Preventing Falls: A Crucial Skill

Preventing Falls: A Crucial Skill

Helping to prevent patient falls is absolutely crucial, as one simple fall can cause so many problems—everything from broken hips to traumatic brain injury.

Michele L. Kimball, RN, BSN, Senior Director of Nursing at Bethesda Dilworth, knows why it’s so important to keep patients from falling and assessing their risks. She took time to give us information about what nurses can do.

What are the most important things that nurses need to know when working with patients in health care facilities?

The most important thing for a nurse to remember when assessing for fall risk and developing a fall prevention plan is that the first step is “getting to know your patient.” But without knowing what places them at risk and knowing their routine, your plan will fail. Patients come to health care facilities for so many different reasons. Staff should consider in the beginning that getting acclimated to the routine of a facility is stressful and, depending on the patient, can be confusing.  Restoring as much of their daily routine as possible can lead to success.

What can nurses do when they have stubborn patients who may insist on getting out of bed without assistance?

Allowing them to make as many decisions that they can and restoring as much of their daily routine as possible can minimize risk. 

Involve family and educate, educate, educate.

For patients who are in their own homes—in the case of home health care nursing—what tips can nurses give to these folks to prevent them from falling?

The key is beginning the discharge process prior to them going home on home health through home evaluations and assessment of daily routines. Knowing where and how the patient would need to navigate inside their home is key. Educating them on needed adjustments to their home and warm hand offs to the home health nurse on outcomes of the assessments and recommendations is vital.

The patient’s willingness and ability to take in this education as well as support systems should be considered when developing a plan. 

What kind of health issues can lead to more falls? What information can nurses give to patients so that they can prevent these health problems?

A lot of fall prevention is learning what places them at risk in the first place.

Patients with high blood pressure need to routinely take their medications as prescribed and continue to monitor their blood pressures. These medications can cause dizziness and at times orthostatic hypotension.

Patients with heart failure should continue to take their medications as prescribed and monitor their heart rate, blood pressure, and fluid status. They should contact their doctor if they become short of breath, seem tired more than usual, or notice swelling in extremities. These symptoms can develop quickly and lead to a major health set back, but most importantly lead to weakness, dizziness, and unsteady gait all key contributors to falls.

Patients with diabetes should ensure that they are controlling their blood sugars and taking their medications as prescribed. Low blood sugars could lead to dizziness and fainting, placing them at a risk for falls. Glucose is food for the brain, and if your blood sugar is low and your brain isn’t getting fed, it leads to being tired and increases risk for poor decisions, lack of concentration, and black outs — again contributing to the risk of falls.

Tell patients not to take their health conditions lightly, to notify their doctors when symptoms occur, and if they feel “funny” or something “doesn’t feel right” err on the caution side and ask their physicians. Falls are dangerous, and for the elderly population they can lead to major injuries such as fractures and even death. There is almost always some functional decline after a major fall, and this decline can be the difference of a patient being able to stay in their home or have to seek out a long-term care facility.

Nurses: What is Your Pet Peeve About Doctors?

Nurses: What is Your Pet Peeve About Doctors?

Doctors and nurses work together to provide patients the best care. But you know that everyone has a pet peeve. In this six-minute video, new medical resident Siobhan Deshauer, MD talks with nurses about how physicians get on their nerves. What follows is a transcript…

Siobhan: Hey, guys. I’m Siobhan, a first-year medical resident. I figured today we could talk about how doctors and nurses get along, specifically the things that doctors do that really annoy nurses. It’s really tough as residents because we just kind of parachute into these ICU teams, which are really well formed. They all know each other well. They know how things work and we just need to figure out how it goes on the fly really quickly. The reason that I think this is so important is because this is a team. If we work and communicate better together, it should be better for patient care. Let’s go figure this out. The number one pet peeve that doctors will do.

Pet Peeve: Respect Nurses and Patients

Female Nurse #1: Not introducing yourself when you come into a patient’s room. Like I was telling you before, there was a doctor that walked into my room this morning wearing a winter jacket, boots, and no ID on him whatsoever. He came up and started reaching for my chart instantly. I was like, “Hi! Sorry, why are you touching my chart? Who are you?” Like, any indication? Introduce yourself! Introduce yourself to the patient and the nurse.

Siobhan: We can do that. We can do better at that.

