“African American women have the highest incidence and prevalence of hypertension among any ethnic, racial, and gender group in the United States,” explains Taylor, who works at NYU Rory Meyers College of Nursing as the first Vernice D. Ferguson Endowed Chair. “It is important for me to understand not only the genetic or hereditary underpinnings of this health disparity, but also the psychological and/or environment interaction with genomic risks that may influence development of hypertension.”
In her research, Taylor says that she’s focused for the most part on African American women and children. Most of her studies have drawn on two or three generations of African Americans. While the ages of the children studied have often been wide, in her most recent study, she targeted children from head start programs, who ranged in age from 3-5 years old, along with their biological mothers.
“We have had a lot of discoveries in our research and have disseminated our findings in journals ranging from nursing, medical, public health, genomic, and interdisciplinary. Overall, we have found that gene-environment interactions for certain factors such as parenting stress, perceived racism and discrimination, and others significantly influence increases in blood pressure,” says Taylor.
She admits that she wasn’t shocked by the findings: “The findings were not all that surprising as I expected that social determinants of health were significant factors in health outcomes and looking at the combinatorial effects with genetics and epigenetics only further illuminates that magnitude of interaction on health outcomes such as hypertension,” Taylor says.
Although Taylor says that her research is important because of what she did discover, “One important aspect of the research is that we are able to identify genetic risk for chronic diseases such as hypertension in children as young as three prior to them developing the disorder. Early identification of risk provides an opportunity for nurses and other health professionals to intervene to reduce risk of developing hypertension as in previous generations. Interventions based on the research with this population may require focusing on social determinants of health and lifestyle modification in addition to or rather than conventional pharmacological methods.”
Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, has spent her career working hard, and as a result, she’s been a standout.
But she recently received an outstanding honor when she was elected to the National Academy of Medicine (NAM)—and she’s only one of two nurses selected this year.
“It is a tremendous honor to be selected as a member of NAM,” says Taylor. “Membership in NAM is one of the highest honors you can achieve in science and medicine.”
In order to be elected to NAM, Taylor explains that you must be nominated by a current member, as nominees are not involved in the nomination process. When you are elected to NAM, it means that you have been elected by a group of experts who see you as a premiere expert in your particular field.
According to a statement from NYU Rory Meyers College of Nursing, Taylor has been recognized for her “bench-to-community research in gene-environment interaction studies on blood pressure among African-Americans that has provided novel contributions on SDoH and omic underpinnings of hypertension.”
“These newly elected members represent the most exceptional scholars and leaders whose remarkable work had advanced science, medicine, and health in the U.S. and around the globe,” NAM President Victor J. Dzau said in a statement. “Their expertise will be vital to addressing today’s most pressing health and scientific challenges and informing the future of health and medicine for the benefit of us all. I am honored to welcome these esteemed individuals to the National Academy of Medicine.”
While Taylor now works as a Professor and Vernice D. Ferguson Professor in Health Equity at the NYU Rory Meyers College of Nursing, she began her academic career working as an Assistant Professor and Director of the Pediatric Nurse Practitioner Program at the School of Nursing at the University of Michigan. Taylor then worked for nine years at Yale, and became the first African American woman to go through the tenure track ranks. In 2014, she earned tenure. Later, Taylor was named the first Associate Dean of Diversity at the Yale School of Nursing where she remained until going to NYU Rory Meyers College of Nursing. She then came to NYU to serve as the first Vernice D. Ferguson Endowed Chair. She also is the Director of the Meyers Biological Laboratory and Co-PI and Co-Director of the P20 Exploratory Center on Precision Health in Diverse Populations.
“Nurses have been members of NAM for a very long time. It is very important to have a membership that is diverse across health disciplines such as Nursing, Dentistry, and Medicine because all work together for the greater good of patients,” says Taylor. “I believe that my membership in NAM will add a greater voice and representation of nursing as an integral part of scientific research and practice.”
Taylor also hopes that this membership will open up opportunities so that she can “move the science forward in a more robust way and at an even larger scale.”
