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22 S E P T E M B E R 2 0 0 5 C A L I F O R N I A N U R S E INTRODUCTION I n the last 45 years, the inherent prob- lems of correctional nursing have received little attention and continue to spiral almost out of control. This has severely affected the correctional RN's ability to provide safe, therapeutic, and effective patient care, as well as act as patient advocate within the prison system. During this time, the California prison population's access to competent healthcare has been compromised and further aggravated by the state prison sys- tem when it unlawfully suppressed the role of the RN and elevated the role of the Medical Technical Assistant (MTA) to serve as gatekeeper of access to and deliv- ery of nursing care, while simultaneously performing security functions. The California Nurses Association has initiated a historic, first task force comprising correctional RNs, community leaders, and advocates for prison health in the state of California to present CNA with a report on the following charge. TASK FORCE CHARGE The task force charge is "to identify and ana- lyze issues facing correctional nursing in Cal- ifornia and to plan and develop strategies to secure access to safe, therapeutic, and effective patient care; access to legally authorized, and competent healthcare pro- fessionals to meet the health care needs of California's prison population. Furthermore, to develop strategies to preserve the integri- ty of the Nursing Practice Act and the cor- rectional RN role as patient advocate in correctional facilities." ENVIRONMENTAL ASSESSMENT Background THE HISTORY OF PRISONS & JAILS It is important to review the overall his- tory of the evolution of correctional facil- ities in the U.S. in order to understand the history of correctional nursing. Since the early 1800s, correctional institutions have struggled with the purposes and condi- tions of confinement and security. In 1929, the National Society for Penal Information published a report, based on field surveys of medical service in Ameri- can prisons and reformatories. The report observed the inadequacy of hospital facil- ities, equipment, personnel, and resources. It supported the idea of rehabilitation and society's responsibility to offer decent healthcare in prisons and the need to stan- dardize health and hospital practices. Despite these recommendations, cor- rectional administrators have abandoned rehabilitation as the purpose of prisons and the quasi-military management style for the purpose of custody has predomi- nated since the 1940s. Security and order still take precedence over all other func- tions in corrections. Health services have been viewed as not contributing to secu- rity goals and in 1975, one researcher identified RNs as vulnerable people in cell- blocks disruptive to prison goals. Prevalent attitudes of indifference to inmates' health needs, and that they are "faking" illness and undeserving of basic human considerations became deeply entrenched within prisons and jails. A cul- ture of power struggles and cynicism between inmates and staff became a pri- mary force inside correctional facilities. Correctional personnel perceived that only those most obviously in need of care, determined by custody, may or may not be allowed access to care. THE HISTORY OF CORRECTIONAL RNS Correctional nursing has always, through- out its history and existence, been thwart- ed in growing and developing as an established, practicing professional spe- cialty by the subtle and powerful forces of correctional personnel. Healthcare administrators in the field of corrections have had a tendency to appease correc- tions and security rather than defend the role of RNs. RNs have also been caught in the undertow of the prison culture and the power struggles between security person- nel and prisoners. The history of nursing in corrections runs parallel to the history of the plight of prisoners' need for healthcare. The dif- ference is that the courts and health administrators have given significantly greater attention to prisoner healthcare, while ignoring the centrality of the role of the RN. Prisoners, in general, do not have access to competent nursing care provid- ed by the highest skilled (RNs). CE Home Study Course Critical Patient Advocacy Issues Facing Correctional RNs in California Submitted by Hedy Dumpel, RN, JD, the California Nurses Association Correctional Nursing Task Force, and the Joint Nursing Practice Commission INDEPENDENT CE This is part one of a two-part home study, with a total of four (4) CEH. The November 2005 issue of California Nurse will publish the second part and the test questions. Please follow the instructions to receive the four CEH credit.