In a Shared Workspace, Respect the Nurse’s Computer

Female Nurse #2: Respecting the nurses’ workspace because you do have your own personal workspace.

Female Nurse #3: I was also going to add that it’s a shared workspace. But sometimes when you’re thinking and you’re thinking for a really long time, that space is just…

Female Nurse #2: There’s a lot of people.

Female Nurse #3: Yeah, there is a lot of people and sometimes you just need… we need that space because it’s the only one we have.

Siobhan: Yeah, you’re actually working on a computer…

Pet Peeve: “RING! RING!” Pick up the Phone…

Female Nurse #3: Yeah. It’s kind of like, “Can you do that stuff and get out?” Because I need to be there. But it’s a shared space obviously and we all respect that for each other. I was just going to say pick up the phone. If it’s ringing, pick it up! It’s not my phone.

Siobhan: You mean even if it’s the phone, even if someone is paging us back?

Female Nurse #2: Yep, wherever you are.

Female Nurse #3: Any phone. Any phone. If you’re walking down the hall and the phone rings…

Siobhan: Just like…

Female Nurse #2: You pick it up.

Female Nurse #3: You’re part of the team. Pick it up. “Hello, ICU. Hang on. Okay, I’ll get you somebody else.” Just pick it up. Usually what happens is you’re sitting in the workspace and you’re taking up this workspace, and we’re probably sitting there like, “Okay. Well, fine, I’ll go do something.” You come back and they’re still there. The phone’s ringing and nobody’s answering, but they are still in the workspace. The phone is still ringing. Pick it up.

Siobhan: That’s amazing. Thank you! I will pick it up. Wow! This is actually very useful to hear all these things just even as a reminder. Let’s go see if there are some more nurses that have a minute to give us their feedback. The number one pet peeve, things that doctors do that you just hate, okay.

Pet Peeve: Again, Respect the Nurse’s Computer, Communicate, and Remember That You Are Not the Nurse’s Boss

Male Nurse #1: Maybe not number one. But when residents or doctors just hop on your computer and look up all these different patients under your name, which compromises my license. Thanks, guys.

Siobhan: Yeah, that’s really bad. That’s really bad. What would be the number one piece of advice that you would give to residents?

Female Nurse #4: Just communication is key. Communication, patient safety, and respect for your colleagues. Don’t think of yourself as we’re in a hierarchy. Again, when I worked on a ward, there was definitely a hierarchy between physicians and nursing staff. Whereas, it’s kind of like you’re not my boss. No. We are meant to work together. We’re a team. We all, I think, some doctors forget that I’m here mainly as a patient advocate and I spend 12 hours a day with them. I spend 12 hours a day with their families. Whereas you guys, yes, you’re all highly intelligent, but you have numerous other patients to see. Just kind of taking into consideration what nursing staff and other members of allied health have to say.

Siobhan: What would be your number one piece of advice for new residents like me?

Pet Peeve: Respect Patients’ Privacy

Female Nurse #5: Carry around an awareness of how immune to privacy, invading people’s privacy, nudity, things that are just commonplace in the hospital. You know what? We’re all guilty of it, walking through that curtain that’s drawn, because we’re trying to address a patient issue. Patients and their families, nurses at the bedside, really appreciate just like a quick hello from the other side of the curtain. “Hey! It’s Dr. so-and-so. Do you mind if I come in?”

Siobhan: I wouldn’t walk up to your room and just like walk in your bedroom door. Right? Like that just seems…

Female Nurse #5: That’s what I am saying.

Siobhan: What if you are changing or anything, right? Just knock. It’s the same thing, right? Pet peeve from doctors.

Pet Peeve: Nurses are Not Your Servants. Clean Up.

Female Nurse #6: One of my pet peeves that I have experienced is that the doctor will come in and do a procedure requiring sterile towels, dressing tray, lots of sharps, and sutures, and they’ll leave it all. They’ll do the procedure and then they’ll leave, leaving the nurse to clean up everything. Really, they should take care of the sharps and ask, “Where can I put these things?” I’d be glad to tell them.

Siobhan: Yeah, that’s so incredibly reasonable and a good reminder.

Female Nurse #7: Just being aware of everyone around that’s participating in rounds.

Siobhan: So not like doing this. [TURNS BACK]

Female Nurse #7: That’s right. Don’t turn your back to the nurse.