Every workplace has its challenges. But, on the flip side, each has its advantages as well. We asked Beverly A. Ely, APRN, FNP-C, who works as a Family Nurse Practitioner in Harrogate, Tennessee, about what it’s like to see patients in a rural area.
Beverly A. Ely, APRN, FNP-C
What kind of work do you do?
I currently am a Family Nurse Practitioner and work with Lincoln Memorial University/DeBusk College of Osteopathic Medicine. We have 2 clinic locations that serve the University and the public. In the clinic, I see patients of all age groups from newborns to the elderly.
Working in a rural area is quite different from what most nurses do. Have you worked in a more urban or suburban area before this? If so, how does working in a rural area differ from those places?
My career spans over many decades and regions. I began a career in nursing in the late ‘80s. I graduated from Lincoln Memorial University with a degree as an Associate Nurse. I chose to begin my nursing career in Knoxville, TN and commute back and forth. Working in a suburban area, I encountered larger volumes of patients in which needs were very different than those in an urban location.
The urban area is different than the area where I first began my career. Coming back to it was a different experience, but one that has proven to be the most rewarding. I help them meet the simplest of everyday needs and assist them with coping skills to understand a diagnosis—this is rewarding. That is what I cherish about rural health and the people of the Appalachian area. I can now say that I can give back and serve the people that have given me so much.
Why did you choose to work in a rural setting? What kinds of patients do you tend to see? How are they different from those you saw in a more urban setting?
I chose to work and serve in the rural area of Appalachia because the needs are so great. I completed 29 years as a suburban nurse and saw many different classes for people. The common denominator for both is survival.
What have you learned from working as a nurse in a rural area?
I have learned to be patient and compassionate. I have learned that there is very little that we truly need in order to survive.
What are the biggest challenges of working in a rural setting?
The biggest challenge is compliance and understanding of their illness.
What are the greatest rewards?
Seeing people feel better and the smiles on their faces.
What would you say to someone considering moving to work in a rural area? What do they need to be willing to do or deal with?
I would voice that rural health is the most rewarding field that you can chose. It requires you to have compassion and patience.
Is there anything else about working in a rural area that is important for people to know?
Yes. Do I plan to continue here? The answer would be YES. It is the most rewarding of my 30 years as a nurse that I could have ever imagined. I’m compassionate and love the people of Appalachian and desire to see them live life to the fullest.
From electronic health records (EHRs) to smartphone apps, today’s health IT tools can help nurses develop innovative strategies for closing the gap of racial and ethnic health disparities.
One of the top priorities of President Obama’s Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is to reduce health disparities—such as disproportionately high rates of chronic diseases in racial and ethnic minority populations—through the “meaningful use” of EHR technology. Seven years after the passage of HITECH, how much progress have we made toward achieving that goal?
In the 2013 report Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) showcases many innovative examples of how health care providers nationwide are using EHRs, as well as other types of health IT, to increase access to care and improve health outcomes in communities of color. From the rural Mississippi Delta to immigrant and low-income communities in large metropolitan areas, “health IT offers promising tools to address chronic diseases by facilitating the continuity of care and long-term follow-up needed for successful management of these conditions,” the report concludes.
That, of course, is where nurses come in. Take a close look at successful model programs that are deploying health IT to help close the gap of unequal health outcomes and you’ll see nurses—including hospital and clinic RNs, nurse practitioners, informatics nurses, case management nurses, nurse researchers, and more—playing leadership roles.
“Nurses are coordinators of care for patients. We’re typically the first person they see when they seek health care,” says Joyce Sensmeier, MS, RN-BC, CPHIMS, FAAN, vice president of informatics at HIMSS. “It’s really a natural extension of the nurse’s role with patients to connect the dots from the information technology side.”
