Thanksgiving

Graphic typographic montage illustration of the word Thanksgiving composed of associated terms and defining words in neutral tones. A pair of autumn leaves completes this dramatic, inspirational design.

This week we celebrate Thanksgiving, an American holiday to give thanks for the abundance of the previous year and the fall harvest. Many, but not all of us, get together with family and friends to enjoy a meal and the company of others as fall turns to winter. Some of us will be working, sharing the holiday with our colleagues and patients. No matter what specific plans we each have for the holiday, it is a time of reflection, to identify and give voice to that for which we are thankful.

Lorry, Gayle and I are thankful for you, the readers of the Essentials of Correctional Nursing. Lorry wrote the first post almost five years ago just as we finished editing, our text, The Essentials of Correctional Nursing. We have posted a new blog nearly every week since then. We are grateful to Gayle for joining our blogging adventure this past year and enjoy her take on issues in correctional nursing.

Our purpose in writing the blog is to amplify the material included in the book and to further explore new and recurrent issues in correctional nursing practice. Our most frequently viewed posts address the subjects of delegation, certification in correctional nursing, vital signs, withdrawal, spiritual distress, the ANA Scope and standards of professional practice, and evidence-based practice. As we look back over our files we are thankful for the opportunity the blog has given us to explore subjects in depth.

Day by day, week by week, year by year our readership has grown. We average over 150 hits on the blog every day and have had over 300 hits on some days. Our readership is from all over the world and we have benefited from our contact with correctional nurses from all across the globe. We have more than 200 regular subscribers on email, over 4,000 on Twitter and more than 700 on Facebook. Thank you for your interest and support for the Essentials of Correctional Nursing.

We published The Essentials of Correctional Nursing in 2012, along with eight contributing authors, to reflect the distinguishing features and practices of this specialty in the field of nursing. In doing so we benefited from the support of many colleagues who peer reviewed the manuscript and offered insight about issues in correctional nursing. The text has since been recommended as a resource applicants use to study for certification in correctional nursing. Lorry also has written a series of posts on this blog about how to study for the certification exam and her own journey becoming certified. We are grateful for the growing legion of nurses who are certified in correctional nursing; you are the voice of the profession! If you are not yet certified, perhaps this could be your goal for the new year. It is easier than you think and there are many benefits.

At the end of every year Lorry and I discuss how we are doing with the blog and decide whether to continue and if so, what subjects we are going to tackle in the coming year. This year we decided that with other opportunities and commitments, it is time to move on and no longer will post on the Essentials of Correctional Nursing blog. However we are maintaining the site and the collection of 220 or so posts as a continuing resource for correctional nurses. Next week’s post will be the last and includes a table of contents so that each of our previous posts can be easily accessed from this page!

We continue to support correctional nursing practice through our writing, consulting, and speaking. Here are some helpful links to other correctional nurse resources that we support and endorse:

CorrectionalNurse.Net Blog

Correctional Nursing Today Podcast

CorrectCare Magazine

The Essentials of Correctional Nursing can be ordered directly from the publisher or from Amazon today!  Lorry and I, or any of the contributing authors, are always glad to sign and personalize your copy of the text.

Have a safe and grateful holiday!

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Correctional Nurse Goals for 2015: Get Certified!

Hand underlining 2015 Goals with red marker, business conceptWhat, you say? Take an exam in 2015? Do I really want to do that? Are these questions running through your mind at the idea of getting a certification this year? Here are some thoughts on why you should consider becoming certified in your specialty this year.

I Have a Nursing License Already

You might be asking yourself – why do I need certification when I have a nursing license? Licensure is definitely required to provide our level of health care. It is a governmental requirement for practice that protects the public from incompetent practitioners. Specific educational requirements, such as the amount of practical hours of training, are often a part of the State Practice Acts governing entry level into the profession.

Certification, on the other hand, is voluntary, non-governmental, and not required to enter into nursing practice. It recognizes an individual’s advanced knowledge and skill beyond initial licensure. Most certification programs require a minimum number of hours of practice in the specialty along with a written certification exam.

