Protective Gear for Correctional Nurses

The post last week talked about the problem of nurses being exposed to inappropriate and hostile sexual behaviors by inmates and the kinds of interventions that should be in place to minimize or control antisocial inmate behavior. Nurses were advised not to confront this behavior single handedly but to look to the facility for guidance. But that is just half the solution, the other half, which is the subject of today’s post, is that individuals can take steps on their own to minimize the adverse effects of these unfortunate situations on themselves.

The reality is that bad things do happen in corrections. Even in the best run correctional facilities inmates are injured and sometimes staff are injured as a result of violence and on some of these occasions died as a result of the violence. The nature of the correctional environment is that it always has the potential for immediate violence and direct trauma. Another pervasive aspect of our working environment is that because of the involuntary conditions of incarceration, there is inherent conflict, particularly between staff and inmates. These two features of the work environment combined with operational stressors, such as high workload, contribute to what has been called “Corrections Fatigue”.

It has been suggested that correctional staff prepare themselves to be in this environment the same way that they don other protective gear. An analogy for correctional nurses would be gowning, gloving and putting on a properly fitted mask before going into the isolation room of a patient with active tuberculosis. By wearing protective gear staff minimize their exposure. The same concept applies to the trauma associated with repeated exposure to violence or threatening behavior. What kind of “gear” minimizes our repeated exposure to trauma in the corrections environment?

Resilience is a characteristic that refers to an individual’s ability to cope with adversity; it is the ability to “bounce back” after a stressful experience. Resilience varies from one person to another but we can each tend to and build our resilience. Resilience, then is our protective gear. The following four behaviors have been identified as building resilience in correctional workers.

Build Supportive Relationships at Work – Building and maintaining social support among co-workers has been found to correlate with resilience for the person offering support. By building genuine bonds with co-workers we increase our sense of safety, reduce interpersonal tension and staff conflict. Examples of behaviors that are supportive of relationships at work include:

  • being friendly and respectful,
  • asking how a co-worker is and paying attention to their answer,
  • acknowledging a job well done,
  • looking for ways to assist others when you have time,
  • thanking others for their assistance, and
  • being compassionate with others’ experiences.

Take Care of Yourself – How many times have we as health care providers offered this advice to others? And yet we are known to neglect ourselves, making us vulnerable to burnout, compassion fatigue and now, corrections fatigue. Being healthy is a basic tenet of resilience. Healthy habits and lifestyle behaviors include those that attend not just to your physical needs, but psychological, spiritual and social needs as well. Healthy habits and lifestyle behaviors include:

  • maintaining balance between work and home life
  • mindfully transition to and from work
  • prioritize free time to be with people who are significant in your family and social life
  • engaging in pleasant activity-having fun
  • regulate negative emotions (emotional intelligence)
  • establish a regular and healthy sleep schedule.

Be Confident and Perseverant – These behaviors build competence handling complex or challenging circumstances at work. Confidence and perseverance are a result of:

  • a resolution to complete tasks even when it is difficult,
  • using self-talk to motivate oneself to persevere in the face of adversity,
  • rehearsing and repeating training so that it becomes more automatic and built in,
  • being flexible, open and adaptive to change
  • being ethical and acting with integrity.

Use Logic to Solve Problems – This approach is recommended as a way to keep your cool in the face of the complex or challenging problems we deal with in correctional health care. Thinking logically about situations means considering more than one possible cause and weighing possible responses before choosing the one that is most likely to have the effect you are seeking. This way you maintain control and composure in frustrating or disappointing circumstances. Practical ways to practice logical problem solving and self-control include:

  • divide complex problems into parts and tackle one component at a time,
  • learn how to detach emotionally from challenging situations,
  • view mistakes as learning opportunities,
  • regulate fear and other negative emotions while acting constructively,
  • accept that you cannot always be in control.

These four behaviors, supporting workplace relationships, taking care of yourself, being confident and perseverant, and logical problem solving are your protective gear (resilience) to reduce the effects of violence and other antisocial behaviors, conflict and other operational stressors that are inherent in the correctional setting on your health and well-being.

