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 23 ifornia's three strikes law, thus reducing the prison population. CCPOA put $2 mil- lion into the campaign to defeat the ini- tiative which was initially favored by a majority of voters. By aligning with the district attorneys association, the gover- nor, and others, CCPOA was a crucial player in the defeat of this proposition. This union is wealthy, politically savvy, and completely committed to its own agenda. As long as prison remains a growth industry, CCPOA will maintain its power and influence thoughout the state. Various unions, whether state, county, or juvenile, will inevitably be competing with the interests of the CCPOA or cor- rectional officers/law enforcement per- sonnel working at the various facilities. State RNs are represented by two Ser- vice Employees International Union (SEIU) locals, Local 1000 and Local 2579. Both are chapters of the California State Employees Association (CSEA). State-employed physicians and den- tists are represented by the United Asso- ciation of Physicians and Dentists, AFSCME/AFL-CIO. EDUCATION National standards specific to correction- al nursing are in infancy stages. The lit- erature on nursing education for correctional RNs has always been sparse at best. Employers of correctional RNs have traditionally required a nursing license but rarely defined any specific level of education or nursing experience needed to practice in the correctional set- ting. The field of correctional nursing needs to identify its experts, leaders, and educators from within and establish cur- riculums, content, and core functions spe- cific to the practice environment. Corrections is a prime field for nursing research opportunities, to collect data and publish results of the actual picture of practice and scope of nursing. Research is needed to define the field and suggest the future of practice. The practice envi- ronment has a clear legal role which also requires leaders and educators from with- in the field to publish and educate. There are very few established curriculums for correctional RNs in university settings and no master's level or doctorate level yet established. Corrections is a very rich human environment which should be spawning education and nursing research, but has yet to do so. FUNDING SOURCES FOR CORRECTIONAL NURSING SERVICES All funding for nursing services for incar- cerated individuals ultimately is paid for by the government. Federal, state, and county governments have opted to con- tract for services from hospitals, individ- ual registries, and private correctional healthcare organizations or other con- tracted healthcare services. Each level of government also employs RNs within their departmental agencies. Recent audit reports have identified budget overruns (e.g., the CDCR was $200 million over budget, six months into the fiscal year) due to waste and mis- management. PRIVATIZATION In 1976, the United States Supreme Court issued a ruling declaring that gov- ernment must provide adequate medical care in jails and prisons. Two years after the ruling, a Delaware nurse founded Prison Health, pioneering a for-profit med- ical care industry that offered prison offi- cials a solution: contract out (for millions of dollars) the delivery of medical care in correctional facilities to private, for-prof- it entities. About 40 percent of all inmate medical care in the United States is now contract- ed to for-profit companies, led by Prison Health, its close rival Correctional Med- ical Services, and just a handful of others. Though the remaining 60 percent of inmate medical and nursing care is still supplied by the state and federal govern- ment, that number has been shrinking as medical expenses soar. A yearlong examination of Prison Health by the New York Times revealed repeated instances of sentinel events due to medical staff trimmed to the bone, under-qualified and out-of-reach doctors, RNs doing tasks beyond their training, (continued on page 26)

• Cover