Worth the Effort?

Is there value to all the effort it will take to gain certification? The American Board of Nursing Specialties completed research in this area and found these 5 components of certification value. Which ones resonate with your professional values?

Professional Recognition: Probably first and foremost is professional recognition among employers, peers, and consumers. Certification denotes a proven knowledge base and documented experience in a given specialty. I experienced this myself as a consumer this past year when my husband prepared for a total hip replacement. The orthopaedic surgeon looked young to me…a problem I have a lot these days as I am getting older (!). While in the waiting room for the consultation visit, I was contemplating asking that uncomfortable question about how many surgeries of this type he had completed. However, just in time, my eyes fell on a framed certificate of board certification with the American Academy of Orthopaedic Surgeons. That was comforting…as was our conversation with him shortly afterwards where he explained the procedure and volunteered his frequency of performing it. By the way, my husband is doing very well after the surgery and we are very happy with the results.

Professional Credibility: Credibility is another component of certification value. This was important to me when I became a correctional nurse educator 10 years ago. If I was going to be orienting and educating nurses in the specialty, they needed to know that what I was saying was credible and that I knew what I was talking about. One way to do this is through certification. I started on my journey to the basic CCHP certification the first year I was a correctional nurse. Actually, I brought others along with me by starting certification study groups in any facility with interest. We had over 20 people sit for the certification exam after we all studied together. It was exhilarating and I recommend this as an idea for you. Start a study group in your facility and go through the process together.

Sense of Accomplishment: It is easy to see how you would have a sense of accomplishment through successful completion of a specialty certification exam. It can be hard work and you deserve congratulations at the finish line.

Knowledge Validation: Certification validates basic knowledge for the particular specialty – above and beyond initial general professional knowledge.

Marketability: All these outcomes also mean marketability. Certification means you will stand out in a crowd of resumes vying for a particular position. It not only speaks to your knowledge but to your motivation and perseverance in the specialty. Someone who is only passing through is not going to bother with certification. Someone who is not interested in their career is not going to get certified. Someone who is not willing to diligently pursue excellence is not going to be certified. You get the picture. Certification says you are someone who is motivated to do a good job in our specialty.

I hope I have convinced you to consider certification in correctional nursing in 2015. Here are some earlier posts that can help you create an action plan to prepare for certification:

Correctional Nurse Certification Options

The Certification Journey #1: Where Do We Start?

The Certification Journey #2: Determining What to Study

The Certification Journey #3: Creating a Study Plan

The Certification Journey #4: Rule the Day

What do you think about professional certification? Share your thoughts in the comments section of this post.

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Correctional Nursing: How to Improve the Practice Environment

Nursing background concept

The first examination of the qualities of professional practice in correctional nursing was done recently in Ontario, Canada. Conclusions from the surveys and interviews of 297 nurses and nurse managers were that the work environment was characterized as understaffed with significant role overload. These nurses also reported limited access to resources, significant autonomy but limited control over practice and experienced significantly higher levels of emotional abuse, conflict and bullying than nurses in other studies. The source of emotional abuse, conflict and bullying most often originated from custody staff followed by other nursing staff (Almost et.al. 2013a). These results support earlier publications about the practice challenges in correctional nursing including limited access to resources and education (Flanagan and Flanagan 2001, Maroney 2005, Smith 2005) , pressure to conform to the values of the custodial subculture (Holmes 2005), and challenges to clinical decision making authority (Smith 2005, Weiskopf 2005).

Reasons to improve the quality of the work environment include the ability to attract and retain nurses, increased productivity, improved organizational performance and better patient outcomes (Almost et.al 2013a, Sherman & Pross 2010, Dall et.al 2009, Needleman et.al 2006). Focusing on improving the professional work environment yields significant results even in the absence of increased staffing (Flynn et.al 2012, Aiken et.al. 2011, Friese et.al. 2008).

The following paragraphs discuss five factors in work environments that can be modified or enhanced to support professional nursing practice.

