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22 M A R C H 2 0 0 6 W W W . C A L N U R S E S . O R G C A L I F O R N I A N U R S E Introduction T he Correctional Nursing Task Force charge was "to identify and analyze issues facing correction- al nursing in California and to plan and develop strategies to secure access to safe, therapeutic, and ef- fective patient care; access to legally-au- thorized and competent healthcare professionals to meet the healthcare needs of California's prison population. Furthermore, to develop strategies to preserve the integrity of the Nursing Practice Act and the correctional RN role as patient advocate in correctional facil- ities." In Part I (September 2005), the CE study gave a broad overview of the histo- ry of nursing in corrections, including the practice environment and current roles played by RNs, as well as documenting some of the common barriers to care in- mate patients experience. In Part II (Jan- uary/February 2006), the CE study described the political environment in which correctional healthcare is run, trends toward privatization, and how the use of medical technical assistants— often LVNs or RNs who embody both a medical and custodial role—conflicts with RNs' duty of patient advocacy. Issues Identified by the Correctional Nursing Task Force Report INCREASING PUBLIC HEALTH THREATS: A. High concentration of high-risk health problems in the incarcerated pop- ulation: TB, HIV, hepatitis, sexually-trans- mitted diseases, substance abuse, violence, and trauma. B. Large populations of mentally ill, dis- abled inmates, and health problems asso- ciated with women and the elderly. C. Lack of (1) competent healthcare providers in correctional facilities; (2) planned, coordinated healthcare systems; (3) administrative and legislative support and planning for the spending of healthcare dollars in correctional facilities; (4) lack of tracking of health problems and risks amongst incarcerated populations; (5) ac- countability of healthcare dollars spent in correctional facilities; (6) enforcement of healthcare standards and laws pertaining to healthcare in correctional facilities; (7) education of healthcare providers and ad- ministrators specific to health problems of incarcerated populations; (8) autonomy for patient-care decision-making by RN staff for incarcerated populations; (9) coordi- nated health services for incarcerated pop- ulations upon release back into the community; (10) security for RNs; (11) legal education for healthcare providers working within highly-litigious environ- ments; and (12) identification and enforce- ment of nursing standards of care specific to the incarcerated population. D. Increasing overcrowding due to se- vere sentencing laws. E. Legislatively-driven changes which constrain healthcare delivery in correc- tional facilities. F. Violation of privacy rights of RNs in correctional facilities regarding security clearances. G. Encroachment upon RN licensure from security personnel and other health- care personnel. Routine interference in daily healthcare delivery by security per- sonnel. Supervision of RN practice by LVN/PTs and security personnel. Prison inmates under the care of unqualified and incompetent physicians with records of criminal or professional misconduct. Un- abated privatization of medical services under the guise of cost containment. Conclusions Patient Advocacy: The ability of correc- tional RNs to advocate for their inmate pa- tients is severely compromised due to the conflicting priorities in the prison system where confinement, isolation, and securi- ty goals override the healthcare needs of the prison population. The correctional environment enforces destruction of RN patient advocacy responsibilities by com- bining the conflicting roles and functions of peace officer with nurse. There is a se- vere lack of recognition of the role of RN as being in charge of inmate patient care. Lack of planning of health services in cor- rectional facilities severely harms nursing in its role as patient advocate. Collective Advocacy Voice: RNs do not have a collective voice in the area of col- lective bargaining in the state prison sys- tem. The role of the RN is suppressed, and consequently the delivery of nursing care in the prison system is severely fragment- CE Home Study Course Critical Patient Advocacy Issues Facing Correctional RNs in California, Part III Submitted by Hedy Dumpel, RN, JD, the California Nurses Association Statewide Correctional Nursing Advocacy Group, and the Joint Nursing Practice Commission This is part three of a three-part home study, with a total of six (6) CEH. Part I was published in the September 2005 issue of California Nurse. Part II ap- peared in the January 2006 issue. Please follow the instructions to receive the six CEH credit.