National Nurses United

C A L I F O R N I A N U R S E S E P T E M B E R 2 0 0 5 23 Correctional RNs have long been sub- jected to an abusive environment, suffering harm in their practice and identification as correctional RNs. Correctional standards define healthcare in prisons and jails while alluding to nursing in general terms. The practice of nursing has been defined by the RN's state practice act, the professional association, and "the community standard" defined in legal decisions. These standards have never been adequately or specifically adapted to the differences of practice in cor- rectional environments. This has left RNs vulnerable to indoctrination by the prison and jail environment. PRACTICE ENVIRONMENT OF CORRECTIONAL RNS PRISONS AND JAILS ARE A HIGH-RISK DISEASE ENVIRONMENT. Concentrated in these facilities are health problems of transmittable diseases such as TB, HIV infection, high rates of Hepatitis C infection; drug and alcohol addictions; the debilitating effects of violence for pris- oners and staff; a growing population of aging inmates due to long prison terms; hospice care; skilled nursing care for the disabled; women's health problems and family issues; poverty and lack of access to outside community health resources; increased cases of mental illness. ENFORCING INMATES' RIGHT TO HEALTHCARE—A LITIGIOUS ENVIRONMENT. The 1971 uprising at Attica state prison in upstate New York, which was sparked in part by complaints of poor healthcare, left 43 inmates and guards dead. The tragedy unleashed a flood of prisoner law- suits that culminated in a 1976 United States Supreme Court decision declaring that governments must provide adequate medical care in jails and prisons. Most civil rights actions of inmates are based on vio- lation of their rights under the Eighth Amendment of the U.S. Constitution, which is the right to be free from cruel and unusual punishment. The inmate's healthcare right in- cludes the right to access care, refuse care, confidentiality, informed consent, and pri- vacy. Once a person is incarcerated, the government is required to provide mini- mum and decent healthcare services com- parable to medical and healthcare services available to the general population With respect to nursing, the primary relationship of RN and inmate/patient will always be the cornerstone of practice for the delivery of qualified and competent nursing care in this environment. Yet the patients of correctional RNs are in vary- ing stages of legal adjudication, as courts become more and more involved in the review of conditions and prison systems. SHORTAGE OF COMPETENT CORRECTIONAL RNS. Incarcerated patient health needs far exceed those of typical societal communi- ties due to their concentration within these facilities. The need for competent profes- sional RNs is increasingly in demand. The nursing shortage and the aversion of RNs to working in a difficult environment, with- out recognition for their profession, desta- bilize correctional nursing. There has been a recent surge of interest among RNs about working in corrections. However, once RNs experience the difficulties of this environ- ment, they leave these jobs quickly and in fairly large numbers. LACK OF FOCUS ON MAINTAINING THE HEALTH OF INMATES. Maintenance of inmate health has far- reaching implications for society. Enor- mous amounts of monies are absorbed by corrections each year, with little empha- sis placed on health maintenance, as well as preventative health. Hardly any money is spent on community reentry programs. As a result, inmates are often released with substantial medical problems that drain community healthcare resources. THE CURRENT ROLE OF CORRECTIONAL RNS The current role of correctional RNs varies in juvenile facilities, county jails, and the state prison system. Juvenile and county facilities have long been influenced by evolving Title 15 regulations (California Code of Regulations) in California. These regulations for adult local detention facil- ities have helped RNs function with a more clearly defined scope in interacting with correctional personnel. The impact of improved definitions in Title 15 of respec- tive roles of custody and healthcare has contributed to a much less severe expo- sure to harm for RNs from problems of interfacing in the criminal justice system. The state prison system in Califor- nia, however, is entirely different than the county and juvenile facilities, and so is the authority and responsibility of the RN. RN standards of care are more accepted as the norm in juvenile and county facilities for nursing, though still fraught with the larger scope and RN role problems that remain undefined in the national field of correctional nursing. Nursing practice at the juvenile and coun- ty level correlate more closely with the standards of care as defined by the accred- itation standards for correctional health- care. Not so in the state prison system. Standardized Procedures: The use of standardized procedures for RNs in coun- ty and juvenile facilities has been adapt- ed and practiced by correctional RNs for over 20 years. Standardized procedures increase direct access to RNs. Their use has been a strong impetus for the auton- omy of correctional RNs and measurable level of skill used in the scope of practice for all RNs. Juvenile and county facilities

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