  1. Control over practice
    • Accurate interpretation and clarification of the state nurse practice act and its guidance in job descriptions, work assignments and policies and procedures (Knox, West, Pinney & Blair 2014, White & O’Sullivan 2012). Workplace directives should also incorporate or reference relevant aspects of the ANA standards of professional practice for correctional nurses (Knox & Schoenly 2014).
    • Work flow should be examined so that barriers to effective practice can be eliminated including system gaps that increase work complexity and work that is not related to patient care (Knox, West, Pinney & Blair 2014, Ebright 2010, Schoenly 2013). An example of the former is locating supplies used for nursing treatments in multiple locations. An example of the later is when nurses are expected to gather and report data on service volume or for quality assurance audits (number of sick call visits, number of clinic appointments, and number of incomplete MARs etc.).
    • Increase nursing participation on committees such as pharmacy and therapeutics, morbidity and mortality review, mental health, utilization review, and medical administration (Aiken et. al. 2011, Flynn et. al. 2012, Almost et.al. 2013a). Staff meetings also should be reviewed to see if meaningful two way dialogue can be increased to involve nurses in identification and early resolution of practice problems.
    • Consider assignment models that emphasize use of nursing process and clinical judgment rather than task completion; where registered nurses provide a greater proportion of direct care themselves while actively supervising care delegated to others (Corrazini et.al 2013a; MacMurdo, Thorpe & Morgan 2013). Staffing takes thoughtful preparation and legacy staffing practices may no longer work as complexity in health care delivery increases (Knox, West, Pinney & Blair 2013, Ebright 2010, MacMurdo, Thorpe & Morgan 2013).
  2. Autonomy in clinical practice
    • Considered one of the hallmarks of correctional nursing it is also an Achilles heel in the absence of appropriate clinical guidelines and support in their use (ANA 2013, Smith 2013, Smith 2005). Protocols should be based upon nursing process and coordination of care rather than reaching a medical diagnoses and rushing to treatment conclusions.
    • Nurses must be appropriately qualified and experienced in assessment and clinical reasoning as well as skilled in surveillance related to the variety of clinical situations encountered in the correctional setting to use protocols.
    • Provide access to information and tools that enhances recognition of clinical patterns and deviations necessary for good clinical judgment (Ebright 2010).
    • Assist nurses to prioritize and coordinate care with daily briefings, debriefings, huddles and work flow tracking to provide real time information about the availability and assignments of other members of the health care team (including primary care and mental health staff).
  3. Positive workplace relationships
    • Establish clear expectations for a respectful workplace in policy, procedure and other written directive. These instructions should define behaviors consistent and inconsistent with professional behavior in the workplace; describe what to do in the presence of unprofessional behavior and how to report these incidents (Almost et.al. 2013a).
    • Joint meetings and interdisciplinary training can be the vehicle to demonstrate support for the goals of both health care and custody (Almost et.al. 2013a, Weiskopf 2005).
    • Nurses may benefit from additional development in the area of conflict resolution because they have such a prominent role negotiating coordination of patient care with custody operations (Schoenly 2013, Weiskopf 2005).
    • Increase communication about patient care between registered nurses and LPN/LVNs (Corrazini et. al. 2013).
  4. Support education and certification
    • Orientation also needs to be tailored to the needs of each individual based upon education, licensure and an assessment of competency (Knox, West, Pinney & Blair 2014; Shelton, Weiskopf & Nicholson 2010). The ANA scope and standards of professional practice should also be incorporated into new employee orientation so that nurses develop institution specific skills consistent with the expectation of the professional discipline (Knox & Schoenly 2014).
    • Mentoring and coaching of new employees should be emphasized in development of expertise in clinical reasoning (Schoenly 2013, Ebright 2010).
    • Use creative, simple approaches to continuing education including self-study, reflective exercises, on-line web based seminars, facilitated case review and discussion, and a journal club (Almost et.al. 2013b, Schoenly 2013). Staff with superior knowledge and skill in a subject area can be asked to assist in developing relevant continuing education material (Knox, West, Pinney & Blair 2014).
    • Certification in correctional nursing is available through both the American Corrections Association and the National Commission on Correctional Health Care. These exams are offered regionally and can be administered at the place of employment if there are enough people taking the exam.
  5. Adequate resources
    • Includes staffing, equipment and supplies as well as access to leadership. Examining the work of first line managers may reveal sources of role overload (scheduling, meetings, payroll data gathering etc.) that impede their availability to line staff and can be reassigned to increase the availability of clinical leadership to line staff(Almost et.al. 2013a).
    • Review legacy staffing practices and work flow to identify opportunities to adjust assignments that result in more appropriate or effective use of existing resources (Knox, West, Pinney & Blair 2013, Ebright 2010).
    • Involve nurses in evaluation of equipment and technology decisions to prevent acquisition of products that complicate rather than improve delivery of patient care (Ebright 2010). For example decisions about how patient specific prescriptions were packaged have impacted timeliness and accuracy of medication administration in some correctional facilities because the packaging was cumbersome and time consuming for nurses to use.

