Regulations, Standards, Policies, Procedures and Protocols

To be identified as a specialty, nursing groups must meet criteria that include having established standards of practice and regulation of the practice. In the profession of nursing, safe and competent practice is ensured through regulation. When nurses thoroughly understand and comply with all regulations and standards, they practice with confidence, which is reflected in the care they provide to their patients. Of all professions, nursing consistently ranks first in Gallup’s annual honesty and ethics survey.

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. Typically, the state Nurse Practice Act regulates nursing scope of practice for all nursing licensures – LVN/LPN, RN, and APRN. Licensure validates mastery of nursing knowledge and competence. Individual states license and regulate their nursing 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. In addition, states can join the Nurse Licensure Compact by passing special legislation that allows their licensed nurses to obtain a multistate license and practice in any of the other member states without having to obtain a separate license for that state. Currently a majority of states have passed such legislation. This does not mean that all member Nurse Practice Acts are the same, and the correctional nurse must know and adhere to the Nurse Practice Act and their scope of practice in the state in which they are practicing.

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 (HHS) is the principal agency for protecting the health of citizens. HHS regulates health care through eleven divisions, including the Centers for Disease Control and Prevention, the Food and Drug Administration and the Office of the Inspector General. Correctional health care programs and correctional nurses must comply with these regulations and applicable laws when providing care in correctional facilities.

The monitoring and oversight of correctional health care programs may not be as visible as in health care settings in the community, but these functions are important and must occur. Providers of correctional health care, whether they are federal, state, or county entities, or private companies, must self-monitor and expeditiously address any deficiency found. Correctional facilities have a federal mandate to provide appropriate health care for detained and incarcerated individuals that meets community standards. If a facility fails to address the serious medical needs of those incarcerated or fails to ensure patient safety, litigation and court monitoring may be initiated.

Several non-governmental organizations have promulgated standards and other guidance for the provision of health care specifically in the correctional environment. 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 nor plan to be accredited, because compliance improves quality, limits liability risk and is the right thing to do. Other organizations, such as the American Public Health Association, the American Nurses Association, and the American Psychiatric Association, also publish standards and recommendations pertaining to the provision of health care in corrections.

Correctional nursing leaders are expected to know and understand the American Nurses Association’s scope and standards for correctional nursing practice; the scope and standards of practice for administrative nursing; and the American Nurses Association’s Nursing Code of Ethics and Social Policy Statement, and ensure that the components of these important documents are incorporated into the applicable correctional health policies, procedures, and protocols.

Nurses must 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, the patient, and the facility at risk. Policies, procedures, and nursing protocols should be congruent with the state Nurse Practice Act to assure that correctional nursing care is always within the scope of practice. Applicable laws and standards should be incorporated into facility policies, procedures, and protocols for the correctional nurse as well. For example, the policies and procedures of the health care program should reflect federal and state regulations for reporting public health issues, conditions of abuse/rape, communicable diseases, unexpected and expected deaths, and care of the mentally ill. The National Commission on Correctional Health Care’s Standards address topics such as access to care; orientation and continuing education; officer training; quality improvement; grievance mechanisms; patient and staff safety; suicide prevention and intervention; pharmaceutical services; screening and health assessment; mental health services; chronic disease services; patient restraint and seclusion; emergency services and response; health record management; and much more, to ensure that correctional health programs are in congruence with these regulations.

Author Lori Roscoe, DNP, PhD, APRN, CCHP-RN, is the Accredited Provider Program Director for NCCHC, co-chair of the NCCHC Nursing Education Subcommittee, and a member of NCCHC’s  Multi-Disciplinary Education Committee.  Through her companies, The Correctional Nurse LLC and Correctional HealthCare Consultants LLC, Dr. Roscoe provides accredited continuing education specialized for correctional nurses and maintains CorrectionalNurse.Net, a blog about correctional nursing practice, and offers professional consulting services in correctional healthcare operations, staff training and legal matters.