Nursing Students are Still Naive. Treasure Them.

Siobhan: As a nursing student, are there things that doctors do that just really bother you?

Female Nurse #7: As a nursing student, I wouldn’t say I’ve had too many negative experiences yet.

Siobhan: Yay!

Female Nurse #7: I would say a lot of them are positive. You guys are very informative and easy to talk to, so overall a positive experience with residents.

Siobhan: That’s awesome! We’ll see. We’ll ask you in like 5 years.

Female Nurse #7: Yes, ask me again in 5 years.

Siobhan: Thank you so much to all of the nurses who helped out with this film. It was fantastic. It was really fun and it gave me a lot to sort of think about and good reminders. Don’t forget to subscribe if you haven’t already and I will be chatting with you guys next week. Bye for now.

Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.

Previously published in MedPage Today.

“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

Part Three of a Three-Part Series

Sherry Cameron, a medical recruiter for correctional facilities across the US, recently wrote a post for DailyNurse as the first part in this Three-part series. (For part Two, see What to Expect as a Correctional Care Nurse). Now, she’s starring in the latest DailyNurse podcast, “What is it like to be a Correctional Nurse?”

Sherry Cameron, correctional facility recruiter for CoreCivic

Nurses in correctional facilities work so closely with other members of the healthcare team that Sherry describes it as a “family-oriented environment.” Often looking after inmates who have never received regular medical care, these nurses perform the usual nursing tasks such as administering medications, blood sugar checks, and tending to injuries incurred in the kitchen or carpentry shop.

Also, correctional facilities offer the opportunity to experience one of the most gratifying aspects of nursing. Corrections nurses act as educators for people who have rarely had any sort of relationship with a healthcare provider. Sherry recalls, “one nurse said to me that ‘it’s a very special moment when you see a patient come to tears because someone took the time to finally talk with them and educate them about their health.’ That to me is a true nurse at heart”.

In this episode of the DailyNurse podcast, you will hear Sherry discuss the character traits that she looks for in potential correctional nurses, the concerns they have when they first consider a career as healthcare providers in a correctional facility, advice for those interested in correctional nursing, and much more.

Certification is not required to be a nurse in correctional facilities, but getting certified always helps! Visit the National Commission on Correctional Healthcare to learn more about the field, and for details on how to become a Certified Correctional Health Professional [CCHP-RN].

Click the arrow button to hear the latest DailyNurse podcast!
Nursing Side Gigs: Raising Puppies for Canine Companions for Independence

Nursing Side Gigs: Raising Puppies for Canine Companions for Independence

This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a volunteer puppy raiser.

In 2017, Catherine Burger, BSN, MSOL, RN, NEA-BC, now a Media & Brand Specialist for, was in the midst of building her own home-based business after having retired from corporate nursing. Along with her husband and their youngest son, Burger had moved from Sacramento to San Diego, California, and she was looking for a volunteer opportunity.

“I kept seeing puppies with yellow vests in my area,” recalls Burger. “We had lost our dog several years prior, and it took many years before I was ready for another dog. I told my family that I believed we were meant to raise a service puppy, so we looked into it more.”

Burger had friends already involved with Canine Companions for Independence (CCI), so she and her family were able to talk with them and ask lots of questions. After completing an online application, as well as a home visit by a CCI staff member, they were approved and placed on a list to receive a nine-week-old puppy to raise.

“Canine Companions for Independence, a nonprofit organization, was founded in 1975 to provide expertly trained service dogs to enhance the lives of people with disabilities,” explains Burger. “These dogs are not just providing help with daily living by being the arms, legs, and ears of their partners, but also open to opportunities to live with greater independence and confidence.”

CCI provides these dogs to adults, children, veterans, and professionals, depending on their needs. The breeds used are yellow and black Labradors, Golden Retrievers, and mixes of these two breeds. “Most service-dog programs charge up to $40,000 for a trained assistance dog. Through volunteer puppy raisers like us, plus donations and sponsors, CCI is able to provide the trained dogs at no cost to the recipients,” says Burger.

When they started working with CCI, Burger and her family received a lot of training. “CCI provides mentoring, guidebooks, and many areas offer weekly training classes. As a puppy raiser for CCI, you commit to attending at least two puppy-training classes each week. There are professional dog trainers available for consult as needed if the puppy has any specific issues,” says Burger. “It is an extremely supportive program and community of puppy raisers. For example, we watch each other’s puppies when anyone is traveling.”