Conclusion: Attention to the work environment of nurses (control over nursing practice, autonomy without isolation, positive working relationships, support for education and specialty certification, and adequate resources) has a profound effect on nursing practice, the ability to recruit and retain nursing personnel and on patient outcomes. More resources about work environments that support professional nursing practice can be found at the sites listed in the resources section below.

What do you think can be done to improve the professional practice work environment for correctional nurses? Are there resources or solutions not discussed here that should be? Please share your opinions by responding in the comments section of this post.

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.

Resources

 

References

Aiken, L.H., Cimiotti, J.P., Sloane, D.M., Smith, H.L., Flynn, L., Neff, D.F. (2011) Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care 49(12): 1047-1053.

Almost, J., Doran, D., Ogilvie, L., Miller, C., Kennedy, S., Timmings, C., Rose, D.N., Squires, M., Lee, C., Bookey-Bassett, S. (2013a) Exploring work-life issues in provincial corrections settings. Journal of Forensic Nursing 9:1

Almost, J., Gifford, W.A., Doran, D., Ogilvie, L., Miller, C., Rose, D.N., Squires, M. (2013 b) Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context. Implementation Science 8:71

American Nurses Association. (2013) Correctional Nursing: Scope and Standards of Practice. Silver Spring, MD: Nursebooks.org

Corrazzini, 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.

Dall, T.M., Chen, Y.J., Seifert, R.F., Maddox, P.J., Hogan, P.F. (2009). The economic value of professional nursing. Medical Care 47 (1):97-104.

Ebright, P.R. (2010). The complex work of RNs: Implications for a healthy work environment. Online Journal of Issues in Nursing. 15(1).

Flanagan, N. & Flanagan, T. (2001) Correctional nurses’ perceptions of their role, training requirements and prisoner health care needs. The Journal of Correctional Health Care 8:67-85.

Flynn, L., Liang, Y., Dickson, G., Xie, M., Suh, D.C. (2012) Nurse’s practice environments, error interception practices, and inpatient medication errors. The Journal of Nursing Scholarship. 44(2):180-186.

Friese, C.R., Lake, E.T., Aiken, L.H., Silber, J.H., Sochalski, J. (2008) Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research. 43(4): 1145-1162.

Holmes, D. (2005) Governing the captives: Forensic psychiatric nursing in corrections. Perspectives in Psychiatric Care 41(1):3-13.

Knox, C.M., Schoenly, L. (2014) Correctional nursing: A new scope and standards of practice. Correct Care, 28 (1) 12-14.

Knox, C.M., West, K., Pinney, B., Blair, P. (2014) Work environments that support professional nursing practice. Presentation at Spring Conference on Correctional Health Care, National Commission on Correctional Health Care. April 8, 2014. Nashville, TN.

MacMurdo, V., Thorpe, G., & Morgan, R. (2013) Partners in practice: Engaging front-line nursing staff as change agents. Presentation at Custody & Caring, 13th Biennial International Conference on the Nurse’s Role in the criminal Justice System. October 2-4, 2013. Saskatoon, SK.

