments section of this post.

Patient Safety: Four Easy Pieces

Could this happen in your work setting?

An inmate was evaluated for a heart condition and found to have several blocked coronary arteries. He was scheduled for cardiac stents at the local hospital where the prison had an agreement for services. He had the stents placed and returned to his cell block the following day. He returned with one discharge order sheet that included a note at the bottom to “see page 2”. No second page was included with the discharge order sheet. A nurse practitioner reviewed his one page of discharge orders, confirmed them, and wrote on the medical order sheet that there were no changes to be made. This was interpreted to mean no changes to the patient’s pre-procedure medications and he was returned to his prior medication regimen. Meanwhile the 2nd page of the discharge orders was faxed directly to the prison medical director. The medical director reviewed them during office hours the next day and placed the orders in his outbox for transcription and return to the chart. That order sheet never got to the chart. The patient told the medication technician who administered medications on his housing unit that he was supposed to be getting Plavix after his procedure. The med tech told the patient that there was no order for Plavix and he was mistaken. The patient continued to ask about the Plavix at subsequent medication lines with similar response. One staff member told him the medication was nonformulary and there might be a 3-5 day delay in obtaining it. Six days after the procedure the patient had crushing chest pain and returned to the hospital where it was found that two of his stents had occluded and required emergency treatment. Fortunately the patient survived the experience.

In a previous post I explained how, even though I am nervous about crashing when flying, there are more deaths each year from clinical errors than from airplane crashes. We would do well to focus in correctional health care on patient safety as there is such a significant return on our time investment. But, where do we start?

Patient safety experts developed a 3-part model for explaining components of a safety paradigm in the traditional health care setting. I adapted this model to the correctional setting and added a 4th element – the care environment to the original representation. As many of us practicing in the criminal justice system know, the environment in which we work has a significant effect on care delivery and outcomes.

Consider how each of these four patient safety elements might have affected the outcome of the case presented above.

Environment of Care

The environment is primarily the organizational culture of the workplace but can also include the physical environment such as the design of the care delivery setting and the available equipment and supplies. The secure environment of the criminal justice system adds intensity to the environment of care by also imparting a unique set of values and cultural norms. There can be a true culture clash or a struggle with dual loyalties among the care staff. We often talk about the impact of the security culture on health care delivery. The inmate culture also has an effect on patient safety. There develops a culture of mutual mistrust that can poison the patient-practitioner relationship. How might the organizational culture in the case presentation have affected the actions of the care team?

Systems for Therapeutic Action

Patient care is delivered through a complex system of intertwined processes. Patients and practitioners interact with these systems within the environment of care. Patient safety principles can increase the reliability of care systems; reducing error and improving outcomes. Do you think there were some real system failures in the case above?

Patient

The patient is also a vital part of the safety framework. Interacting with health care workers and the systems of therapeutic action within the environment of care, patients have opportunity to actively participate in and monitor care delivery. There are many barriers to engaging patients in the criminal justice system that must be considered and overcome. Was the patient a factor this critical incident?

Practitioner

The competence and judgment of health care staff is a major factor in patient safety. Staff interact with the patient and take therapeutic actions to deliver health care. Internal and external factors such as fatigue, work stress, impairment and shift rotation affect our abilities to deliver safe care. Emotional issues like burn out, vicarious trauma and compassion fatigue affect our clinical judgment. Could any of these be attributed to the actions taken in this case?

By using this model of patient safety in correctional health care, a full evaluation of the missing Plavix case can be undertaken and system improvements initiated.

Share your thoughts on what you would investigate further in the comments section of this post.

Of Airplanes and Patient Safety

Let me tell you a little secret. I’m not very fond of air travel. In fact, when I am preparing for a flight like the one that I took recently to speak in Sacramento, I had to distract myself from picturing all kinds of plane disasters. But, really, what were the chances that my plane would be hit by lightning or have engine malfunction and crash over the Rocky Mountains? Pretty slim, right? In fact, the most fatalities from air travel were clocked in the year 1972 when 2,429 people died in air crashes around the world. Most years are well below 1000; and this is worldwide. Much can be said for the safety mechanisms hardwired into high-risk airline industry.

How do you think that compares to deaths from medical errors? A 2013 study in published in the Journal of Patient Safety found there are as many as 440,000 deaths from hospital errors each year; and that is just in the United States! This is equivalent to 1000 jumbo jet crashes a year or wiping out the entire city of Colorado Spring…every year.