Burger and her family are raising their second puppy for CCI. Their first puppy, Nancy VI, is now a Change of Career (COC) dog, and they adopted her. Unfortunately, Nancy wasn’t able to get over having car anxiety. “We worked closely with the professional trainers to try to break her of the panting, drooling, and stiff body language,” says Burger. “While we were thrilled to adopt Nancy as our own COC dog, we were disappointed that she was not able to move into professional training to offer help and hope to someone in need.”

As puppy raisers, Burger and her family volunteer to provide everything for the puppy for the first 10 months of its life. Then they turn the puppy in for professional training. “We pay for the food, vet bills, vaccines, anything the puppy needs,” says Burger. “We are responsible to teach around 30 commands to the puppies at home — which are modeled through puppy class sessions — such as sit, down, back, side, heel, up, car, off, etc. Along with this training, our most important role is to socialize the puppies in public to get them ready to handle numerous situations in order for them to provide the most support to their future handler. Puppy class also provides field trips for the puppies to experience trains, buses, and even practice with getting through TSA and onto an airplane. The more confidence through varied experiences we can provide to the puppy, the more prepared they are for professional training and better prepared to be a strong assistance dog.”

Although they give so much to CCI and the community through raising puppies, Burger says that she and her family get a lot back as well. One of the best experiences has been seeing how the lives of those who receive dogs from CCI are radically changed. “Parents of an autistic child who, after receiving a dog for their son, were able to sleep through the night for the first time in 8 years because having the dog in bed gave him so much comfort,” says Burger. “I have also participated several times at Paloma Valley High School’s ‘Paws for Finals,’ where puppy raisers in the area bring their puppies to the school during finals. The kids are able to come pet and love on the dogs to minimize their stress. It brings tears to my eyes every time when I see a group of the popular kids, the geeky kids, the Emo kids, the shy kids, and the athletes all sitting around with their hands on my puppy, sharing dog stories together. It is also interesting that the puppies are absolutely exhausted after this stress-absorbing time with the kids!

“We are very proud to be associated with such an organization,” says Burger.

From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

When people experience sexual assault, they may sustain more than just physical injuries; trauma also affects short- and long-term mental health. The medical treatment needed may require a provider to examine parts of the body that were recently violated, which can cause more distress. When reporting an assault, survivors often lack the information they need about how to proceed.

Sexual assault nurse examiners (SANEs) are trained to help survivors across this spectrum of patient care. From providing evidence-based treatment to performing assessments to collect forensic evidence that can be used in a criminal trial, these nurses play a critical role in supporting survivors at the beginning of their recovery process.

What Is the Role of a Sexual Assault Nurse Examiner?

When a sexual assault survivor comes to a SANE-certified hospital or community health center, a sexual assault nurse examiner is the first point of care, according to Kim Day, forensic nursing director for the International Association of Forensic Nurses (IAFN). SANEs ask the patient if they would like a forensic exam, which can be completed even if the patient decides to not report their assault to law enforcement.

“Just going through the process with someone and providing holistic patient-centered care for that patient during a traumatic time in their life can really impact the way they leave the hospital,” Day said.

Forensic exams are meant to document trauma from the assault and collect evidence that could be used in a criminal trial. This includes taking a medical history; documenting scratches, bruises, abrasions, and other injuries on a body map diagram; taking photos of injuries; collecting DNA swabs to be processed; and observing the patient’s behavior. In cases where toxicology information is relevant, SANEs will also perform those tests on a patient.

In addition to performing a forensic exam, the main duty of a SANE is to provide holistic nursing care for the patient. Survivors of assault may need access to testing for pregnancy, as well as prophylactic antibiotics to prevent the contraction of diseases. Depending on the patient’s needs, SANEs also provide referrals to see other specialists, such as a licensed professional counselor, who can help them in their recovery process.

The SANE in Court: It’s Not Like “Law and Order”

Beyond working in the clinical setting, SANEs are qualified to testify in court if a patient’s case goes to trial. The specialized training SANEs receive prepares them to effectively answer questions regarding evidence discovered during a forensic exam. However, while SANEs can play a critical role in the trial process, the legal aspect of the job is not the main focus, Day said.