For most nurses, health IT begins with the EHR. This essential platform enables them to instantly access a patient’s complete health record, document patient data in real time, monitor changes in the patient’s condition, and use clinical decision support tools—such as computerized alerts—to respond to those changes. But increasingly, nurses are also waging war against health inequities by arming themselves with an arsenal of other high-tech tools, including the following:
• patient portal websites, which give patients convenient access to their personal health information and enhance communication between clinicians and patients;
• health information exchanges, which allow patient data to be securely shared between different providers—such as hospitals, ERs, and primary care providers—to improve continuity of care;
• wireless and mobile health (mHealth) technologies, such as smartphone apps and text messaging;
• external databases, such as state and national disease registries and immunization registries, that collect clinical information about specialized populations of patients across a large geographic area; and
• population management software (PMS) systems, which help nurses track health trends among specific groups of patients they care for—for example, pediatric patients, or patients with diabetes.
Seeing the Bigger Picture
For nurses who are working to improve minority health outcomes, one of the biggest advantages of using health IT is that these tools make it easier than ever before to capture, compare, and analyze patient data. And that translates into unprecedented opportunities for leveraging that data to better manage the needs of patients with chronic illnesses, identify gaps in care, and develop targeted interventions.
“Clinicians have always been information workers,” says David Hunt, MD, FACS, medical director of patient safety and health IT adoption at the ONC. “It’s just that so often we’re focused on that one patient, that one chart. IT tools give you the ability to step back and look across groups of patients to really get insight into how to make care better.”
In other words, these technologies maximize nurses’ ability to address health disparities from a population health perspective. You can “slice and dice” the data stored in the EHR to classify and group patients in many different ways—for example, by race, ethnicity, age, and gender. Nurses can also zero in on patients who have particular conditions—such as heart failure, asthma, or HIV—to generate condition-specific reports and action plans, says Wanda Govan-Jenkins, DNP, MS, MBA, RN, lead nurse informaticist for the ONC.
“You can look at the EHR and extract these groups of patients to see which patients’ blood pressure was elevated at their last visit, or which patient hasn’t been seen for a while,” she explains.
Patient portals are another vehicle for communicating chronic disease management reminders to whole populations of patients, adds Lisa Oldham, PhD, RN, NE-BC, FABC, vice president of practice operations and chief nursing officer at the Institute for Family Health, which provides care to medically underserved communities at multiple facilities in New York City and state. The institute’s portal, MyChart MyHealth, is available in both English and Spanish (MiRecord MiSalud).
“We can create an electronic letter for the entire organization’s patients who fall into a specific category and send it to them through the portal,” Oldham says. “The patient will get an e-mail that says, ‘Please go into your MyChart,’ and that’s where they’ll see the letter. For instance, we just sent out an e-mail blast to all our geriatric patients reminding them to come in for their annual wellness visit.”
At the Cherokee Indian Hospital (CIH) in North Carolina, a tribal health system that serves more than 14,000 members of the Eastern Band of the Cherokee Indians, care management nurses develop outreach campaigns using the hospital’s PMS, which works in conjunction with the EHR.
“By pulling data out of these platforms, our nurses can target in and pinpoint things like how many people need to get a colorectal cancer screening or a Pap test,” says Sonya Wachacha, MHS, RN, CCM, executive director of nursing at CIH. “Then the nurse generates a reminder letter to that person, such as ‘Mrs. Smith, it looks like you’re due for your mammogram. Can you please come in and get that done?’”
On an even larger scale, says Hunt, “disease registries are wonderful resources, because you can identify characteristics and trends that you don’t have insight into when you’re just looking at a group of patients within your own practice. Having the benefit of looking at large amounts of data from many, many providers gives you tremendous insight in terms of being able to infer more information about your patient population.”
Educate, Engage, Empower
Nurses are also finding that consumer-driven health IT tools, like patient portals and mHealth technology, can offer exciting new ways to help patients who are living with chronic diseases become better educated about their conditions, more engaged with their treatment, and more empowered to self-manage their own health.
Patients can log into their care provider’s portal and access disease management educational materials, which health systems can tailor to meet the needs of limited-English-speaking and low-literacy patients. For example, the Institute for Family Health’s portal has links to patient education resources in more than 40 languages.
At the Institute’s Ellenville Family Health Center in Ellenville, New York, a rural community with one of the highest poverty levels in the state, “the most prevalent disease processes in our patient population are diabetes and cardiovascular problems,” says staff nurse Santiago Diaz, RN. “The portal has information specifically for these patients. We walk them through the basics of where to find the information, and we show them the shortcuts so that they don’t get lost in all the information that’s up there.”