This calculation of deaths from clinical errors is based on traditional hospital care information. Unfortunately, we have no nation-wide data collection process for correctional health care. What do you think, though? Is our patient care likely to be safer than that provided in hospitals? Possibly. However, there are indications that our delivery systems may be even more risky given the nature of our patient population and environment.

Keeping our patients safe from clinical error, then, is an important part of our professional practice. Patient safety emerged as a concern in the early 1990’s. The Harvard Medical Practice Study published in 1991 is credited with starting the movement when it identified higher than expected rates of preventable medical errors. Over the last two decades, the patient safety movement has developed into a primary focus in traditional settings but is only now gaining interest in correctional health care. Yet organizing health care processes around patient safety can be particularly helpful in a setting such as correctional health care where the fragmented nature of care delivery, the transient nature of the patient population, and the added application of security structures can overwhelm and overshadow patient care.

As health care clinicians, focusing on the best for our patients through a patient safety perspective is a satisfying way to view our role, our values, and our professional goals. In addition, a patient safety perspective allows us as clinicians to fully address the ethical basis of our profession – beneficence (doing good) and nonmalfeasance (not harming).

I made it to Sacramento unharmed; in large part due to the many safety mechanisms in place to be sure the flight was safe. Regrettably, I review many an incident in correctional health care that indicate missing or omitted safety procedures.  How can we make correctional health care practice more like the airline industry? Any thoughts?

On Being Thankful

Be thankful for what you have; you’ll end up having more. If you concentrate on what you don’t have, you will never, ever have enough.” – Oprah Winfrey

Heart shape hands on the blue sky

As a reforming whiner, I often need reminding to be thankful. Yes, given the choice between appreciating a situation and complaining about it, I will regularly choose the later. That’s why I so appreciate having a holiday every year that focuses on gratitude and thankfulness. What better way to re-center our thoughts on the good in our lives and the contributions of others?

With that in mind, I’d like to offer my Thanksgiving gratitude list (not in any particular order):

  • Correctional Nurses: Frankly, I didn’t know correctional nurses existed 10 years ago. When I discovered this invisible nursing specialty, I know I found a home. It has been a blast getting to know so many nurses who work in difficult environments with often-difficult patients. Our patient population is marginalized and vulnerable, frequently forgotten by society and the traditional healthcare system. I am grateful for your work on behalf of our patients and delighted to have meet so many of you in my travels and through this blog.
  • Blog Readers: Speaking of blogs, Catherine and I are energized by the number of visits and comments on our posts over the years. You are our inspiration and the focus of our efforts.
  • Professional Associations: I am truly thankful for professional associations like National Commission on Correctional Health Care and the American Correctional Health Services Association. These organizations do great work in advancing correctional nursing practice and providing a wonderful venue for networking and communication. I enjoyed meeting many of you at NCCHC and ACHSA conferences this fall.
  • Correctional Officer Colleagues: This Thanksgiving season I have been pondering the great contribution of correctional officers to both public safety and the personal safety of correctional nurses throughout the criminal justice system. Our CO colleagues live with similar social stigma and feelings of invisibility. We are all in this together and need to support each other.
  • Family and Friends: Without the support of my husband, family, and friends I could not do what I do. Those I know who have much family stress and drama have no energy left to create new things. I often forget that I am free to write and speak and learn new things because I have a great support system.
  • A God Who Cares: Having a caring God who made me unique and expects me to use the gifts He gave me is also a cause to be thankful. Even when everything is ‘going wrong’ there is a comfort in knowing there is a plan in play and I don’t necessarily need to know what it is. I do need to do my part, though, by making a difference where I am with what I have been given.

Cultivating Gratitude in the Year Ahead                      

I am inspired to renew my efforts to reduce whining and increase appreciation this coming year. Are you with me on this? Here are two ways I’m going to increase my gratitude and decrease my whining:

  • Count My Blessings: Spend regular time meditating on the simple blessings of life such as a roof over my head and food on the table.
  • Say Thanks: Consciously sharing gratitude for friendship, support, assistance, and information provided by others in day-to-day living.

Will you join me in my efforts to ‘keep on the sunny side’ in the days ahead? Rather than concentrating on what is missing, as Oprah states, we can focus on what we have and end up having more!

