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When Health Care is Not a Primary Mission

Having come from a traditional healthcare setting, one of the challenges I faced in entering correctional nursing was the stark difference in organizational mission. I was now working in a setting whose primary mission was not health care. A strange situation. In fact, the health care needs of my patients were secondary to the primary goals of safety and security in a correctional facility.

Correctional nursing research affirms this peculiarity of our nursing specialty. Research into the unique nature of nursing practice in jails and prisons reveals correctional nurses must deliver care in a frequently uncaring custody framework. One nurse researcher examined the relationship of care and custody and found correctional nurses are often put in an adversarial role within the correctional setting in order to advocate for their patient’s health care needs. This can be the result of clashing world views. For example, is the incarcerated person a prisoner or a patient? A philosophical discrepancy of this type can lead to conflict among professionals and between the nurse and the custody officer. Correctional nurses must negotiate necessary patient care within a world very different from traditional health care settings. Nurses in this study expressed a “constant struggle to find the balance between health care needs of the prisoner and the security limitations of the institution.” (pg 166)

Besides the security environment and worldview of our custody peers, limited resources also challenge correctional nurses. It has been said that correctional nurses must be able to do everything with nothing. Supplies and equipment are often minimal in an environment that is not focused on health outcomes. Correctional nurses may need to deliver care using converted cells as exam rooms or in remote locations within the security perimeter. They may have to complete care duties within a limited time frame based on availability of security staff or rigid inmate movement requirements.

Although personal safety can be of concern in other care environments, the continuing need for personal safety vigilance adds to the stress of correctional nursing practice. One of the first things nurses new to corrections learn is the need to await security clearance before entering an area such as a cell or yard to deliver emergency care. This action can strain every fiber of a nurse’s being as we are there to deliver immediate life-saving care but must stand-by until allowed to proceed.

All of these components of correctional nursing practice make our specialty unique. We are continually challenged to return to the core values undergirding our practice; to re-center ourselves on the meaning and importance of our role and the difference we make in the health of a vulnerable patient population.

Learn more about working in a correctional setting by visiting the Pedagogy Correctional Healthcare Campus and taking the course Correctional Healthcare Patient and Environment.

This post first appeared in the Essentials of Correctional Nursing blog.

Posted: 8/3/2014 7:14:43 AM
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