National Nurses United

C A L I F O R N I A N U R S E J A N U A R Y / F E B R U A R Y 2 0 0 6 21 Conflicts of Duty and Encroachment in Correctional Nursing C ustodial correctional personnel are responsible and account- able for internal order, disci- pline, and security. RNs, on the other hand, are responsible for providing therapeutic, restorative, and preventative care. The RN duty of care does not include the enforcement of prison discipline and custodial rules. RNs engaging in this dual role (care provider and correctional officer) are seriously jeopardizing their duties to act as inmate/ patient advocate. In the 1940s, the California prison sys- tem created a job classification called the Medical Technical Assistant (MTA), com- bining custody and security with the deliv- ery of healthcare. Most were originally "medics" from U.S. Armed Forces and fil- tered into the prison system after the wars ended. MTAs are a classification used solely in the California Department of Corrections and Rehabilitation (CDCR). MTAs can be either an LVN or an RN, but are predom- inantly LVNs. MTAs are peace officers within the CDCR. They are peace officers and LVN/PTs or RNs in the same person. LVN/PT, RN MTAs are only used in the Cal- ifornia Department of Corrections and Reha- bilitation. LVN/PT MTAs are supervising the prac- tice of RNs to this day in the state prison system. They have acquired these super- visory positions through the old MTA- dominated system of the past. Yet the California Board of Registered Nursing (BRN) states that only an RN can evalu- ate another RN's ability to perform the nursing process. This encroachment on RN practice is a critical issue that requires the enforcement of the licensing boards. POLITICAL ENVIRONMENT THE OVERVIEW First, some basic statistics: California has the largest prison system in the United States with over 301,000 inmates (includ- ing parolees); 33 state prisons; 38 camps; 45,200 employees; and a $6 billion budg- et. Approximately 6.5 percent of the Cal- ifornia inmate population are women. The federal system is larger than California. People of color are over represented among California prisoners and, increas- ingly, the prisoner population confines a larger percentage of older inmates. There are many political forces and fac- tors involved in the administration of the California state prison system. The gover- nor appoints the Secretary of Corrections and designs the budget which allocates the operating budget for corrections. The Leg- islature approves the budget and has var- ious oversight duties regarding the prison system, as well as obligations to the elec- torate. The judicial branch becomes involved when lawsuits concerning prison conditions are brought to court, and often remain involved through settlement agree- ments and enforcement issues. Major play- ers include the California Correctional Peace Officers Association (CCPOA), the prison guards' union, and the Department of Corrections and Rehabilitation itself (CDCR), which is a huge state agency with its own issues and agendas. Each of these entities has its unique area of responsibility and oversight and often confronts conflicting interests. Often these players abuse the public trust, and fail to meet the needs of prisoners and their families. Additionally, many CDCR employees, such as correctional RNs, lack a meaningful voice in this system. Fur- thermore, a chronic budget shortfall com- bined with powerful special interest groups exacerbates an already volatile system. The California state prison system (youth and adult) is archaic in its func- tioning as a correctional system in that it follows no current standards in the cor- rectional industry established nationally. The state youth and adult correctional sys- tems are at a first-ever historic standoff between the CCPOA, the governor's office, the Legislature, and a federal judge named Thelton Henderson. Judge Henderson is overseeing the largest medical class action lawsuits against any state prison health- care system in U.S. history. This judge placed the entire adult prison system under federal receivership, an unprecedented action in this country's prison history. The state financial crisis has also placed CE Home Study Course Critical Patient Advocacy Issues Facing Correctional RNs in California, Part II Submitted by Hedy Dumpel, RN, JD, the California Nurses Association Statewide Correctional Nursing Advocacy Group, and the Joint Nursing Practice Commission INDEPENDENT CE This is part two of a three-part home study, for a total of six (6) CEH. Part one was published in the September 2005 issue of California Nurse. Part three will be published in the March 2006 issue and will include the test questions. Please follow the instruc- tions to receive the six CEH credit.

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