Prison Nursing Leadership
Nursing leadership encompasses advocacy, actions, and critical thinking which exist in all the areas of practice within the profession. Through nursing leadership, patients, the nurses and the whole healthcare system get impacted either positively or negatively (Weiss & Tappen, 2014). In offering services within a correctional unit, the leadership is not only essential for the care for inmates but is also different based on the different structure that the unit assumes. In spite of this difference, the nursing roles remain the same to provide care to the prisoners.
Prison nursing leadership is vital based on the complexity of the prison environment (Dhaliwal & Hirst, 2016). All the nursing care providers within the unit lead various care units in the process of negotiations related to the care of the clients as well as coming up with positive changes to improve the services they offer. For all the leaders within the institution to be trusted and respected which is crucial in the provision of services to the inmates, they have to show care, competency, and capability while approaching various issues in their daily activities.
Nursing leadership within the prison has multiple roles and responsibilities that are pegged to them. According to Wong, (2015), nurse leaders have the task of helping the inmates to work towards changing their environment while at the same time adapting to the conditions of restrictions. Since the prisoners are in the unit for corrective purposes, the nurse leader can make use of the transformational leadership by recognizing the potentials and skills of both the inmates and other prison staffs to attain the set nursing goals and objectives. By exploring the inmates’ competencies and skills, they get engaged thus improving their lives within the unit and obtaining the correctional services that they opted for.
In addition to the above roles, the prison nursing leadership spearheads health promotion activities and disease prevention in the unit. If a disease develops within the unit, the leadership together with the nursing staffs intervenes promptly to curb the spread to other individuals. The nurse also supports the prisoners battling chronic c health conditions. Nurse leaders act as communication agent between the security personnel together with other specialists serving within the prison and the inmates themselves concerning the coordination of patients’ health and the planned activities that they are supposed to undertake.
Prison nursing leadership is crucial to the fact that that prison is a unique unit that is surrounded by issues of inmate’s presence as well as the legal system that comes with the care that the individuals needs. For example beside the provision of care, security is another area that has to be taken care of at all times. This situation prompts the nursing leadership to act as mediators to prevent conflicts from differences and open up ways to ensure a smooth running of operations.
Nursing leadership priorities
Beside the above roles, there occur various issues that encroach the nursing services in prison setting. These occurrences then lead to various issues that the nursing leadership has to put on top of their list to ensure an appropriate and prompt response. The priorities enable the prison nursing leadership to respond to various pressures that may arise as illustrated below.
Retention of nursing staff
In the prisons, there exist various systems and structural challenges that do not only affect the nursing staff but also the entire prison community. For many years, the funding directed to the prisons and jails is usually inadequate leading to insufficient funds being allocated to various departments including healthcare. This issue has been part of the problem leading to failure in providing sufficient care to the prisoners. With the low fund allocation, the healthcare unit finds it hard to purchase various supplies and equipment needed for quality care. In the long run, the presence of inadequate equipment translates to a poor working environment for care provision leading to stress that ends in high nursing turnover (Twigg & McCullough, 2014). The stressful situation is further enhanced with the low potential of the prison to higher sufficient number of nurses to offer quality care. Fatigue and burnout emerge among the present staffs who may also resolve to resign. At the same time, the unfavorable environment is created by the complex nature of prisons does not only entail care provision but is also marred by correctional and security issues.
In approaching the retention of nursing staff retention, the nurse leader is tasked with the role of advocating for more funding to the healthcare department. This can be done through collaboration with other interested and charity organization to facilitate the purchase of healthcare supplies and equipment. Besides, the leadership can take care of various difficulties that nurses face within prisons such as security by collaborating with the prison security personnel on ensuring the staff is always secure so as not to interfere with the services that they offer to the inmates. In prevention of stress and burnout from the shortage of nurse that further leads to the high turnover, the leadership ought to recruit more nurses in trying to balance the nursing care demand and supply (Twigg & McCullough, 2014). For the nurses working within the unit, proper remunerations and recognition can be done to motivate them to enhance their retention. For the newly recruited nurses, proper indoctrination can be employed to reduce the stress that can come with the failure to understand the prison structure and systems. In the end, the staff will embrace their duties with increased instances of retention.
