National Nurses United

California Nurse magazine January-February 2006

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26 J A N U A R Y / F E B R U A R Y 2 0 0 6 C A L I F O R N I A N U R S E prescription drugs withheld, patient records unread, and employee miscon- duct unpunished. For-profit company performance around the nation has provoked criticism from judges and sheriffs, lawsuits from inmates' families and whistleblowers, and condemnation from federal, state, and local authorities. Companies have paid millions of dollars in fines and settlements. Yet the practice continues unabated because of a game of hopscotch from state to state and the corporate shell game of mergers and acquisitions. For-profit companies have a high pres- ence on the East Coast (e.g., in August 2003, Pennsylvania signed a $300 million contract with America Service Group, the parent company of Prison Health, also known as the jailhouse corporate giant). The contract is to provide healthcare serv- ices for more than 40,000 inmates. About 45 percent of California's coun- ties contract out jail medical services to private companies. Even San Francisco handed over its jail psychiatric program to an outside agency—Haight Ashbury Free Clinics—nearly three decades ago. This clinic is currently under scrutiny for possible mismanagement of funds. In the summer of 2004, the mayor of San Francisco waged a political fight to put San Francisco's jail medical services out for bid, forcing the Department of Public Health, which provides the medical serv- ices now, to compete against private com- panies for the contract. If the services are contracted out, 130 health department workers would receive pink slips, possibly including RNs. With an average daily inmate population of 2,000, the city now spends almost $34 million a year provid- ing medical care to men and women behind bars. The mayor believes the serv- ices could be provided much more effi- ciently. For instance, he has said that highly-trained nurses are distributing medication, when perhaps a lower-paid worker can do the job. The lowest bidder meeting the minimum qualifications gets the job. Also, in 2001, the city of Oakland awarded Prison Health Services a contract to provide correctional healthcare servic- es to Oakland inmates. Hedy Dumpel, RN, JD is Chief Director of Nursing Practice and Patient Advocacy for the California Nurses Association. CE Home Study Course The correctional setting for RNs pres- ents powerful obstacles, starting with a struggle over control of nursing care for patients with correctional authori- ties who are still deeply entrenched in attitudes antithetical to nursing. Access to prison nursing care, despite major improvements overall in the correctional industry's standards of care, is limited. RNs lack the autonomy enjoyed by their counterparts in the community and other specialty areas of nursing practice. There has traditionally been no positive recognition among other nursing specialties of correctional RNs. Instead, the larger RN community has shunned them as either incompetent or defective in some way. This silent form of discrimination within the pro- fession has left correctional nurses with little credibility or positive rewards for their work. These correc- tional RNs have been isolated from the larger nursing community. Conflicts with the security environ- ment include personal safety and per- sonal privacy issues for correctional RNs. Security and privacy issues are large and looming hindrances in the practice setting for correctional RNs. These issues are complex and numer- ous in literally every nursing proce- dure and assessment of patients. Access to patients to provide nursing care is still determined and controlled by custody and law enforcement per- sonnel. When nursing acts in cohesion under defined goals and mission, the ability of inmates/patients to access RNs is increased. The lack of support for the role of the correctional RN, particularly in the CDCR system, and the existence of disgraceful and unethical practices enforced by the culture of custody is harmful to RNs. The root cause of these practices has been essentially unchanged for nearly 70 years now. Blurred lines of practice are deeply entrenched in the practice setting. Scope of practice of RNs is encroached upon by other health disciplines such as nursing assistants, LVNs, NPs, PAs, MDs, LCSWs, PhDs, mental health pro- fessionals, clerks, medical records per- sonnel, and larger problems with law enforcement and custody personnel. The security environment has a fatal and inherent tendency to treat licensed healthcare professionals as largely interchangeable as long as the purposes of security are served, whether they are legitimate or not. Law enforcement personnel remain unwilling to differentiate between the scope of practice of various health dis- ciplines. RNs, within their rightful decision-making authority granted by law, are overpowered in the correc- tional environment. RNs have yet to take goal-directed charge of patient care as critical and necessary care- givers and explore the full potential of their scope in this field. The larger and ever-grinding machine of custody dictating and intimidating health professionals in correctional facilities remains a pre- dominant force to be contended with by correctional RNs. The reality of practice is that correctional forces covertly overrule medical and nursing decisions for patients, as if it were an inherited right or granted by mythical laws that do not even exist. This is an unwritten assumed power over nursing simply because "they run the correc- tional facilities." The autonomy, role, and scope of practice of RNs needs to be established inside these facilities as it is written in the RN practice act and related law. Custody personnel and their unlawful practices have been changed slowly by exposure, litigation, the courts, and industry standards. Facilities vary greatly in their enforce- ment and implementation of legitimate and legally-proper practices for law enforcement personnel. State and fed- eral agencies have failed in their legal duties to routinely monitor and enforce the lawful practices of law enforcement personnel, largely due to lack of political will. The defining of the role and scope of practice for correctional RNs in the future should come from RNs and other advocates for patient care who have a vision for what is just for patients. The Practice Environment of Correctional RNs (continued from page 23)

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