Regulations, Standards and Policies
To be identified as a profession, a discipline must meet criteria that include having established standards of practice and regulation of the practice. In the profession of nursing, regulation is an important component in ensuring safe and competent practice. Nursing consistently ranks No. 1 of all professions in Gallup’s annual honesty and ethics survey. Confidence is supported when nurses thoroughly understand and comply with all regulations and standards.
As in the larger health care industry, correctional health care systems are subject to regulation. Importantly, laws and rules that pertain to nursing in the community also apply in the correctional setting. However, issues related to regulations, standards and compliance with nurse practice acts and scope of practice are not always well understood by correctional nurses and sometimes do not gain the expected level of knowledge, compliance and value.
Because nursing practice has a significant impact on health care delivery, patient safety and patient outcomes, regulation of the profession and individual nursing practice is necessary. The practice of nursing is regulated at the state level through administrative rules (laws) and civil procedures. Licensure is one method of validating knowledge and competence. Individual states license and regulate the profession through their nursing boards, while the National Council of State Boards of Nursing works to create uniformity and consistency in nursing practice and standards.
Many other government agencies—federal, state and local—also issue regulations, standards and guidance to assure safe and appropriate nursing care. At the federal level, the U.S. Department of Health and Human Services is the principal agency for protecting the health of citizens. HHS regulates through 11 divisions, including the Centers for Disease Control and Prevention, the Food and Drug Administration and the Office of the Inspector General. At present the Centers for Medicare and Medicaid Services has little impact on correctional health care, except, for example, when a facility receives federal funding, such as reimbursement for dialysis. However, that may change as provisions of the health care reform law are implemented.
Correctional health systems and their employees are expected to comply with applicable laws and regulations. The monitoring and oversight of these systems may not be as visible as in health care settings in the community. Nevertheless, these functions are important. Correctional facilities have a federal mandate to provide appropriate health care for individuals detained and incarcerated. If a facility fails to ensure safety and fails to meet the serious medical needs of those incarcerated, this likely will lead to litigation and court monitoring.
Several nongovernmental organizations also issue useful standards and other guidance. With respect to health care, the National Commission on Correctional Health Care’s Standards are the most recognized and well-accepted. Many facilities strive to meet these standards for accreditation even if they are not accredited because compliance improves quality and limits liability risk. Other organizations, such as the American Public Health Association, the American Nurses Association and the American Psychiatric Association, also publish standards and recommendations on aspects of health care in corrections. The correctional nurse must understand these standards and ensure that nursing practice is consistent with them. In all cases, measuring and monitoring systems is essential.
Nurses must also understand and comply with the policies and procedures established at their facilities. Policies and procedures provide guidance, standardization and consistency in practices, and failure to comply places the nurse, patient and institution at risk. For example, the patient may be at risk of endangerment, while the nurse and institution may be subject to litigation if poor patient outcomes occur.
Policy topics are wide ranging. Applicable laws and standards should be incorporated into institutional policies, procedures and protocols for the correctional nurse. For example, they should reflect federal and state regulations for reporting public health concerns, conditions of abuse, rape, communicable diseases, trauma, unexpected and expected deaths and care of the mentally ill. Regarding standards, NCCHC standards address topics such as access to care, quality improvement, grievance mechanisms, patient and staff safety, medication services, screening and assessment, patient restraint and much more.
When developing policies, nurses are expected to know and understand the American Nurses Association’s standards for nursing practice, administrative nursing and the specialty of corrections nursing. Nurses and their leadership are held accountable to these standards as well as the nursing social policy statement and code of ethics.
— Mary V. Muse, MS, RN, CCHP-RN, CCHP-A, is chief nursing officer, Wisconsin Department of Corrections, Madison. This column is coordinated by Lorry Schoenly, PhD, RN, CCHP-RN, an independent consultant specializing in correctional health care and social media; she is based in Pennsylvania. For correspondence, write to firstname.lastname@example.org.
[This column appeared in the Fall 2011 issue of CorrectCare.]