“If the nurse goes into this work thinking that they’re going to get the bad guy and put him behind bars, they will fail at this… because that is not what we do,” she said. “The work we do is nursing. We take care of the patients.”

This is a key factor to consider when choosing to become a SANE. Nearly 80 percent of sexual assaults are not reported to law enforcement, according to a Justice Department analysis of violent crime in 2016 (PDF, 669 KB). While performing a forensic exam and being prepared to provide evidence in court is a requirement of the job, the emotional and medical needs of a patient come first.

SANEs are trained to work within a multidisciplinary team, also known as a Sexual Assault Response Team (SART), which includes survivor advocates, members of law enforcement, and mental health providers. Together, these professionals coordinate the response to survivors of sexual assault.

What Is a Sexual Assault Response Team?

SANEs and other trained health care providers: When an individual decides they would like to have a sexual assault forensic exam (SAFE), health care providers like Nurse Practitioners (NPs) or SANEs address the initial physical and psychological needs the patient might have as a result of their assault.

Survivor advocates: Individuals who need access to information and emotional support can work with an advocate to navigate their path to recovery. A survivor may reach out to an advocate via a crisis center, or one may be brought in to support someone who has decided to seek treatment at a hospital or report their assault to the police.

Law enforcement: In cases where an individual decides to report their assault, police officers and detectives are responsible for taking statements, coordinating with the hospital to receive the results of the forensic exam, and investigating the alleged assault.

Prosecutors: In cases where the survivor has chosen to report their assault and enough evidence is present, prosecutors are tasked with making the decision on whether to bring the case to court.

Therapists and counselors: In the aftermath of an assault, whether a case goes to trial or not, survivors need additional support to continue their recovery process. Mental health professionals trained in working with sexual assault survivors may provide care at any step in the recovery process, from coping with the immediate aftermath of an attack to navigating long-lasting trauma.

Why Is Access to SANE Care Important?

According to the Centers For Disease Control and Prevention (CDC), one in three women and one in four men have experienced sexual violence involving physical contact during their lifetimes. The effects of experiencing an assault can be both physical and psychological, necessitating specialized care that embodies the concept of cura personalis, or care for the entire person. This holistic attention to the entire individual is the expertise of clinicians like nurses.

SANE education programs are designed to train nurses to address survivors’ specific needs. After completion of this training, SANEs become uniquely qualified to treat this vulnerable patient group. This means that they can provide trauma-informed care to minimize the harm of invasive exams that may trigger a patient. In doing so, they can also equip their patients with forensic evidence that can be used if they decide to report their assault.

Not all hospitals have SANE programs. IAFN’s database of registered SANE programs   indicates that there are currently 962 in the United States. As a result, patients are sometimes required to travel long distances to access SANE care, according to a 2016 report on the availability of forensic examiners (PDF, 191 KB).   This means that the facilities with SANE expertise must be ready to do what they can to help every patient who walks in the door.

Trauma-Informed Care and Practicing Consent

One of the key challenges of completing a sexual assault forensic exam (SAFE) is examining a patient’s physical injuries without retraumatizing them. To help survivors feel comfortable, SANEs ask for consent during each step of the way while providing information on why they are doing each test.

“Consent is not just a piece of paper with a signature on it,” Day said. “It’s a process throughout the exam.”

In practice, the process of asking for consent may resemble the following:

  1. The SANE will inform the patient what body part they will examine and ask permission to do so.
    “I’m going to examine your neck now to see if there are any injuries. Do I have your permission to do so?”
  2. If the patient grants this permission and the SANE notices something that may require a sample collection, the nurse will again ask for permission to collect a specimen and explain why collecting that evidence is appropriate.
    “I notice a scratch that wasn’t mentioned when I documented your health history. There may be DNA or other materials near this wound, so I would like to swab it. Is that OK with you?”

In any instance where the patient does not want a test performed, the SANE is directed to honor the patient’s request. This integration of consent throughout the exam is meant to give the patient a sense of control, a feeling that may have been lost during their assault.

What Are the Requirements to Become a SANE?

Because SANEs work with a patient population that requires specialized care, nurses are required to meet certain expectations in order to take on this role. While some nurses go through training at the local level or through smaller programs, IAFN offers the most recognized certification for SANEs. Nurses can become certified as a SANE-A to care for adults and adolescents or a SANE-P to work in pediatrics. Some nurses elect to pursue both certifications so they can provide care to patients across all age groups.