In the provision of healthcare, there is need of an enabling environment to both the caregiver and the care user. This scenario is not the case with the prisons which any violent situation can be anticipated. Within the prison, there are many inmates that have the potential of becoming violent. Usually, the safety concern leads to the accompaniment of correctional officers to the inmates during the process of receiving care (van de Mortel et al., 2017). However, the presence of another person breaches the nurse-patient relationship that is usually paramount for therapeutic care. Despite the presence of the officer, the patient can still turn violent and cause injuries to him or herself as well as the nurse or the officer.
In response to safety, the nurse leader can lead and spearhead training of all the nursing staffs on the handling of the inmates which in one way enhancing privacy and at the same time ensures their safety during the period of care. For example, precautionary measures such as the nurses being next to the exit and entry of the inmates first in the examination rooms or during the time of assessment or history taking can assure the nursing fraternity some safety issues. At the same time, the nurse leadership can lead the nursing fraternity in ensuring safe handling of sharp objects that are usually objects of suicidal attempts to the prisoners as well as gargets that the inmates can use to endanger the lives of the staff members. The sharps can be under control and at any time of use, the security personnel can be involved.
Besides the above measures that the nursing leadership can impact, there can also be coordination and collaboration with the administration to enhance security surveillance and monitoring all the times for the healthcare unit to enhance the security measures. By employing these systems, the nurse leader can promote and safe and a secure environment for the nursing staff. In addition to the safety issues directed towards the staff, the nurse leadership has a role in surveillance to determine suspected case so infection disease and work towards isolating the patients (van de Mortel et al., 2017). Through working with the administration, the nursing leadership can allocate a room for isolation of patients to prevent transmission to other inmates and staffs.
Working with other officers
The organizational structure determines the various operations that occur within the facility in the process of achieving its goals. The structure and systems define the roles, supervision, and coordination. In the prisons, the various levels of management in various units such as the healthcare, recreation, and fitness, control unit, security, rehabilitation, kitchen and dining, counseling, library, and education are required to operate in coordination to each other. The staffs from the unit are obliged to offer their best services, comply with all the legal requirements in prison and addressing all the duties that fall in their lines. For all these to be achieved, there is a need for professional collaboration, and that is the point where the nursing leadership creeps in to assist in handling the institutional matters.
Due to the diverse activities and services that are critical to the correctional units, the prisons have various specialists. These include the nurses, prison healthcare officers and other specialists that provide their services to the inmates such as counselors, advice, probation, referral officers, Security and Assessment and Through Care teams. The inter-professional collaboration among the staff of the prison allows for coordination and smooth delivery of services to the inmates. The collaboration is vital especially in the nurse-led hospital wings which usually encounter tension in the process of care provision as well as the control of prisoners by taking care of the security of patients, staffs and those visiting the unit. The collaboration is staged on the fact that for proper welfare and services to the inmates, various specialists need to get into continuous communication and coordination.
Achieving the inter-professional collaboration is essential for the nurse leadership though it cannot be achieved by their singly evident positions. By understanding the prison structure and presence of various leaders from different departments, the nurse leaders can use such opportunity to involve the various appointed or elected leaders form the subsections of the unit is the process of establishing the inter-professional practice. The leader then intervenes through the administration that makes the inter-professional collaboration policy with the middle management level reinforcing the policy to be implemented at the grass root level. In so doing, the collaborative working will be accepted and adopted by various staff members working in the unit thus leading to prisoners to receive well-integrated services and consequently better outcome.
Maintaining patient confidentiality
Ethics and moral values require that all patients including inmates have their information kept confidentially and only used by the healthcare personnel for the sake of nursing care (Sasso et al., 2015). The patients’ confidentiality becomes a nursing priority in the prisons and challenges the nursing leadership due to the structure and systems that exist within the facility. Usually, the patient is always accompanied by the security personnel in the process of care provided by the nurses. At the same time, some of the service delivery points are under surveillance through the visual cameras. Despite the fact that these mechanisms being employed to ensure the security of both the patient and the healthcare provides ate maintained, the results are usually the breach of patients’ privacy and confidentiality to the information provided by the inmates.