Because nearly everybody today seems to have a smartphone or cellphone, these devices can help nurses connect with hard-to-reach populations, such as young people. Jo-Ann Eastwood, PhD, RN, CCNS, CCRN, associate professor and advanced practice program director at UCLA School of Nursing, recently conducted a research study that used custom-designed smartphone apps to teach young African American women who were at high risk for heart disease how to make heart-healthy lifestyle changes.
“When we look at chronic disease prevention in minority populations,” she says, “we have to look at the population that’s between 25 and 45 years old, or even younger. If we’re going to develop prevention strategies that are relevant to this population that is very technologically astute, that is fast-moving, that is busy, we have to hit them where it’s salient.”
Govan-Jenkins, who is also a professor of informatics in the graduate program at Walden University School of Nursing, recommends teaching patients how to download and use the many free or low-cost mobile apps that are available in the consumer health marketplace. For instance, there are diabetes management apps that let patients monitor their blood glucose levels and upload that data to their patient portal for nurses to track.
“Patients who have smartphones or mobile devices can download continuous self-monitoring apps that let them see things like how many steps they took that day and how many calories they burned,” Govan-Jenkins continues. “The nurse can also send weekly or monthly text messages to condition-specific groups of patients, such as reminding them to take their medication.”
Ultimately, Wachacha believes, being able to interact with their own health data and personally follow their progress toward meeting their health improvement goals can make a big difference in engaging patients to take a more active part in their care.
“With our EHR, we can create graphs that let patients see how their blood sugar or blood pressure readings are going up or down over time,” she says. “When our tribal members who have diabetes, for example, can look at that graph and see that their A1C levels are going down after they start exercising, it’s meaningful for them. It gets them motivated to do more with their care, because they can see that the things they’ve done are having an impact on their results.”
Reaching Across Barriers
According to the ONC report, health care providers must find solutions for overcoming “challenges and barriers to the use of health IT” in medically underserved communities of color. Some of those challenges include limited access to Internet service and cellphone connectivity in underdeveloped rural areas, cultural and linguistic differences, and low rates of technology literacy among these patients.
Telehealth remote monitoring systems (software-based IT tools that let nurses collect data via a device they install in the patient’s home) are an effective strategy for reaching patients in rural communities who don’t have access to computers, says LaVerne Perlie, MSN, RN, senior nurse consultant at the ONC.
At the initial home visit, telehealth nurses show patients how to record their health information, such as blood pressure readings, and enter those numbers into the system. “That data is sent directly to the nurse in the provider’s office so that he or she knows when to come out and visit the patient and make recommendations for ongoing care, such as scheduling an office visit or even a hospital admission,” Perlie explains.
As members of the nation’s most trusted profession, nurses are ideally suited to educate patients who are unfamiliar or uncomfortable with technology about how to use health IT tools and become more computer-literate.
At Institute for Family Health facilities, patients receive information about MyChart MyHealth as soon as they walk in the door. In the examination room, says Oldham, nurses explain how the portal works and the benefits of using it. They answer any questions the patient has. Then they help patients register for the portal right there, guiding them through the process of how to log in, create a correctly formatted password, and navigate the website. For patients who don’t have a computer at home, “we encourage them to use the computers at the public library [or to download the MyChart MyHealth mobile app to their smartphone if they have one],” adds Diaz.
Still, another challenge cited in the Understanding the Impact of Health IT report is that “customization of off-the-shelf health IT products often necessary to ensure that they [meet] the needs of underserved populations.” For example, the Cherokee Indian Hospital serves a patient population that has a high risk for suicide, substance abuse, and tobacco use. Because its EHR and PMS didn’t include functions for monitoring these risks, the hospital had to add them.
