Inmate Workers

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We are considering training Spanish-speaking inmates to interpret for newly arrived Hispanic inmates. I can’t find a specific prohibition from doing so in the prison standards; is this OK?

Unless it is a dire emergency, this is not appropriate. The responsible health authority should not use inmates in place of interpretation services. The standard on inmate workers, P-C-06, indicates that inmates should not be substitutes for regular program staff.
— From CorrectCare Volume 26, Issue 1, Winter 2012

 
 

We are considering offering basic first aid and CPR classes to our inmates. It is not our intention to use inmates in any capacity to provide routine care for other inmates, but rather, to provide those inmates who are interested with skills that may be of value in the event of an extreme emergency situation. What is NCCHC’s position on training inmates in basic health care issues? Would you consider this a violation of standard C-06?

C-06 Inmate Workers prohibits the use of inmates as health care workers. Since you have stated that you would not be using inmates in this capacity, there is no violation of the standard. NCCHC supports health education programs for inmates. As long as you do not intend to use inmates to provide ongoing care, there is no reason that they should not have an opportunity to learn CPR and basic first aid.

Examples of violations of this standard include inmate workers taking pulse and oximetry readings on patients waiting for sick call, checking abnormal blood pressure readings and changing bandages, or even taking supplies from the cabinet. Inmates translating sick call slips from English is a violation of patient confidentiality. These situations may place inmate workers in a position of power over their peers. It may be tempting to use inmate workers in health care delivery when staffing is an issue, but besides violating the NCCHC standard, doing so frequently violates state laws, invites litigation and brings discredit to the correctional health care field.
— From CorrectCare Volume 22, Issue 3, Summer 2008

 
 

In our facility, we have hospice inmate volunteers and some inmates are permitted to help others with activities of daily living (ADL), such as toilet assistance. Where is the line between nursing care and ADL assistance?

In the 2008 standard C-06 Inmate Workers, Compliance Indicator 1 states that inmates do not make treatment decisions or provide patient care. Compliance Indicator 4 indicates that while inmates are not substitutes for regular program staff, they may be involved in appropriate peer health-related programs such as hospice or buddy systems for potentially suicidal inmates. Our answer assumes that the inmate-worker has been properly vetted and trained to work in the hospice program. As in most hospice settings, family members may assist in feeding, bathing and dressing their loved ones. In a correctional hospice setting, it is understood that some inmate-worker volunteers may perform these functions.
— From CorrectCare Volume 22, Issue 2, Spring 2008

 
 

Would use of a “lifeline” suicide prevention program affect our prison’s accreditation with NCCHC? In this program, staff from a community suicide prevention agency train inmates to provide peer support to suicidal inmates. When inmates are identified as suicidal, a mental health clinician or nurse assesses their mental status. Those admitted to the infirmary on mental health watch are assigned a trained “lifeliner,” who comes to the infirmary to sit and talk with the suicidal inmate. Afterwards, the lifeliner debriefs with a mental health worker. These services are not in lieu of formal mental health treatment but are a complement to it.

As long as the inmates in the lifeline program are not used to substitute for staff but only provide supplemental services for the suicidal inmates, you would be in compliance with the relevant standards, P-C-06 Inmate Workers and P-G-05 Suicide Prevention Program (2003 Prison Standards). As you implied, training and supervision of the lifeliners is essential to the success of such a program.
— From CorrectCare Volume 21, Issue 2, Spring 2007

 
 

Please clarify your standards concerning inmate workers. In C-06, Compliance Indicator 3 states, “Inmates do not provide direct patient care,” but the Discussion says they may assist other inmates in activities of daily living, such as ambulation, bathing, dressing, feeding and toileting. In the community, ADLs are direct patient care for certified nursing assistants. How do you define direct patient care?

In general, NCCHC defines direct patient care as health interventions or services that in the free world usually are provided only by appropriate health professionals who have the necessary clinical skills. Inmate workers are not to take the place of health staff. However, ADLs can be provided on different levels and, depending on the patient’s status, may or may not require clinical skills.

In the free world, when assistance in ADLs is part of services provided by family members, volunteers, paraprofessionals, etc., in what are considered non-inpatient settings (home, assisted living situations, hospice care, etc.), it generally falls under the category of nonskilled nursing care. But when a patient is hospitalized, those same ADLs become part of the skilled nursing care provided by nurses of various levels according to the tasks needed.

Similarly, different levels of ADL assistance may exist in correctional settings. Here’s how NCCHC distinguishes between these levels to assess compliance with the intent of the relevant standards (C-06 Inmate Workers and G-03 Infirmary Care). When the patient is housed in general population (defined as any noninfirmary setting, such as medical housing, sheltered housing, segregation, hospice, etc.), trained inmate workers (known by various names in different facilities) may provide the ADL assistance. However, if the patient is admitted to an infirmary on infirmary status, the ADLs become part of the skilled nursing care required and inmate workers may not provide the assistance.

Some infirmaries may house patients who are not classified as on “infirmary status.” In such cases, it is possible for an inmate worker to assist one patient living in the infirmary who is there on sheltered care status, but not assist another patient who is there to receive infirmary care.
— From CorrectCare Volume 19, Issue 1, Winter 2005

 
 

In the infirmary, may inmate-orderlies assist patients with activities of daily living such as bathing, brushing teeth, transferring and feeding? Do the NCCHC standards allow this as long as the orderlies are directly supervised by nursing? If so, does it have to be an RN or can it be an LPN? I could not find anything about this in our state regulations.

The standards governing this matter are C-06 Inmate Workers and G-03 Infirmary Care, both of which are essential. (They are the same for prisons, jails and juvenile facilities.)

Infirmary care is skilled nursing care within the facility’s defined scope of practice. In the correctional environment it is considered inpatient care. It differs from outpatient care for those who may need sheltered housing or observation.

When a patient is on infirmary status, the usual activities of daily living (e.g., bathing, feeding, dressing) are within the nursing discipline’s scope of practice. Inmate orderlies, assistants or whatever they are called may not provide such assistance to patients, whether or not the inmate workers are under the direct observation of nursing staff. It does not matter how well they are trained. If an inmate needs skilled nursing care, assistance with these tasks requires the attention and assistance of nursing staff.

However, trained inmate workers can assist other inmates in general population or other outpatient housing areas with these tasks. In settings other than an infirmary they are providing assistance that parallels home care in the community. They also may assist inmates who happen to be housed in the infirmary, but who are not on inpatient status.

That said, it may be confusing to staff, patients and inmate-workers as to who’s who in the infirmary, so most clinicians prefer that such assistance by inmate-workers not take place in the infirmary.
— From CorrectCare Volume 18, Issue 3, Summer 2004; updated February 2010.