Maroney, M.K. (2005) Caring and custody: Two faces of the same reality. Journal of Correctional Health Care. 11:157-169.

Needleman, J., Buerhaus, P.I., Stewart, M., Zelevinsky, K. Matke, S. (2006) Nurse staffing in hospitals: Is there a business case for quality? Health Affairs. 25(1):204-211.

Shelton, D., Weiskopf, C., Nicholson, M. (2010). Correctional Nursing Competency Development in the Connecticut Correctional Managed Health Care Program. Journal of Correctional Health Care. 16 (4). 38-47.

Sherman, R. & Pross, E. (2010) Growing future nurse leaders to build and sustain healthy work environments. Online Journal of Issues in Nursing. 15(1).

Schoenly, L. (2013) Management and Leadership. In Schoenly, L., & Knox, C. (Ed.) Essentials of Correctional Nursing. New York: Springer.

Smith, S. (2013) Nursing Sick Call. In Schoenly, L., & Knox, C. (Ed.) Essentials of Correctional Nursing. New York: Springer.

Smith, S. (2005) Stepping through the looking glass: Professional autonomy in correctional nursing. Corrections Today 67(1):54-56.

Weiskopf, C.S. (2005) Nurse’s experience of caring for inmate patients. Journal of Advanced Nursing 49(4):336-343.

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: Nursebooks.org.

Photo credit: © Kheng Guan Toh – Fotolia.com

 

Challenges providing end-of-life care in prisons and jails

imPossible conceptThe first prison based hospice was established in the United States in the late 1980’s.  Since then 75 hospice programs are in place in prisons and jails across the country. Most of these programs were established within the agency’s existing budget. One of the distinguishing features of the programs in correctional facilities is the use of inmates as hospice workers. Inmate hospice workers may assist patients with activities of daily living (ADLs), provide companionship, assist with relaxation techniques, run errands, provide translation or interpretation for deaf and non-English speakers and perform clerical work (MaAdoo, 2012). Hospice practices that have been adapted for use in prisons and jails include:

  • Increased family involvement made possible by modified visiting rules
  • In addition to nurses and other health care professionals the interdisciplinary treatment team includes the chaplain, a social worker, one or more members of the correctional staff, the inmate, and family as well as the hospice workers.
  • An individualized plan of care that includes structured, documented discussion about treatment options in the form of advanced care planning.
  • Skilled clinical management of pain and other symptoms as evidenced by access to analgesia used to manage pain, protocols for proper administration, and training of clinical staff in palliative care.
  • Bereavement services for patients, family, other inmates, hospice workers, and staff to cope with death and associated grief.
  • Modification of the physical environment to increase comfort and provision of special food (Craig & Ratcliff, 2002).

Nurses have often been the change agent responsible for bringing hospice care into correctional facilities and they continue to be instrumental in the adaptation of hospice practices to this population and setting. One of these nurses is Tonia Faust CCNM, RN the hospice program coordinator at Louisiana State Prison who is featured in The American Nurse by Carolyn Jones (2012).  Her interview was featured in a segment about the book done recently on the Newshour on the Public Broadcasting Service.

Is hospice care available at your correctional facility? What are some of the challenges you have experienced in providing end-of-life care in the correctional setting? The following are some challenges in developing hospice programs in correctional facilities that have been described.

There is conflict between priorities of caring for the patient and ensuring security.  This includes challenges related to trust for both inmates and staff. Staff voice concern that an inmate in pain will over-report distress to obtain narcotics or other medication that is then misused. Inmates see health care providers, including nurses as serving the goals of the criminal justice system instead of meeting the patient’s needs.  Inmates may not have sufficient health literacy to fully engage as members of the treatment team and be wary of asking for assistance. Special consideration must be given to the role of correctional officers so that they can support of end-of-life care and maintain safety and security.  Unaddressed these conflicting priorities can result in delaying access to appropriate, clinically responsive end-of-life care.