Steps to SANE Certification
  • Education: To become a certified SANE, a nurse must have the minimum of a registered nursing (RN) license.
  • Experience: Prior to starting the certification process, a nurse must have at least two years of clinical experience working as an RN or at a higher level, such as an NP.
  • Training: As part of the certification process, nurses are expected to complete 300 hours of SANE clinical skills training.
  • Testing: The final requirement to become a certified SANE is to pass a certification examination. IAFN holds exams two times a year.

Information for Further Reading

Citation for this content: [email protected], the online MSN program from the School of Nursing & Health Studies

What to Expect as a Correctional Care Nurse

What to Expect as a Correctional Care Nurse

Part Two of a Three-Part Series

With more than 2.1 million adults incarcerated in America’s prisons and jails, (PDF, 543 KB), there is a great need for correctional care providers to support this underserved population. Many people taken into custody are experiencing serious and preexisting health issues, while others will need medical attention to address illness and injury that occurs during incarceration.

The demand for health care professionals, especially nurses, is high and expected to grow. According to the Bureau of Labor Statistics, employment of registered nurses is expected to increase 15 percent between 2016 and 2026, while employment of nurse practitioners is set to increase 36 percent. Correctional care is no exception to this trend.

Health care is a field that requires compassion — but this is especially true for those working in correctional care. It requires the ability to see beyond someone’s criminal record and provide the best possible support for every patient, many of whom did not have access to health care prior to being brought into custody.

Understanding the Correctional System Population

Working in a correctional setting means working with a vulnerable and underserved population. A 2016 report from the Bureau of Justice Statistics on the health issues in American prisons and jails (PDF, 910 KB) found that incarcerated individuals were more likely than the general population to experience chronic conditions and infectious disease. Of those surveyed, 40 percent reported having a current chronic medical condition, while 21 percent of individuals in prison and 14 percent of individuals in jail reported a history of tuberculosis, hepatitis B or C, or other STDs (excluding HIV or AIDS). 

The prominence of health issues in correctional facilities is compounded by the fact that many incarcerated people do not have consistent access to treatment, meaning they arrive with undiagnosed conditions.

“We see our patients at their worst,” said Richard Hammel, the nursing program manager for the Denver Sheriff Department.

When an individual arrives for the intake process, Hammel and his colleagues are tasked with performing an initial medical exam. He said that many of his patients find out for the first time that they have an existing condition like hypertension or that they have contracted an infectious disease. Others may show signs of substance abuse, in which case they are taken through a detox process. Many incarcerated patients also show symptoms of mental illness, (PDF, 454 KB) which necessitates further care from clinicians.

What Is the Role of a Correctional Nurse?

Nurses are critical in the continuum of care for people who are incarcerated. While procedures can vary from facility to facility, nurses are typically the first point of contact. Correctional nurses perform intake exams, distribute daily medications and assess when a patient may need to see a specialist for further observation.

Given the responsibilities of a correctional nurse, paired with the range of health issues they encounter, it’s important to have a broad skill set that includes dealing with chronic medical conditions, substance abuse, mental health, infectious disease and injuries. Having experience in an emergency room setting, for example, may help a nurse more easily transition to working in a correctional setting.

Correctional nurses are also expected to work autonomously in most cases, which can be a desirable aspect of the job to many in the nursing profession.

As for specialized training, there is no universal standard for experience or certifications for nurses in order to be hired to work in a correctional facility. Most facilities instead institute on-the-job training to prepare their health care staff  according to the International Association of Forensic Nurses.

Correctional nurses do have the option of earning certifications from the National Commission on Correctional Health Care  or the American Correctional Association  to hone their specialized skills.

Health Care in Correctional Facilities

It takes a team to care for an incarcerated population. Below are some examples of the points care providers offer to meet the physical and psychological needs of those in correctional facilities.

Intake Exams

When individuals are incarcerated, they undergo an initial physical assessment to determine what needs they will have during their time in custody, including chronic health issues, mental health and substance abuse.

Who provides this service: nursing staff, including registered nurses, nurse practitioners

Medication Administration

Patients with chronic conditions may need daily medications, which are distributed by a provider to ensure adherence.