Hunt and Perlie emphasize that the best way hospitals can make sure their investment in technology will provide information that’s the right fit for their population health management needs is to get nurses involved in the design of health IT systems right from the start—before the technology is implemented. Many health IT projects fail, Govan-Jenkins cautions, because the implementation team didn’t seek input from frontline nursing staff. “And then they had to rebuild and re-implement the system, because it was just not capturing the data they needed to capture for their specific type of patients.”
That, says Sensmeier, is what reducing health disparities through the meaningful use of health IT is really all about. “It’s not just about adopting the technology. It’s about using it in such a way that we can capture the data that’s been entered and learn from it—learn what makes an impact in different patient populations, what care models and treatments work, what outcomes are being realized, and how we can change our practice.”
With more than two million men and women in custody in American jails and prisons, there’s a great need for nurses to care for the correctional population. Nurses who can cast off their biases and follow strict security rules while helping inmates restore and maintain health could find an ideal career in correctional nursing, says Mary Muse, Director of Nursing for the Wisconsin Department of Corrections. “Correctional nursing allows you to really focus on what nursing is: caring for people,” she says. “If nurses want to be autonomous in their position, there’s probably no better setting than correctional nursing.”
Muse, a nurse for three decades, faced common misconceptions and stereotypes early in her career. Many perceive that correctional nurses aren’t held to the same standards as nurses in other health care settings, such as hospitals and doctors’ offices. “It was a job you took when you didn’t necessarily have something else,” Muse says. “This was a nontraditional health care setting.” Vowing to ignore the stigma, Muse made it her mission to enhance correctional health delivery and help eliminate disparities, while making the fi eld more visible. “Nurses who practice in correctional settings have really been absent from the larger landscape of nursing,” she says.
Of the many ways correctional nursing differs from nursing in a health care setting, the most obvious might be the “challenge of caring versus custody,” says Ginette Ferszt, associate professor of nursing at the University of Rhode Island. While nurses come to their work from a caring science perspective, she says, the primary goal in U.S. prisons is custody and safety.
That disconnect makes the role of a correctional nurse even more important, says Pat Voermans, a correctional nurse consultant and nurse practitioner with the Wisconsin Department of Corrections. “What’s so striking to me is the need of the people in these systems,” she says. Inmates can’t choose their providers, and correctional nurses are the gatekeepers to getting prisoners the health care they need. And, she adds, “We can’t choose who we get. Sometimes we get patients who don’t have the best handle on their decision making and how they interact with others. They’re angry and you have to try to work with them. Trust is a really hard thing to establish with an inmate because they often see us as part of security.”
A day in the life of a correctional nurse
Every day is different for a correctional nurse, but many of the nurse’s duties are the same at jails and prisons across the country. In Connecticut, where the Department of Corrections oversees jails and prisons, intake screening is a major responsibility for nurses, says Dr. Connie Weiskopf, Director of Nursing and Patient Care Services for Correctional Managed Health Care at the University of Connecticut Health Center. Correctional nurses in the state perform about 35,000 intake screenings every year, she says, filling out a four-page document on each inmate’s physical and mental health status.
In addition, correctional nurses in Connecticut administer more than one million doses of medication each year, Weiskopf says. “Many of the inmates in the system are on medication. The nurses administer medication to all the patients.” Inmates who were recently released from the hospital are cared for by nurses in the prison infirmary. Other nursing duties include coordinating outside services for inmates and overseeing care management for HIV-positive patients.
When it’s time for an inmate to leave prison, Weiskopf says nurses coordinate with the correctional department to facilitate the patient’s discharge and arrange for continued care and medications on the outside. Nurses also run hospice units within some correctional facilities, and they can play a role in decisions on early release for ailing inmates. “Sometimes there’s a great deal of effort put into compassionate releases,” she adds.
Voermans, who has spent 25 years working in correctional facilities, deals with programs and policies and provides chronic disease management care to male inmates in minimum security settings. The population, often disproportionately minorities, faces chronic conditions such as obesity, diabetes, and liver disease. Lab work is done on-site, and medications are provided by the state pharmacy. With several inmates sometimes crowded into the same cell, infection control is key, Voermans says. “If you get a transmissible disease like H1N1, you’ve got a crisis on your hands.”
