half of cover shot nurseDec 10, 2021

The Importance of Custody-Health Care Collaboration, Part 1



If you work in correctional health care, you not only have to interact and care for incarcerated patients; you also need to collaborate with security and correctional administration at your facility. That might seem obvious, but it never ceases to amaze me how often correctional health care professionals don’t seem to understand the importance of developing good working relationships with custody staff, or how to do that.

Health staff – and other civilians – are often thrust into a very foreign world with little or no training on how to navigate a correctional environment. As a result, the relationship between custody and health staff can at times seem almost adversarial. All too often, it’s “us vs. them.” But health and custody staff are on the same team, and “playing well together” benefits everyone – most importantly, the incarcerated patient population.

The importance of collaboration is directly addressed in NCCHC Standard A-03 Medical Autonomy, which states, “The delivery of health care in a correctional facility is a joint effort of custody and health staffs and is best achieved through trust and cooperation.”

Inside the Head of a Correctional Officer

For effective communication to occur, each party needs to understand the other’s background, motivation, and priorities. Health care professionals are trained to provide care and save lives; that is our priority. It can be difficult, especially when new to corrections, to understand that custody’s priorities are different, but complementary: that is, to ensure the safety and security of the incarcerated, staff, and facility.

No matter the designation – sheriff’s deputies, correctional officers, or private security – the custody staff in your facility is a law enforcement group. Their ranking structure, training, tactics, and even professional interactions mirror those of other law enforcement groups. There are strict procedures, protocols, and orders that all custody staff must follow. Understanding the orders that dictate procedures in your facility, especially concerning inmate movement, will improve your department’s workflow and also make the job of the custody staff in your area easier. For example, during count is not a good time to request that a patient come to the medical department or clinic for an appointment.

Custody officers respond well to direct communication. Be respectful, polite, and succinct. Always address them by their rank and surname, e.g., “Deputy Chief Meyer.” Be careful not to appear to be commanding or demanding. Showing respect and understanding for the work of the custody staff will go a long way in building trust and building a good working relationship.

Navigating the Chain of Command

In any law enforcement organization, the chain of command is essential. To maintain good relations with custody staff, you need to understand – and follow – the chain of command.

For example, if there is an issue in your department, your first step should be to speak with the officer in charge, followed, in most situations, by contacting the sergeant, lieutenant, captain, and major, in that order. Finally, if you have followed the chain of command and the issue is not resolved, you can bring your complaint to the warden or administrator. Breaking the chain can mean breaking the trust that custody staff have in you and your department. It would be like a staff nurse skipping over the director of nursing and health services administrator and going directly to a regional manager. Better to follow the chain of command.

Health care administrators should find out from the warden or facility administrator who they are to speak to in a variety of situations. Some administrators want all issues brought to them; others would rather have a major or captain be the contact point. Whatever the case, meet with the appropriate people regularly. Be responsive and address their concerns as priorities. Provide updates between meetings.

Custody Is the Customer

It’s important to remember that as civilian contractors, which most of us are, we are guests in the facility. That is one of the most difficult things for correctional health care professionals to wrap their minds around, especially if they are new to the field. But treating custody staff like valued customers will go a long way toward cementing good relationships.

If an officer from one of the housing areas calls with a question or request, for instance, do your best to assist. If the warden or administrator needs information or has an issue, respond quickly and accurately. Promptly addressing requests and concerns improves not only your reputation, but that of the company you work for as well.

It is also vital for health care administration to lead by example. Maintaining a customer service mindset will not lessen your position but rather make you a stronger leader.

If at any time custody asks you to do something that is not in the patient’s best interest, you can – and should – advocate for your patient. You can voice your concerns and suggest an alternative but do so in a respectful manner and follow the chain of command. Approaching custody staff as members of the same team will help ensure that they are open to your suggestions.

Listen and Learn

Listen. That one little word will foster the best working relationships you can have … and could actually save a life. Custody staff interacts with the incarcerated population every day; they can notice subtle changes that the health staff, busy taking care of patients in the clinic, might not. If a custody staff member expresses a concern, listen, and take that concern seriously. If an officer tells you that an incarcerated individual does not look well or does not seem like themselves, that individual should be seen and evaluated. It is always better to spend five minutes evaluating a patient than risking a poor outcome. In addition to improving patient care, this practice will validate the officer, who in turn will continue to monitor the population for signs of medical or mental distress.

Pro tip: If you want to know what really went on during the previous shift or get a heads-up on a potential problem, talk the custody staff working in your area.

Communicate to Collaborate

While it is fine for health care professionals to have camaraderie with custody staff, always be professional. We are licensed health care professionals and should conduct ourselves as such. Follow these tips:

Do not communicate (in any form) in an overly familiar manner. Save your emojis for personal emails and texts.

Do not take part in gallows humor.

Reputations are built quickly within the correctional setting. Make sure that yours is glowing.

Managers, lead by example. Make it clear to your staff that you value and respect the custody staff, their role, and their contributions to the care of your patients.

Be transparent. Always be the one to bring issues to custody; don’t let them hear it from someone else. Stuff happens; bringing problems to light and working together on solutions will foster trust.

If corrective action is necessary, present your plan, monitor progress, and follow up.

Get custody staff involved in medical emergency drills and disaster drills.

Invite custody staff to your meetings and ask for their opinions and ideas.

Encourage custody to participate in CQI or performance improvement projects.

Most importantly, don’t allow an “us vs. them” feeling to fester between health staff and custody staff. Remember we are working with each other, not next to each other.

No matter the setting – pretrial, prison, or reentry – the strategies presented here will serve you well as a civilian health care professional working in corrections. Most of the difficulties for civilians in the correctional setting are about adapting to the environment and learning how to function within a law enforcement setting.

Understanding the role of custody, respecting the chain of command, having a customer service mindset, and maintaining professional communication will foster a collaborative and cooperative relationship with custody staff, and that will improve your work environment and facilitate your ultimate goal: to provide the best care possible to your patient population.    

Michael Teasdale, RN, CCHP, is a regional nurse manager with Rutgers University Correctional Health Care, which provides medical, mental health, dental, and sex offender treatment services to individuals involved in the New Jersey criminal and juvenile justice systems.

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