Who provides this service: licensed nursing practitioners, registered nurses

Chronic Care

Some chronic conditions, such as asthma or hypertension, require additional treatments and monitoring.

Who provides this service: registered nurses and specialists, including nurse practitioners

Inpatient Care

Incarcerated individuals who have sustained an acute injury or serious illness may need specialized treatment from an inpatient facility, such as a hospital.

Who provides this service: radiologists, respiratory therapists, phlebotomists, pharmacists, physical and occupational therapists, registered nurses and nurse practitioners and specialists such as surgeons, gynecologists and oncologists

Mental Health

Patients may have existing conditions such as schizophrenia or bipolar disorder or may need aid if they experience trauma within a correctional facility.

Who provides this service: behavioral health care specialists, counselors, nurse case managers, social workers, psychiatrists

How Does Working in Correctional Care Differ from Traditional Settings?

While the mission of a correctional nurse is the same as any nurse—to provide the best possible care for every patient—working in a correctional facility has some distinct differences from traditional health care settings. 

Correctional facility protocols are, in a word, strict. Because the presence of a deputy or corrections officer is required during exams, for instance, it can be difficult to maintain patient-provider confidentiality. Also, when an individual knows someone else is listening, they may feel uncomfortable or even be unwilling to speak openly about their health problems.

While the safety and security measures of a correctional facility may be unfamiliar to those who have only worked in traditional health care environments, correctional nurses can still provide compassionate care for their patients. For example, Hammel said that he and his staff are trained to assess whether it is safe to ask the officer on watch to step out briefly during an exam. This helps build trust with a patient, and makes him/her less likely to withhold any relevant information that may impede their care plan. 

The need to be vigilant and protective of one’s personal information is another aspect of the job that may feel foreign to health care providers outside of the correctional environment. Providers are advised not to share any details about their life outside of work with patients who are incarcerated, which can create some barriers for building trust and showing empathy. 

“Sometimes nurses like to use themselves as a tool in treatment and share stories [to empathize]. That is just something you can’t do here,” Hammel said. 

Instead, Hammel implements the following strategies when building rapport with his patients:

  • Ask questions to gauge a patient’s fears, concerns and general thoughts about their health issues.
  • Take time to appreciate a patient’s perspective.
  • Follow through with what you say you can do for a patient.

There is also a common perception that treating individuals in a correctional setting is less safe than working in a traditional environment. Hammel, though, says that in his experience, this perception is largely a myth.

“I have never felt afraid or been attacked [in the workplace],” he said, because “there are deputies close by to step in and make sure everyone is safe, both the patient and the health care worker.”  Other correctional nurses have voiced similar sentiments, saying that working in a correctional facility often feels safer than in a hospital. There is not current data to compare the experiences of correctional nurses to those in traditional settings, but safety and security are top priorities for correctional facilities. The presence of correctional officers, the access to call buttons in every room, and training to identify the early signs of escalating and agitated behavior are all factors in preventing incidents between patients and providers.

Correctional Health Care and Employee Burnout

While compassion fatigue is a common term known among health care providers, clinicians and other correctional care providers may experience a more specific feeling known as corrections fatigue.

Corrections fatigue is “the cumulative negative change over time of corrections professionals’ personality, health and functioning” that results from poor coping strategies or a lack of resources necessary for the requirements specific to working in correctional care, said Caterina Spinaris, executive director of Desert Waters Correctional Outreach in Florence, Colorado.

When someone experiences a series of stressors during their day-to-day life, as a result, “these stressors interact,” Spinaris said. “They are cumulative.”

How to Avoid Correctional Burnout

Build your support system
This can include your partner, family members, fellow colleagues and friends.

Practice mindfulness
Find activities that help ease your stress and process your feelings. This can include journaling, meditation, exercise and other calming activities.

Find activities that don’t intersect with work
Finding a balance and separating your personal life from your work life can help avoid burnout. Hiking and outdoor activities, for example, put you in an environment that is completely different from your job.

Get help
If serious symptoms such as depression, panic attacks or substance abuse begin to manifest, consider seeking help from a mental health professional.

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Be sure to tune in for Andrew Bennie’s podcast with Sherry Cameron on the world of correctional healthcare–available on Spotify November 5!

From [email protected], the online FNP program from the University of Southern California

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