For more information about promoting wellness among staff who work in correctional settings please see the National Institute of Corrections has collected articles and other resources on this subject. They also sponsored a podcast on the subject in 2014 which can be accessed on the NIC website. Much of this information was adapted for correctional nursing from a series of articles written by Caterina Spinaris PhD., Executive Director of Desert Waters Correctional Outreach which provides training and other materials to support wellness of correctional staff including a monthly newsletter, Correctional Oasis.

I was most surprised to learn from my research for this blog post that when I offered support to co-workers it had a positive effect on me by building resilience. This new idea has me thinking about my work relationships and how I support others to see what I could do better. What resilience building behaviors have caused you to reflect on your own behaviors? Is there more you could do to protect yourself from the negative attributes of your working environment?

If you wish to comment, offer advice or share an experience concerning the subject of staff wellness please do so by responding in the comments section of this post.

Read more about correctional nursing in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

Photo credit: © designer491 – Fotolia.com

Sexual Harassment by Inmates Against Nurses

A nursing colleague recently asked for advice about how to address the problem of inmates masturbating and making verbal threats during nursing encounters. It is a problem nearly all correctional nurses will face at some point in their career. This post is written to ask nurses how they have dealt with inmates who expose themselves or masturbate in front of the nurse while administering medication, evaluating a health care complaint or responding to a man down call.

While nurses put up with some anti-social behavior in almost any setting, nurses really can be challenged with the pervasiveness of this in a correctional setting. Some nurses will confront the behavior, others will ignore it, and some dish it right back all in an effort of controlling the offensive behavior and getting nursing care delivered. However unchecked exhibitionism is a form of violence towards others that is not acceptable even in a correctional facility. In 2006, the Ninth Circuit Court of Appeals agreed with the lower court’s ruling under Title VII of the Civil Rights Act finding for the employee and noted that prison officials in the California Department of Corrections and Rehabilitation may “not ignore sexually hostile conduct and must take corrective action to safeguard the rights of victims, whether they be guards or inmates”. Similar litigation has been successful in Florida.

Nurses should not attempt to confront the problem alone and have good cause to look to their immediate employer as well as prison officials to address the problem of sexually hostile conduct. Another colleague, who is a corrections expert, recommends addressing the problem in an integrated way that includes making expectations for behavior explicit, delineating graduated consequences that include criminal charges and involvement of the local prosecutor. Here is a list of items which if in place at a correctional facility provide the means to address sexual misconduct:

  • There is an inmate handbook including written rules of conduct for inmates that specifically addresses the issue of exhibitionist masturbation and other forms of sexual misconduct.
  • The handbook also delineates the inmate disciplinary process- what specific offenses bring what penalties – including a description of the inmate disciplinary process.
  • The handbook is available in the languages of those who are incarcerated and written at a 5th grade level for those with low literacy skills.
  • Inmates are provided an orientation at intake – that is documented (video or in person) and goes over the rules, including the rules regarding exposure, masturbation and other forms of sexual misconduct.
  • This information is repeated by the housing unit officer, posted on the housing unit or televised in the living areas.
  • There are facility policies and procedures for staff that describe:
    • inmate housing unit management
    • inmate rules of conduct (including exhibitionism, masturbation in public and other forms of sexual misconduct)
    • how rules of conduct will be enforced and
    • the inmate disciplinary process.

          Also there is evidence that staff training about the facility policies and procedures has taken place     and repeated as necessary.

