CorrectCare

Correctional Nursing: The Evolution of a Specialty

by Mary V. Muse, MS, RN, CCHP-A

The field of correctional nursing is poised for its next big advance: specialty certification through NCCHC’s Certified Correctional Health Professional program. This is an idea whose time has come. But how did we get here? Let’s reflect on the evolution of this profession.

A Look at Our Past
The specialty of correctional nursing has been visible for more than 30 years. Although its early days are not well chronicled, it appears to have emerged largely in response to the forces that propelled correctional health care in general, such as the 1976 U.S. Supreme Court ruling in Estelle v. Gamble.

Before the 1970s, much inmate health care was provided by other inmates, correctional officers and the occasional physician. The first documentation of correctional nursing may be a 1975 article by Rena Murtha, a director of nursing for a large correctional system. In her account, nurses were “a tool of the warden, a slave of the physician and an unknown to the patient.”

Since then, the literature on correctional nursing in this country has been limited. Some articles describe blurring boundaries between corrections and nursing, others found a lack of professional practice or lack of concern for inmate-patients. For many years, correctional nurses themselves felt they were viewed as substandard, as castaways who could not practice anywhere else. Similar perceptions existed of correctional physicians.

It is true that initially there were no real standards or expectations for nurses or physicians working in corrections. Because recruitment was often a challenge, it was easier to simply hire someone without relying on a systematic method of reviewing credentials or experience.

However, as standards for correctional health care emerged, such as those of the National Commission on Correctional Health Care, likewise standards for health professionals took hold. These standards guided provision of care in jails and prisons, helping to improve quality and to reduce negative stereotypes.

Despite these advances and the hiring of better qualified nurses, the perception persisted that good nurses would not work in corrections. In large part, this belief stems from the lack of knowledge about the environment and practice of correctional nursing, often coupled with fear and, occasionally, instances of nurses taking on aspects of their security counterparts. Consequently, some nurses left this field and others were reluctant to choose it.

It didn’t help that many facilities lacked the leadership and structure for nurses that exist in traditional health care settings In years past, nurses usually reported to a corrections administrator or to a physician. In the absence of solid knowledge and expertise in nursing theory and standards, this reporting structure failed to optimize nursing practice in correctional health care.

A Critical Role
Correctional nursing has experienced considerable growth in the past 30 years. The complex health needs of patients entering our systems require nurses with specialized knowledge and skill. Today, correctional nurses play a critical role in ensuring inmates’ access to care and in health care delivery. It is the nurse with whom the inmate interacts most frequently and whom the officer consults when an inmate has a health problem.

As in most health care settings, correctional nurses are the primary clinical providers of care. Registered nurses are necessary to lead care delivery, as well as to direct the licensed nurses who work under their guidance.

Correctional nurses must be clinically competent and well grounded in nursing practice. They must possess excellent skills in assessment and critical thinking. Their judgment is critical to the inmates’ access to care.

It’s also important to have a good understanding of the level of care that can be provided in their institutions. Correctional facilities can ill afford to have nurses who cannot or will not practice within the scope of their license or correctional nursing standards, or who have an aversion to the patient population they are expected to serve.

Thus, correctional nurses have a high degree of accountability and responsibility. The flip side, naturally, is that they also are highly subject to possible litigation.

Today, many facilities have added correctional nurse administrators to their staff. Under this structure, expectations for nursing practice are clearly defined and quality is strongly promoted. The growth in nursing leadership positions has contributed greatly to improvements in delivery of services and quality of care.

A Distinct Specialty
As the practice of correctional nursing has coalesced, it was natural that professional organizations would step up to foster professionalism in this specialty. The American Nurses Association, for example, promulgates standards for correctional nursing.

The ANA defines nursing as “the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and the advocacy in the care of individuals, families, communities, and populations.” Nurses’ broad-based knowledge and holistic focus positions them as the logical network of providers on which to build health care systems with a focus on education, practice and facilitating patients’ efforts to meet their fullest potential.

The ANA’s Corrections Nursing: Scope and Standards of Practice was revised in 2006 with input from nurse leaders across the country. The standards state that “Matters of nursing judgment are solely the domain of the registered nurse.” A major emphasis of this work is primary health care. These services include intake screening and evaluation, health screening, direct patient care, assessment and evaluation of an individual’s health behavior, teaching, counseling and helping inmates to assume responsibility for their own health. The nurse also may identify and provide community linkages for inmates upon discharge.

Thanks to the increasing professionalism in correctional nursing, our colleagues in the correctional health care arena now understand and appreciate the value of this specialty. Beyond the walls, as well, negative perceptions are fading and enthusiastic interest in correctional nursing is growing, both in the community and from academic institutions.

It is not clear how many nurses work in correctional health care settings. However, several years ago a national study of the nursing workforce reported 18,033 RNs working in this field.

Opportunities Ahead
Clearly, correctional nursing is on a roll, and even greater opportunities lie ahead. Last spring, CCHP program leaders began to explore the development of specialty certification for correctional nursing. Given that 53% of the more than 2,000 active CCHPs are nurses, this only made sense.

Certification is the formal recognition of specialized knowledge, skills and experience that demonstrate competence and achievement of standards of a specialty that fosters and promotes optimal health outcomes. A key part of the CCHP program is a test designed to measure a candidate’s mastery of the specialty.

Aided by a nurse consultant with expertise in test design and psychometrics, a CCHP task force of nurse leaders started by listing nursing task statements that describe correctional nursing and distilling this list to its key essentials. These statements were used to develop a job analysis survey tool, which was sent to a broad group of correctional nurses. The results guided and validated the development of a test for specialty certification.

Certification for correctional nursing helps to legitimize this specialty and validates that these professionals must possess a unique body of knowledge and skills. Just as important, it will certainly inspire others to pursue careers in correctional nursing and will stimulate scholarly research in this field.

Correctional nursing has reached a milestone. Our next challenges include expanding the knowledge of correctional nursing by seeking to more clearly define the profession, to identify the various levels of care delivered by nurses, to document the impact of nursing care on patient outcomes and to pursue research and evidence-based practice.

This is a wonderful time for correctional nurses, our patients and the field of correctional health care as a whole.

— About the author: Mary V. Muse, MSN, RN, CCHP-A, is a correctional health care consultant based in the Chicago area. She is a surveyor for NCCHC, a frequent presenter at NCCHC conferences and past chair of the Academy of Correctional Health Professionals. She also serves on the task force that is developing the CCHP-N program. To contact her, e-mail mvmuse@ameritech.net.
   The ANA book Corrections Nursing: Scope and Standards of Practice is available for purchase from the NCCHC catalog.

[This article first appeared in the Winter 2009 issue of CorrectCare.]