NCSBN Discipline Case Management Conference

Indianapolis, Indiana June 2, 2015

§ Barbara Burchell Braid, RN, MSN, Director of Nursing , WA Department of Corrections

§ Catherine Woodard, Associate Director of Discipline, WA State Department of Health, Nursing Care Quality Assurance Commission

§ Joseph Grangnelli, RN, MN, Health Care Investigator III, WA State Department of Health, Nursing Care Quality Assurance Commission

§  Primary mission of Corrections is safety and security of the community and the offender.

§  Healthcare is secondary. 

§ Nursing goals may be inconsistent with expectations of the prison culture or routine, such as promoting trust and openness during psychiatric encounters, when this behavior may be life threatening in the correctional setting. (Hufft and Kite, 2003)

§ Practice environment must include security mindset: o Counting things like sharps, syringes. Not having them at

fingertips. o Not leaving anything around that can be used as a weapon. o Consider what actually can be used: toothbrush, pen or

pencil. o Privacy isn’t guaranteed.

§  The nurse is put in the role of First Responder.

§  Other staff may be injured.

§ Writing reports to the shift lieutenant. § The nurse must complete reports for both medical and custody reasons, often leading to documentation fatigue.

§ Access to care is a right, but “movement” in a prison may limit that.

§ Treatment is limited to what is in “the offender health plan.” Similar to

your insurance plan.

§ Insulin lines: monitoring syringes and meds.

§ Working in confined spaces: in cells, on the floor, in the visit room, having to move a patient in order to actually provide care.

§ Nurses find things where they don’t belong as a result of body searches.

§ Being “watched” all the time, and videotaped

§ Nurses must work around restrained patients, assessing them when they are angry, spitting, and cursing.

§ Nurses must carry radios and know how to use them.

§ Cultural differences exist within the prison culture, including gangs.

SECONDARY GAIN FOR PATIENTS § Health care results in special status to

offenders, such as trips to an outside provider where there is a chance for contact with family or friends, or even escape.

§ Lower bunks, special food or snacks, desirable medications that they can trade with other offenders.

§ More secure housing assignment and greater safety in the facility.

§ Lots of complaints, demands for nurses and providers to be fired for such deliberate indifference.

§ What that really means? I didn’t get my wedge pillow and I get indigestion at night.

§ I need that extra pillow or blanket.

§ Physical - both environment and personal

§ Emotional - vicarious traumatization

It is a challenging job with a very diverse population. It gives you every aspect of nursing and challenge those skills. You also have a lot of independence where you can use critical thinking skills to resolve issues or implement processes. It not only challenges you as a nurse but also as a person. You will be constantly multi-tasking with balancing health care services and security together all the while handling and taking care of the most challenging patients.

§ Professional Boundaries are black and white. § Must be firm, fair, and consistent. § Can’t have a bad day. § Must wait until the scene is safe before responding to an emergency.

§ The Cooper Awareness Scale o White Zone o Yellow Zone o Orange Zone o Red Zone o Black Zone

§ Must interpret behavior.

§ Landmark case: 1976 US Supreme Court Estelle v. Gamble (429 U.S. 97).

§ Texas Department of Corrections offender Gamble alleged that prison officials inflicted undue suffering on him when they failed to provide adequate health care for an injury sustained in 1973 while incarcerated.

§ The Supreme Court held that “deliberate indifference to serious medical needs of prisoners constitutes the ‘unnecessary and wanton infliction of pain…’ proscribed by the Eighth Amendment.” (Estelle, 429 U.S. at 104)

§ Thus, Estelle gave recognition to offenders’ constitutional right to health care.

§ Did prison officials manifest deliberate indifference to offenders’ medical needs?

§ Were those medical needs serious? (Posner, 1992)

§ Whether the deliberate indifference is manifested by correctional healthcare providers in their responses to offenders’ healthcare needs, or

§ by corrections officials who intentionally deny or delay access to health care, or

§ intentionally interfere with prescribed healthcare treatment. (Blair, 2000)

§ The right to access care. § The right to professional judgment. § The right to prescribed health care treatment.

The definition reads, in part, to provide: § protection, promotion, and optimization of health and abilities,

§ prevention of illness and injury, § alleviation of suffering through the diagnosis and treatment of human response, advocacy, and delivery of health care to individuals, families, communities, and populations under the jurisdiction of the criminal justice system.

§ Nurses who work in correctional facilities must complete the six-week Correctional Worker Core Academy (CORE).

§ Replaces the traditional Corrections Academy and is attended by all employees working in a correctional facility.

§ Includes the same instruction blocks and skills platform as provided to correctional officers.

§  Prison Rape Elimination Act of 2003 (PREA) §  Purpose of the Act was to provide analysis of incidence and effects of prison

rape in federal, state, and local institutions. §  Provide information, resources, recommendations, and funding to protect

individuals from prison rape. §  The National Prison Rape Elimination Commission drafted and published

standards in 2009, which the Department of Justice reviewed and passed as a final rule in August 2012.

PREA

§  Pill lines are challenging.

§  Correctional facilities rarely have onsite dispensing pharmacies

§  Borrowing medication from one patient for administration to another.

§  Boundaries of licensure and scope of practice.

§  Provide required care with the staff available.

§  Nurse/patient power differential accentuated by offender/patient with limited freedom.

§  Professional boundaries are more complex

§  A personal relationship with an offender is inappropriate and the relationship can be personally dangerous.

§ Failure to administer medications. § Failure to deliver care. § Failure to respond to an emergency. § Boundary violations and sexual misconduct. § Drug diversion.

§  Intimidating environment.

§  Hearing the gate close behind you.

§  Emphasis on security first.

§  The facility is able to provide badge in/ badge out times for each unit door if location of the nurse at a particular time is an issue.

§  Often he said/ she said issues with no witnesses.

§  An offender not taking prescribed medication is his right.

§  Loss of evidence.

§  Most board or commission members (decision makers) are unfamiliar with the corrections nursing and apply typical nursing care standards.

§  Tracking communication and records between offenders, custody staff, and medical staff.