  • There are provisions for management of inmates with mental illness, or suspected of mental illness, related to in-custody behaviors and related discipline, and treatment.
  • There is documentation that inmates who engage in prohibited behavior receive disciplinary notices, participate in a disciplinary process, and if found guilty serve disciplinary sanctions. These sanctions may include but are not limited to disciplinary segregation.
  • For offenses such as exhibitionist masturbation one effective strategy to develop behavior contracts. For example, if the inmate serves X days of disciplinary sanctions without incident they get X days off their sentence.
  • There is a record of disciplinary notices, hearings, sanctions, etc. for these specific offenses.
  • There is a process by which staff notify their supervisors and/or the leadership regarding offensive inmate behavior.
  • The facility has programming and other services that can be withheld from inmates who violate policies/procedures and found guilty of disciplinary infractions.
  • Inmates who engage in this behavior repeatedly are charged via law enforcement and referred for prosecution. At one facility a prosecutor actually speaks to the inmates about how if they engage in this behavior and are administratively and/or criminally charged – how it effects their sentencing at trial, parole consideration, and conditions of release. Most inmates don’t think about the longer term consequences on their own so it helps to point it out.
  • Finally the agency should be aggressive in referring for prosecution – if the prosecutor declines- then the facility should focus on ways to convince the prosecutor to change their position.

Are these measures in place at the correctional facility you work at? You might want to review the inmate handbook at your facility and see if there are explicit guidelines about sexually hostile behavior and the consequences. Have you had experience addressing the problem of inmate masturbation during delivery of health care? If so, what was successful? Please share your experience by responding in the comments section of this post.

Read more about correctional nursing in our book the Essentials of Correctional Nursing. Order a copy directly from the publisher or from Amazon today!

Photo credit: © Maridav – Fotolia.com

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

 

Reflective Practice: A Means of Professional Growth

Catherine snapping the Bean in Chicago 10 2008In last week’s post the use of reflection was suggested as a means to improve skill and competency in conflict management.  In this post we will take a closer look at this technique. Reflection is thinking about a situation, experience or event to gain insight that changes how you respond to the next situation.  Reflection is not a casual reminiscence or venting about an event; it is a deliberate assessment to identify problems and areas of improvement. Reflection is an excellent learning tool because it requires nothing more than an experience to analyze.

Take a moment to identify a conflict that you experienced recently. It should be an experience that you would like to have handled better. It could be a coworker’s attitude expressed at a staff meeting, asking for help and getting shrugged off by another nurse, arguing with the treatment team about a plan for a patient, an encounter with the on-call provider or a supervisor; the possibilities are endless. The following are three phases of reflective analysis. You can choose to write about the situation and your answers to the questions below or you can talk it through with a mentor or coach.

1. Describe the conflict situation. Identify and describe your relationship to each of the others in the situation. Your description should identify each of your actions but also what you were thinking and feeling at the time. The description also includes any biases, values, ethics or culture of the work setting that were a factor.  Stop here and wait a couple days before returning to complete the next two steps.

2. Examine your description of the conflict. Select a yardstick or reference against which to evaluate the situation. You could use the conflict management styles discussed in Chapter 17 of the Essentials of Correctional Nursing. You could also use the Corrections Nursing: Scope and Standards of Practice (American Nurses Association, 2007), particularly Standards 10-12 and 15 or another reference on conflict management. How did your actions, thoughts and feelings compare to the standard you selected for comparison?  How did the environment or other aspects of the situation influence you?  What intentions motivated each of your actions?

3. Identify gaps between what happened and what you would like to have happened.  In this phase you are looking for gaps between actual practice and the standard of practice you selected for comparison. Gaps can be in the area of knowledge, skill, attitude or belief. These areas become the focus for further professional development. Typical questions you ask yourself in this phase are:

  • Were my actions the most appropriate and successful ones possible?
  • What were the most important things that got in the way of doing well and why?
  • How could I change to better address conflict in the future?

At the conclusion of a reflective analysis of conflict you decide what you want to do differently in the next conflict experience. This may include changing the way you think or feel about a conflict or gaining knowledge or skill in a particular aspect of conflict management. At the very least reflection provides you with insight about the factors that influenced your feelings, decisions and actions during the conflict experience.

Have you used reflection to evaluate your practice in correctional nursing? Let us know how this technique works for you and any additional tips you have about the use of reflection to improve practice by writing in the comments section of this post.

