From the Ethics Inbox: Conflicting roles for a correctional nurse

Author(s):

To: Ethics

From: Nurse in correctional setting

Subject: Team service

As an RN in a state penitentiary, can I serve on the hostage negotiation team or the special operations team at my correctional institution? Hostage negotiation team members don’t carry weapons, but special operations team members carry weapons and are authorized for use of force, if necessary.

From: ANA Center for Ethics and Human Rights

The ANA Code of Ethics for Nurses with Interpretive Statements and ANA Correctional Nursing: Scope and Standards of Practice are excellent tools to help you answer your question. Both documents offer guidance and express the ethical standards that are expected of a professional nurse in a correctional setting.

Correctional nurses recognize that promotion of patient and staff safety includes educational awareness and adherence to institutional security procedures to achieve a safe work environment. Additionally, correctional nurses are expected to have effective communications with security staff within the institution to support the mission of preserving safety. The scope and standards state that correctional nurses must collaborate with security staff, but this does not mean correctional nurses should take part in security activities, such as punitive disciplinary procedures.

Provision 2 of the Code notes: “The nurse’s primary commitment is to the patient, whether an individual, family group, community, or population.” At times this commitment to care for the patient may conflict with the importance of safety for staff and other inmates. A correctional nurse, even when acting as part of a negotiation team, should understand that safe patient care is paramount for all patients, including the inmate whose actions have resulted in the negotiation team alert. “Nurses strive to preserve the human dignity of prisoners regardless of the nature of the crimes they have committed,” according to ANA’s position statement on capital punishment, and must provide health care to their patients without judgment of criminal allegation, convictions, or histories, as noted in the correctional scope and standards.

When a nurse is in a practice setting with competing roles, it should be clear when he or she is not performing in a clinical role. As a correctional nurse, you must be able to clearly communicate the scope of your practice to other members of the hostage negotiation team. A corrections nurse acting within the role of nurse-negotiator must not take part in any type of actions that may negatively affect the nurse-patient relationship. If you choose to participate on a special operations team, where team members could use deadly force against inmates, it is recommended that you do not represent yourself as a nurse.

When the safety of the inmate population conflicts with an individual patient’s care, the correctional nurse must be able to partner with security staff to ensure patient safety is protected. As the scope and standards state, “Correctional nurses have a primary role as patient advocates and champions for health care.”

Response by Elizabeth O’Connor Swanson, DNP, MPH, APRN-BC, member of the ANA Ethics and Human Rights Advisory Board.

Photo Source: The American Nurse Project by Carolyn Jones

Selected references

American Nurses Association. Correctional nursing: Scope and standards of practice. 2nd ed. Silver Spring, MD: American Nurses Association; 2013.

American Nurses Association. Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association; 2015.

American Nurses Association. Capital punishment and nurses’ participation in capital punishment. 2016.

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