Leave your suggestions and encouragement in the comments section of this post.

An earlier version of this post first appeared on CorrectionalNurse.Net

Best of the Blog #1: The Five Rights of Delegation

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 January 13, 2013.

The post last week included a case example about a licensed practical nurse (LPN) responding to a medical emergency after an altercation between two inmates. The LPN determined that neither inmate required further medical attention. Later in the shift one of the inmates was taken to the emergency room after being found unresponsive in the cell. The inmate subsequently died of the head injury that was sustained in the altercation. This example highlighted the registered nurse’s role in the assignment and supervision of patient care. Correctional nurses use their knowledge of state regulations defining the scope of practice for personnel assisting in the delivery of patient care as well as the employers’ expectations (job description, post orders, policy and procedure) to assign and supervise these personnel.

The American Nurses Association (ANA) describes correctional nurses as responsible for direction of patient care including the assignment and delegation of tasks to others (2007). These responsibilities are unchanged in the draft of the 2013 edition of the Correctional Nursing: Scope and Standards of Practice which was posted at http://www.nursingworld.org/Comment-Correctional-Nursing.html.aspx. Delegation has been described as an essential skill and yet is one of the most difficult responsibilities of a registered nurse. It is a complex process that requires sophisticated clinical judgment about the patient care situation, the competence of staff and the degree of supervision required (Weydt, 2010; NCSBN, 2005).

There are many resources available to help nurses build skill and competency in delegation of patient care tasks. The state board of nursing is an excellent first resource as well as the National Council of State Boards of Nursing (NCSBN) website which can be accessed at https://www.ncsbn.org. A resource suggested in the Essentials of Correctional Nursing is a framework for delegation from the NCSBN referred to as the Five Rights of Delegation (1997). These are discussed in relation to the case example from last week’s post.

1. Right Task: The nurse makes an assessment of the patient or a group of patients and determines that an activity can be delegated to a specific member of the health care team. Knowledge of state practice acts and agency directives are essential when making decisions about what patient care tasks can be delegated. In the case example the registered nurse’s decision to have the LPN respond to the medical emergency was problematic because the LPN was required to assess and make a complex clinical decision about the inmate’s need for medical care.

2. Right Circumstances: The nurse’s assessment of the patient or group of patients also identifies the health care need(s) to be addressed by the delegated task(s) and the goal or outcome to be achieved. The nurse’s decision about which task(s) to delegate matches the staff’s competency and level of supervision available. The registered nurse in the case example did not assess the patient’s needs or identify the outcome to be achieved by the task that was delegated to the LPN. The nurse also made no judgment about what level of supervision or monitoring would be appropriate in the circumstance.

3. Right Person: The registered nurse considers the skills and abilities of individual personnel in making decisions about delegation of tasks. The registered nurse works with each member of the team to improve performance and implements remedies when performance is below standard. In the case example the LPN had considerable experience responding to medical emergencies at the correctional facility and had worked in the emergency department at the local hospital. The registered nurse did not understand that monitoring or supervision of the LPN’s performance was required as part of the state practice act and expected by the employer.

4. Right Communication: The registered nurse communicates specifically what, how and by when delegated tasks are to be accomplished. Communication includes the purpose and goal of the task, limitations and expectations for reporting. In the case example there was no meaningful communication that took place between the RN and LPN. The LPN was not expected to communicate assessment data to the nurse and no limitations on the LPN’s actions were stipulated. The LPN reported the conclusion that both inmates were “okay” but was asked no follow up questions by the RN to amplify the basis for the decision. The LPN did not communicate with the registered nurse when the inmate was later found unresponsive even after the “on call” physician was called.

5. Right Supervision: The registered nurse monitors and evaluates both the patient and the staff’s performance of delegated tasks.  The registered nurse is prepared to intervene on behalf of the patient as necessary and provides staff feedback to increase competency in task performance. In the case example the RN had several opportunities to monitor the patient’s care and to intervene but failed to do so. The nurse was unaware of the responsibility to monitor and supervise the LPN in the performance of the delegated task. The nurse said that the LPN always provided the response to medical emergencies and did not think the RN could alter this “assignment”.