The environment is a deterrent to quality at the end of life. Housing hospice patients in a specific location such as part of the infirmary or a housing unit can create stigma, increase isolation, reduce access to programming and other privileges, prevent the patient from receiving support from friends living in general population. Another challenge with regard to the setting is that the location, even the infirmary, may not have proper equipment or supplies to deliver hospice care.

Comfort measures may be prohibited or too restrictive.   Most correctional systems prohibit staff from touching prisoners except as necessary to perform a duty.  The use of touch by staff to provide comfort in health care is usually not allowed or very restricted. In addition staffing ratios in most correctional health care programs are not rich enough for nurses to spend time comforting dying patients. The use of inmates to provide hospice care has enhanced the ability to provide comfort but this may be limited by operational needs such as lockdowns, restricted line movements, and other security measures which can reduce access to hospice workers when comfort care is most necessary.

Expression of grief is restricted.  Inmates and staff are concerned that expression of grief within the correctional setting makes them vulnerable to being taken advantage of by predatory inmates. Cultural practices within the correctional setting may not acknowledge vulnerability especially as it relates to emotions like loss and grief. Many inmates have experienced the loss of a family member and because of their incarceration were not able to make a deathbed visit or participate in the funeral or other memorial service. The inability or failure to grieve loss contributes to depression, anxiety and the inability to cope with subsequent losses.

Clinical care is inconsistent with standards for hospice and palliative care.  The normal operation of the health care program may limit the time providers can spend with patients and the patient may experience frequent changes in the care provider they are assigned. Further some facilities limit the number of problems an inmate can bring to a health care appointment. End-of-life care requires a different kind of patient provider interaction to discuss choices about life prolonging interventions, to make decisions about limiting care and to develop a plan of care that anticipates and addresses symptoms quickly and responsively. Another challenge is to ensure access to the full complement of analgesics including controlled substances and other medications used to manage pain and other distressing symptoms. Finally health care staff must be knowledgeable and skilled in the practices of palliative and end-of-life care along with all of the other areas of expertise that a correctional health care provider must have to care for this population.

What successes have you had as a correctional nurse addressing these challenges to delivery of end-of-life care? Please share your experience by responding to this post in the comments section. To order a copy of The American Nurse go to www.welcomebooks.com/americannurse. Proceeds from the sale of the book will support a scholarship fund for nurse education. For more on nursing and end-of-life care in the correctional setting see Chapter 8 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1209 the price is discounted by $15 off and shipping is free.

References:

Craig, E. & Ratcliff, M. (2002). Controversies in correctional end-of-life care. Journal of Correctional Health Care, 9, 149-157.

Howe, J.B., Scott, G. (2012) Educating prison staff in the principles of end-of-life care. International Journal of Palliative Nursing.  18(8): 391-395

Jones, C. (2012). The American Nurse: Photographs and Interviews by Carolyn Jones. Welcome Books

Knox, C. (2012). End-of- life care. In Schoenly, L. & Knox, C. Essentials of Correctional Nursing. Springer. NY.

Loeb, S.J., Penrod, J. Hollenbeak, C.S., Smaith, C.A. (2011) End of life care and barriers for female inmate.  Journal of Obstetric, Gynecological and Neonatal Nurses. 40: 477-485

McAdoo, C., Price, C. (2012) Models of Care: End-of-Life Care in Prisons. Presented at Updates in Correctional Health Care. National Commission on Correctional Health Care. May 2012. San Antonio TX. Accessed 8/12/13 at http://ncchc.sclivelearningcenter.com/index.aspx?PID=4622&SID=128752

Stone, K., Papadopoulos, I., Kelly, D. (2011) Establishing hospice care for prison populations: An integrative review assessing the UK and USA perspective.  Palliative Medicine.  26(8):969-978

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Do You Wonder How Many Correctional Nurses Are Out There?

Medical multiethnic team

I renewed my nursing license this week and was reminded of how isolating the specialty of correctional nursing can feel at times. As part of the online renewal process I was asked to provide information about my work location and practice area.  A correctional facility was not among the choices available for work location. Nor was correctional nursing among the choices for practice area. There was an option of writing this information in the “Other” category. This is what I chose to do but only after wondering whether it was going to be worth it.