Ferszt says some correctional nurses also try to help patients with mental health issues. “They also do a lot of psychosocial support,” she says. Many of the women prisoners Ferszt works with in Rhode Island put in requests to get medical treatment for reasons other than physical concerns, such as anxiety related to the death of a family member.
Correctional vs. health care nursing
Nurses accustomed to working in hospitals or doctors’ offices might fi nd a correctional setting takes some acclimation. Correctional nurses work closely with security officers, Muse says, in an environment much more regimented than the outside. Sometimes, nurses are prohibited from even bringing a cell phone into the prison clinic. “One of the primary differences is the work environment,” she adds. “It’s not necessarily a warm, bright environment. It tends to be dark.
” Even the equipment available to correctional nurses might be different than in a hospital, Voermans says. While nurses in health care settings can often access state-of-the-art tools and the skills and input of other providers, that’s not always the case in a correctional facility. And, in some ways, the extent of care provided might be different in a prison. “The care you give here is medically necessary care,” she adds. “It’s not elective care.”
Weiskopf says interactions between correctional nurses and patients can take on a new quality within prison walls. While a hospital nurse wouldn’t hesitate to tell a patient with a broken leg about her own similar experience, discussing such details is inappropriate in a correctional facility. “You really do not divulge anything personal to prisoners at all,” she says. And while a hospital nurse might hug a patient with dementia, Weiskopf says, a correctional nurse wouldn’t hug an inmate. “You really need to just focus on the care.”
Correctional nurses need to maintain boundaries because of the potential for an inmate to take advantage of a health care provider, Muse says. “You have to be aware that someone might say, ‘I’m really concerned about my mom. I haven’t heard from my mom in a while,'” she says. While a hospital nurse might help the patient reach out to a relative, correctional nurses would be ill advised to accept a request that could lead to more demands from the inmate. Even when it comes to discussing an inmate’s upcoming surgery, correctional nurses should only give family members vague details, since the inmate could be planning an escape attempt. “You have to clearly present yourself as a professional nurse,” she says.
The differences between correctional nursing and nursing in health care settings can lead to challenges. When nurses can’t hug or touch patients, it might be difficult to show empathy, says Arleen Lewis, a nurse consultant for infection control at the University of Connecticut Health Center Correctional Managed Health Care. Instead, correctional nurses can verbally empathize with patients grieving the loss of a loved one or reeling from a disease diagnosis. “We’ll bring that patient to an area where we can maintain confidentiality,” Lewis says, “and we’ll allow that inmate to verbalize his or her feelings.” Patients are encouraged to discuss their fears while nurses express their support and, if needed, bring in mental health clinicians.
Even routine patient interaction can prove challenging in a correctional setting, Ferszt says. When prison nurses perform tuberculosis or fl u clinics, inmates are lined up for vaccinations. But if a patient wants to speak to the provider, there’s not always time for counseling. While the nurse can request for the inmate to be brought back to the clinic for a later discussion, everything moves more slowly due to facility rules and inmates’ tight schedules. “You just can’t be as spontaneous in your teaching,” Ferszt says, “and in communicating with a woman or man when you’re providing health care.”
Patient privacy and safety
Patient privacy is another potential hurdle for correctional nurses. In private practice, Ferszt says, a quiet, calm setting is the most amenable to counseling a patient. But in a correctional facility, it can be tough to find a private room. Even then, other staff members sometimes walk in and out during a session. “You don’t have the same total privacy you would in another setting,” Ferszt says. The same goes for physical assessments, Voermans adds, which sometimes take place in noisy cells as patients wears chains or shackles.
Because correctional nurses work in a security setting, rather than a health care environment, they follow a different set of rules. “You’re basically in the house of the department of corrections,” Weiskopf says. “That means we need to obey their rules around safety.” For instance, while nurses in health care settings might leave needles on the counter in a patient room, she says, correctional nurses are “constantly counting sharps.”
Muse, who hasn’t experienced any safety issues on the job, says it’s important to be mindful of what nurses leave unattended in exam rooms. Even a seemingly innocuous roll of tape, she says, could be used as a weapon. “It doesn’t mean that weapon is to be used on you. For many people, it’s so they have something to protect themselves should they get in trouble.”