Conclusion of the Case Example: The agency policies, procedures and the description of job duties were consistent with state practice guidelines but were too general. The nurses were not familiar with the nurse practice act and had simply continued practices on the evening shift that had been in place at the time, including staff defining the duties that they were most comfortable performing. The “after action” review resulted in increased staff knowledge of the nurse practice act, coaching of the nurses on delegation of tasks, and increased communication between staff on shift about the goals and process of patient care.

Your thoughts about this subject are important to us. Have you had experience clarifying nursing scope of practice in correctional health care?  What tools or resources did you find most helpful? 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.

References:

American Nurses Association. (2007). Corrections Nursing: Scope and Standards of Practice. Silver Spring, MD: Author

National Council of State Boards of Nursing and the American Nurses Association. (2006). Joint Statement on Delegation. Retrieved December 31, 2013 at https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

National Council of State Boards of Nursing. (1997) The Five Rights of Delegation. Retrieved December 26, 2012 from https://www.ncsbn.org/fiverights.pdf

Weydt, A. (May 31, 2010). Developing delegation skills. OJIN: The Online Journal of Issues in Nursing. Vol. 15, No. 2, Manuscript 1 

Photo Credit:   © igor– Fotolia.com

 

Best of the Blog #2: Correctional Nurse Certification Options

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 Lorry Schoenly, originally aired July 19, 2012.

Blank award ribbon rosetteHave you considered certifying in the correctional nursing specialty? Most established specialties have a certification process. Correctional nursing has several options for your consideration. Is certification for you?  According to the American Nurses Association, certification validates nursing skills, knowledge, and abilities. In addition, they contend that certification contributes to better patient outcomes. Certified nurses are role models of professional accountability. Certification empowers nurses and validates their understanding of the unique nature of their specialty. It can lead to increased self-esteem, job satisfaction and respect. Certified nurses distinguish themselves through a commitment to lifelong learning and career advancement, according to the American Association of Critical Care Nurses.

In Chapter 3: Legal Considerations in Correctional Nursing of the Essentials of Correctional Nursing, Jacqueline Moore, PhD, RN, CCHP-A, CCHP-RN suggests that another benefit of certification may be decreased liability. Since certification is fairly new in correctional nursing, the jury is still out on that aspect.

Certification is not only important for the individual nurse, it is also important to the correctional nursing profession. The development of specialty certification for correctional nursing is an important milestone. It helps to legitimize the specialty of correctional nursing and validates that professionals possess a unique body of knowledge and skills. It inspires other correctional nurses to seek certification and stimulates interest in correctional nursing research. Correctional nursing certification is another action toward enhancing and fostering professionalism in this specialty.

There are two main certifications available to correctional nurses.  The National Commission on Correctional Health Care (NCCHC) awards the CCHP-RN (Certified Correctional Health Professional – Registered Nurse) to registered nurses working in the correctional setting. The American Correctional Association offers two certifications:  CCN (Certified Corrections Nurse) is a generalist certification and CCN/M (Certified Corrections Nurse/Manager) is a manager certification. Certification requirements and exam content areas are listed below.

Eligibility Requirements

CCN-Licensed RN, LPN, LVN; One (1) year work experience in correctional nursing in present position

CCN/M – Registered Nurse (RN) in good standing with State Nursing Board;  Associate, Bachelor of Science, Master of Science in Nursing, or a three (3) year Nursing Diploma;  One (1) year of Correctional Nursing Management experience; individual supervises other medical personnel and administrative staff

CCHP-RN – Current CCHP certification;  Current, active RN license within a U.S. state or territory or the professional, legally recognized equivalent in another country, not restricted to corrections only;  Equivalent of 2 years full-time practice as a registered nurse (2,000 hours of practice in a correctional setting within the last 3 years);  54 hours of continuing education in nursing, with 18 specific to correctional health care, within the last 3 years

Certification Exam Content Areas

CCN & CCN/M

CCHP-RN

Health care in corrections Clinical management of patients
Legal issues in corrections Promotion of a safe & secure health care environment
Mental health Health promotion & maintenance
Nursing practice & standards Professional role & responsibilities
Managing security & environment
General & offender management
Conflict management
Human resource management

Have you taken one of the certification exams described above? How has it benefited you?

Photo Credit: © valdis torms – Fotolia.com

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 http://nursesbooks.org/Homepage/Hot-off-the-Press/Correctional-Nursing-2nd.aspx. 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.

References:

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 http://ncchc.sclivelearningcenter.com/index.aspx?PID=4622&SID=172421

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