Have you had this kind of an experience?

The task group that revised the Correctional Nursing: Scope and Standards of Practice (American Nurses Association, 2013) went to some effort to identify how many nurses practiced in correctional settings.  While the Forum of State Nursing Workforce Centers recommends that correctional facility be listed as an employment option for data collected about the nursing workforce there is little evidence that this recommendation has been acted upon.  My own experience this week is consistent with this conclusion. When you renew your nursing license is there an option to indicate that you work in a correctional setting?

The best source of data the ANA task group found was from the Health Resources and Services Administration (HRSA) which reported in 2008 that 20,772 registered nurses or 0.8% of all registered nurses identified a correctional facility as their employment setting.  The ANA task group identified several reasons why the HRSA estimate under represents the number of correctional nurses.  What do you think are the reasons correctional nursing is under represented?

I recently purchased The American Nurse by Carolyn Jones (2012) which is a beautiful coffee table book of 75 portraits of nurses. The purpose of the book is to celebrate the role of the nurse in the health care system by capturing and sharing the images and stories of nurses from all across America.  I wondered if these 75 nurses were a representative sample of working nurses, how many would be correctional nurses?

The results surprised me. Four of the nurses or five percent of the sample portrayed in The American Nurse identified themselves as providing health care in a correctional facility.  This means that an estimated 131,750 nurses were working in a correctional setting at the time of the 2008 HRSA report (a lot more than 20,772)!  Another nurse portrayed in the book, Sharon Kozachik, described working as a prison nurse early in her career.  She is now a nurse researcher and assistant professor at the Johns Hopkins University. They have a combined total of 40 years of correctional nursing experience in Kentucky, California, Louisiana and Michigan.  Four of the nurses worked in prisons and one in juvenile detention.  In the interviews they talk about why they got into correctional nursing, the importance of being a role model, the challenge negotiating for patient needs in the custody setting, and how the work affects their lives.  One is a Certified Correctional Nurse Manager; this is the exam Lorry wrote about studying for and just passed!

It was a rich and exhilarating experience to read about nurses in all kinds of practice settings making such a difference in the lives of patients and their families. I was proud to see evidence that correctional nursing has attained a rightful place among the healers in our community.  To order a copy of The American Nurse go to www.welcomebooks.com/americannurse. Proceeds from the sale of the book support a scholarship fund for nurse education.

Read more about the profession in Chapter 19 of the Essentials of Correctional Nursing.  Order your copy directly from the publisher; use promotional code AF1209 for $15 off and free shipping.

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Certification Journey: Rule the Day

Scantron TEST blocks and pencil.After weeks and months of planning and study, the exam day finally arrives. Now is the time to focus your mind and do your best. Exam day came for me just last Saturday, January 26, 2013. I had some challenges following the study plan I had created for myself, but tried to keep positive about my knowledge and background to be successful on exam morning. Staying calm and positive is important when taking an exam. Anxiety can block thinking and thwart efforts.

The day before the exam I located the exam room. It was a bit of a walk from the convention center entrance to the room and I was glad I took the time to look for it. Although that worked out well, my breakfast plans did not. It wasn’t until Saturday morning that I discovered that breakfast is served later on the weekends at my hotel so I had to arrive at the convention center without the hearty breakfast I had expected. Fortunately Starbucks opened in time for me to enjoy a yogurt parfait and a Grande Latte before heading to the room.

The CCN/M certification exam consists of 200 questions that include multiple choice and true/false formats. They allow 4 hours to take the test. That is about 50 questions per hour, so you need to pace yourself. A watch would have been helpful. We had to shut off our cell phones so I didn’t really know what time it was. I’m usually a fast test taker so I wasn’t concerned about running out of time.

Knowing your test-taking personality is an important part of successful certification. Here are seven personalities to consider. Which one are you?