As for Muse, she didn’t consider the potential safety hazards of correctional nursing before she started the job. Walking through the correctional facility during her fi rst week, a supervisor mentioned gang activity there, surprising Muse that such affiliations existed behind bars. The supervisor also noted that nurses should greet passing inmates. “They remember the people who were kind and respectful of them,” Muse says. “If you treat people with respect, generally you get that back.”
Diversity in correctional facilities
Despite the challenges of correctional nursing, the compliance rate, at least anecdotally, is sometimes better among the prison population, says Michael Ajayi, a prison administrator and regional nurse manager, and clinical faculty member at the University of Medicine and Dentistry of New Jersey. “I’m sure many of them know they get good care,” he says. “They respond better to therapy than patients who are on the outside.”
It’s estimated that African American and Hispanic prisoners account for more than 60% of the inmates in jails and prisons, according to the Bureau of Justice Statistics. Although the prison population is quite diverse, that isn’t always the case with the staff of correctional nurses. “You see more minority inmates,” Ajayi says, “but almost all the nurses working with them are Caucasian.”
Correctional nurses should be conscious of this diversity and treat all inmates with respect. “With people from so many different places immigrating to our country,” Ferszt says, “we really need to work on becoming culturally aware.” Patients with certain cultural backgrounds might resist taking medication due to their beliefs, while others turn to herbs for healing. Just as in a traditional health care facility, nurses working in corrections should make an effort to understand those beliefs and find ways to work with patients. “It requires a nurse to be proactive and comfortable seeking out individuals from different backgrounds.”
Health risks and challenges
Because correctional nurses work with a disproportionate number of incarcerated minorities, Voermans says health issues particular to the groups might be more likely inside prisons than on the outside. The correctional population sometimes faces higher rates of HIV/AIDS, hepatitis C, MRSA, and even infectious diseases. Working with minorities means correctional nurses can serve as advocates, shining a light on health issues that afflict certain populations more frequently. One example she mentions is sickle cell disease in black patients. Muse also encourages correctional health care providers to consider the unique needs of female prisoners who are sometimes forgotten in the male-focused field. “For a patient to see a minority nurse they can connect to that might advocate for their health is helpful,” she says.
Since language is sometimes a barrier, Weiskopf says health education materials are often available in English and Spanish. Many correctional nurses have access to a language translation line and chaplains of various religions. Her unit has mandatory diversity training for staff. “We try to be culturally sensitive,” she adds.
Not everyone is cut out for correctional nursing. “It’s important to be someone who wants to serve that population,” Ferszt says. “Nurses need to, like anyone, examine their own potential biases toward that population.” Voermans adds that patients can experience bad medical outcomes when their complaints aren’t taken seriously by medical personnel. And as for the nurses, “If they don’t like the disadvantaged and the poorest, they shouldn’t be there,” Ferszt says.
Correctional nurses should be generalists, Muse says, but also ready to cross over into specialty areas. “In correctional nursing, you never know how your patient is going to present.” Correctional nurses should be poised to leap from oncology to mental health at a moment’s notice, Muse adds. Critical-thinking skills and a strong background in nursing assessment are also key. Ferszt says there are other important traits for correctional nurses, including flexibility and the ability to maintain good working relationships with correctional officers and administrators. “The system can be very frustrating because of its structure. You need someone who can be really flexible.”
It’s sometimes tough to recruit new nurses to corrections. But despite the challenge, Muse says, it’s just as important to recruit the right type of nurse, especially to correctional leadership positions. “There is a need to have minorities in more leadership roles,” she adds. Opportunities within the correctional nursing field include positions for advanced practice providers, nurse practitioners, managers, quality assurance personnel, juvenile nurses, and more. For nurses who feel ready for the challenge of practicing in a correctional facility, Ferszt says there’s an unending opportunity to do good for patients. “By realizing the issues they deal with, we can become better advocates for them in the community and change health care,” she says. “There’s an opportunity to make a real, significant impact.”
