National Nurses United

38 J U L Y / A U G U S T 2 0 0 5 C A L I F O R N I A N U R S E T he California Nurses Association has initiated a historic first task force comprising correctional RNs, community leaders, and ad- vocates for prison health. The fol- lowing report presents its main findings and recommendations to date and acts as a policy statement for future work—a particularly timely document as Califor- nia's prison health system has come under recent scrutiny and a federal judge finds the situation so appalling that he is considering putting the whole system into receivership. The Task Force Charge The Task Force Charge is "to identify and analyze issues facing correctional nursing in California, and to plan and develop strategies to secure access to safe, thera- peutic, and effective patient care; access to legally authorized and competent healthcare professionals to meet the health care needs of California's prison population. Furthermore, to develop strategies to preserve the integrity of the Nursing Prac- tice Act and the correctional nurse role as patient advocate in correctional facilities." This report is based on extensive re- view and discussion of nursing and health- care delivery problems in correctional facilities. Several conclusions reached by the Task Force are described as follows: CONCLUSIONS Patient Advocacy: The ability of correc- tional RNs to advocate for their inmate pa- tients is severely compromised due to the conflicting priorities in the prison system where confinement, isolation, and secu- rity goals override the healthcare needs of the prison population. The correctional environment enforces destruction of RN patient advocacy responsibilities by the conflicting role of combining peace officer functions with nursing functions. There is a severe lack of the role of the RN being in charge of inmate patient care. Lack of planning of health services in correctional facilities severely harms nursing in its role as patient advocate. Collective Advocacy Voice: RNs do not have a collective voice in the area of col- lective bargaining in the state prison sys- tem. The role of the RN is suppressed, and consequently the delivery of nursing care in the prison system is severely frag- mented with multiple and intentional vi- olation of the Nursing Practice Act. RNs are still subjected as individuals and as nurses to harsh treatment in the security environment no matter what the law states. There is still a lack of en- forcement and support for RNs to func- tion as competent health care providers within the correctional industry at large. Access to Healthcare: Although in- mates have a right to healthcare, they are generally forced to litigate access to care. There is a severe lack of safe, therapeutic, and effective patient care for incarcerated patients in California's correctional facil- ities. Delivery of nursing care for incar- cerated patients has reached crisis proportions in California due to lack of po- litical solutions and failure to retain qual- ified RNs to work in a chaotic and violent environment fueled further by the nurs- ing shortage. There is, however, one ad- ditional hurdle to access since the state prison system has elevated the role of the MTA as gatekeeper to access to competent care provided by legally authorized healthcare professionals. Competency: There is a critical need for training, education, and support—spe- cific to the unique problems of the cor- rectional practice setting which hinders the delivery of patient care that is quali- fied, ethical and competent. Competent, educated RNs have a difficult time strug- gling against this environment. The edu- cators and leaders in the field are not recognized as those setting the standard of care and their expertise is being lost in a field that needs the nursing torch passed on directly from their hands. Recommendations Inmate patients will greatly benefit from access to competent RNs at all levels of care. Correctional nurses will need strong, purposeful direction to define themselves as unique in their service to inmate pa- tients. There is a great need for them to acquire a basic legal education of the com- plexities of this practice setting. Correc- tional nurses seldom define their mission and goals of patient care specific to their practice environment. The scope of prac- tice of the correctional nurse must recog- nize a need for autonomy distinctively different from other healthcare disciplines in order to promote safe, therapeutic, and effective patient care, including patient advocacy Correctional nursing must separate from the legitimate functions and needs of corrections personnel in order to serve the legitimate purposes of nursing. Clear identification of the boundaries between collaboration with other disciplines and Nursing | Practice Correctional Nurses and Collective Patient Advocacy Conclusions and recommendations from CNA's first Correctional Nursing Task Force Submitted by the Joint Nursing Practice Commission

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