Rusher– Rushes to complete the test before they forget everything

Turtle– Repeatedly rereads, underlines, and checks answers

Personalizer– Relies heavily on own background and experience

Squisher– Preoccupied with grades and personal accomplishment

Philosopher– Searches questions for hidden or unintended meaning

Second Guesser– Frequently changes initial responses

Lawyer– Attempts to place words or ideas into the question

Turns out I am a philosopher test-taker so I needed to be careful not to get tied up over-thinking the questions. In fact, by the time I was done answering 200 questions, I was rather unsure of myself leaving the room on Saturday morning. Did I answer enough questions correctly?

One of the toughest parts of certification can be the waiting after completing the test. Fortunately, more and more certification programs have speedy responses. Six days after exam day I received an email from the certification director. I PASSED!

I hope sharing my certification journey has been an encouragement to you to obtain certification in correctional nursing. If you are considering certification, read this blog post on your certification option.

Preparing for the CCHP-RN or CCN/M Certification Exams? Order your copy of Essentials of Correctional Nursing directly from the publisher. Use Promo Code AF1209  for $15 off and free shipping.

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Certification Journey: Creating a Study Plan

Now that I have committed to taking the CCN/M certification exam and determined what I need to study, the next step is creating a study plan. Like any project, successfully completing certification takes time and effort. The date of the exam gives me the due date for this project. Now I need to chart a course to reach that destination ready to pass the test. Having certifications in six different specialties over the course of 25 career years, I have done my share of exam prep. Here are my key strategies to prepare for exam day.

Get Your MoJo

2012-12-06_11-03-58_11I have to really want to do this to succeed. Studying is hard work; even harder when you get into my age range! If I do not have a good reason to take this exam, I will not focus on my study plan. Writing out a list of reasons why this is an important project and posting it somewhere handy can help. Here is my WHY list in eye-view from my desk top.

Claim Free Time

Earlier this year I read the book 168 Hours: You Have More Time Than You Think. It helped me realize where I could more effectively use my time. Which exam study in mind, I’m looking for where I can switch out ineffective time use with study time. Everyone has 168 hours in the week. It is how we use our hours that is important. Even with 40 hours of work and 40 hours of sleep a week, there are still plenty of hours left for exam study. After an analysis of my current time use and my energy levels, I decided on 3-5pm on Monday, Tuesday, and Wednesday for my study schedule.  That is 6 hours per week for the next 6 weeks (accounting for the Christmas/New Year week off for festivities).

Find Your Study Personality

Knowing how best to absorb and retain needed information is both and art and a science. The art part comes in knowing yourself. Do you concentrate best in total quiet or do you need background music? Are you better studying in small chunks of time or to you need a concentrated block to zone-in on the information? Do you absorb information better in the morning, afternoon, or evening? By understanding your study personality, you will be more effective in the time you take to prepare for an exam. I am best in the morning and worst in the evening but I save my morning hours for writing so I am going to make the best of my exam study in the afternoon. From my writing experiences, I know I concentrate best with classical music in the background. In addition, I need to be away from my desk and computer, if at all possible, as they easily distract me. My reading chair will be my study spot.

Plot Your End Game

The final part of a study plan is planning for the exam day. I want to be sure I am organized and well-rested to reduce as much stress as possible. The exam starts very early on Saturday morning so I have arranged to arrive in town early the day before to be able to find my way around, locate the exam room, and plot my morning – including where to get a good breakfast. I am keeping a folder with all the exam day materials such as the entrance pass. I will be sure to pack my pencils with erasers. I will also pack comfortable clothing that is in layers so I can adjust to the room temperature.

I’ll be using these strategies to prepare for exam day in Houston on Saturday, January 26, 2013. If you are also planning to be at the ACA Winter Conference, be sure to let us know by emailing essentialscorrectionalnursing@gmail.com. We’ll arrange a meet-up!

Preparing for the CCHP-RN or CCN/M Certification Exams? Order your copy of Essentials of Correctional Nursing directly from the publisher. Use Promo Code AF1209  for $15 off and free shipping.

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