Read more about reflective practice in Chapter 19 from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

Resources:

Asselin, M. E. (2011) Improving practice through reflection. Nursing 2011 April, 44-47

Freshwater, D. (2008). Reflective practice: The state of the art. In D. Freshwater, B. Taylor & G. Sherwood (eds). International textbook of reflective practice in nursing (pp. 1-18). Oxford, United Kingdom: Blackwell Publishing

 

Photo Credit:Catherine Knox 10/22/2008 at NCCHC in Chicago

Managing Conflict is Essential to Safe and Effective Correctional Nursing

picket fenceI live in a neighborhood of 36 houses that are built very close to one another. The neighborhood is surrounded by a beautiful landscape. The peacefulness and beauty of the setting was the reason I chose to live here. Last week the moving truck used by a new homeowner blocked the neighbor’s driveway for most of the day.  The neighbor raised such a ruckus that the whole community heard about it and the homeowner’s association had to get involved. The incident made me appreciate how important it is to a “healthy” community that conflict be addressed well by each of the members.

These skills are even more important in health care because they contribute to patient safety and retention of nurses.  Unrecognized or unresolved conflict in the health care setting causes a decrease in nurses’ morale, increases physical and emotional stress, as well as the likelihood that conflict will escalate (Longo, J., 2010; Almost, J., Doran, D., Hall, L., Laschinger, H., 2010; Johansen, M., 2012). “…conflict management skills have been identified as an essential competency for the professional RN to provide safe, quality care to patients…” (Johansen, M., 2012 p. 50).

Conflict is an inherent aspect of correctional nursing practice. Sources of conflicts that are unique to correctional nursing are detailed throughout the Essentials of Correctional Nursing. The American Nurses Association draft of the Correctional Nursing: Scope & Standards of Practice, which has been out for public comments the last month, also discusses conflicts experienced by correctional nurses. Two of the proposed standards explicitly address expectations of correctional nurses to assess and improve their skills in conflict management.

What are the sources of conflict in your day to day nursing practice? How often are these conflicts resolved satisfactorily? Do you wonder what you can do to better address conflict in the practice setting?  The following are some steps to assess and improve conflict management skills.

1. Explore your own emotional triggers and reactions. Nurses who have good self- esteem, perceive themselves as successful, feel they are in control of their life and are optimistic are also more constructive in managing conflict.

2. Identify and review the organization’s written directives related to conflict management. These may be in the code of ethics, rules for professional behavior, bylaws of the governing body or in the collective bargaining agreement. Know what is expected of staff, the methods to identify and resolve conflict as well as avenues for redress when conflict is not satisfactorily resolved.

3. Address conflict quickly, fairly and respectfully. Sometimes people are not aware that their behavior contributes to conflict at the workplace. Communicating in a way that increases understanding and resolves conflict among participants is not an easy task. It should always be done in private. Chapter 17 of the “Essentials” book provides resources and suggests that nurses build their repertoire of conflict management styles, especially those of collaboration.

4. Take care of yourself. Stress can contribute to increased emotions, particularly anger. Nurses who understand how emotions affect their behavior have less risk of burnout associated with conflict in the workplace. Take appropriate breaks; attend to personal needs for nourishment, relaxation and other self-care habits. Reflective journaling has been suggested as way to process negative personal feelings after a conflict. In addition to reliving the negative effects of a conflict situation, reflection can be used to build skills and competencies in conflict management.  We will take a closer look at this technique in a future post on this site.

5. Report abusive or disruptive behaviors through your chain of command. Many nurses opt to ignore or avoid conflict without knowing that if left unattended, it contributes to an escalation in conflict. Avoiding conflict at the worksite only reinforces disruptive, dysfunctional and unprofessional behavior. Knowing your organization’s policies regarding workplace conflict is an important first step.

This post was written from the perspective of the individual registered nurse. Nursing supervisors, managers and executives have an exceedingly important role in creating a workplace that supports the professional practice of nurses and safe environments for patient care. Going back to the example of conflict in my neighborhood, our community works best when individual homeowners address conflict quickly and well.  The same goes for the workplace; it is the everyday acts of individual nurses managing conflict that does the most to keep staff and patients safe.

To read more about conflict management order your copy of the Essentials of Correctional Nursing directly from the publisher. Use promotional code AF1209 for $15 off and free shipping. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

References:

Almost, J., Doran, D., Hall, L., Laschinger, H. (2010). Antecedents and consequences of intra-group conflict among nurses. Journal of Nursing Management, 18, 981-992.

Dombrowsky, T. (2012). Responding to verbal abuse. Nursing 2012, November, 58-61.

Hocking, B. (2006). Using reflection to resolve conflict. Association of Operating Room Nurses Journal, 84 (2) 249-259.

Johansen, M. (2012). Keeping the peace: conflict management strategies for nurse managers. Nursing Management, February 50-54.

Kupperschmidt, B. (2008). Conflicts at work? Try carefronting. Journal of Christian Nursing, January-March, 10-17.

Longo, J. (2010). Combating disruptive behaviors: strategies to promote a healthy work environment. Online Journal of Issues in Nursing, 15 (1) 3.

Siu, H., Laschinger, H., Finegan, J. (2008). Nursing professional practice environments: setting the stage for constructive conflict resolution and work effectiveness. Journal of Nursing Administration, 38 (5) 250-257.

Thomas, C. (2010). Teaching student nurses and newly registered nurses strategies to deal with violent behaviors in the professional practice environment. The Journal of Continuing Education, 41 (7) 299-308.

Photo Credit: © zimmytws-Fotolia.com

Correctional Nurses: Always on Guard

Personal safety is a growing concern in all nursing specialties. Patient violence can take place in the emergency room, on inpatient psychiatric units and dementia wards. Correctional nurses are no strangers to the need for personal safety. We have visible proof all around us that our patients may turn violent. Officers often escort nurses around the compound and many locked doors must be negotiated to gain access to deliver care. The routine nature of security operations can blunt our continuing vigilance, however. I like to consider personal safety as multi-dimensional with the very basic start being physical safety. Here are some tips in three areas of safety concern for correctional nurses.

 

Guard Your Body
• Be aware of your surroundings and the location of the nearest security officer.
• Travel in pairs whenever possible. Always tell others in your unit where you are going and when you expect to return.
• Observe all security procedures. Wait for clearance before entering any area, including when responding to an emergency.
• Do not leave sharps and other potential weapons out on surfaces. Keep equipment locked and maintain counts of all potential contraband items.
• Be careful to limit personal conversation or discussion of facility procedures when patients are present.

Guard Your Mind
• Our patient population can be a difficult one to care about. Patients may have cruel or violent histories. To avoid developing a judgmental attitude, do not seek out information about the crimes of your patients. Focus your mind on nursing care provision and the health care issue at hand.
• Our patients can also seek health care for secondary gain such as a privileged status, more comfortable accommodations or items to fuel the underground prison economy. Guard your mind toward manipulative behaviors while maintaining a professional nurse-patient relationship.
• Because inmate patients can try to con you or game the system, it is easy to become jaded or synical. Guard your mind against these attitudes which will decrease your ability to deliver care.

Guard Your Heart
• Regular contact with the inmate population can lead to professional boundary crossing in relationships. Some patients may seek additional ‘favors’ from nursing staff. Be firm, fair and consistent in all patient interaction. Immediately report any such requests to your manager.
• Guard your heart toward flattery or flirtatious comments and actions by inmates. Respond firmly and initiate security procedures with the slightest indication of personal contact. You are guarding yourself from harm and protecting the patient from disciplinary action.
• Agree with your fellow nurses to watch out for each other. Comment on observations of inappropriate conversations or behavior toward patients.

Do you have additional safety tips to add to this post? Use the comments section to expand on these points.

Read more about Safety for the Nurse in Chapter 3 from Essentials of Correctional Nursing. Order your copy directly from the publisher. http://www.springerpub.com/product/9780826109514#.UDqoiNZlQf4

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