The nursing leadership can assist in maintaining the confidentiality concerning patient information by embracing a system where both the written, verbally provided and electronically stored information is under control. Besides, the move can take the form of maintaining an up-to-date file on the rules and regulations that dwells on the confidentiality of the health records including the information that may be shared or those that may not be shared even among the inter-professional staffs.
In facing system and structural barriers to confidentiality such as the security personnel and virtual monitoring of patients at all times in various units, the nurse leader can liaise with the administration to set up the healthcare department where despite the presence of security personnel, a social distance can be maintained. The examination rooms may be designed to have transparent screens as well as both front and rare doors to allow for the privacy of the client while at the same time, the security personnel continues to monitor the interaction between the nurse and the patient. The virtual monitoring can be exempted from specific areas to ensure the patients’ privacy and confidentiality is maintained. All these can then enable the patients to develop trust with the nurses and provide information that would assist in their care since they are confident that the information is only held by the healthcare staff and does not fall in the hands of any person they may fear to have the ability to access the data or records.
Multicultural and diversity
Culture revolves around the customs, ideas and social behaviors exhibited by the various individual, professionals or even in the society. This aspect is determined by the environment thus various people exhibit different cultures depending on the surrounding that they came into contact with. According to Sue, Rasheed & Rasheed (2015), the cultures affect the individuals, beliefs, attitudes and thinking concerning various subjects. Regarding profession, the employees working in for same agencies or facilities demonstrate many similarities than differences. Irrespective of these similarities, there still exists a cultural difference that leads to diversity and a vast of experiences that the team in the workplace can use.
Multiculturalism and diversity turn to be a concern to the nursing leadership in prisons based on the various groups of people that are present in the unit. Both the staff members and the inmates themselves come from different cultures and ethnic groups with different beliefs and values. With the diversity that exists, various staffs, as well as the prisoners, do feel uncomfortable with these situations within a common setting such as the prison (Bruya, 2017). To overcome these differences and confrontations, the nurse leadership together with the staff members can work towards cultural tolerance for peaceful co-existence thus promotes their role of care provision.
Moreover, the nurse leadership out to ensure the service provided to the inmates are culturally and linguistically sensitive. The views and beliefs of the patients, as well as the staff, are taken into account. In the long run, the care provided can be considered to be patient-centered. Multiculturalism can also be viewed positively by enhancing the working of various people from diverse culture and learn new things from each other within the unit.
Power dynamics contribution to the nursing leadership priorities
As illustrated by Li, Matouschek & Powell (2017), the power dynamics have challenges to various organizations especially when it comes to collaboration amongst professionals. Those who end up feeling the impact of the power dynamics are usually the service users. Concerning power dynamics, the various staff members usually come across the issues of the use of their powers to protect their autonomy. This aspect usually comes in the case of misunderstanding of the autonomy while working with other professionals. For the nursing leadership, this ought not to be the case so that all that comes out of their association within the entire unit may be geared towards making the prisons favorable environments to enhance correctional activities to the inmates.
Another issue about the power dynamics is the reduction of the interdependent between the prison staff members with the aim of maintaining their power. This move may be undertaken to isolate oneself from participating in various activities. It is however not the case since the decisions usually impact other staffs within the organizations. In recognition of these two aspects, the nurse leadership should be keen on the whims of power in driving their agenda to go through. The nursing leadership priorities do affect not only the inmates but also the nurses as well as other officers working within the prison. The nursing leadership steps in to build trust and respect amongst the prison staffs via multiple moves to ensure theirs exist balance of power that will not only spearhead collaboration but will also see improvements in other departments. In the end, the services offered to the inmates would be improved.
Structure of the prisons influencing the desired changes
The prisons consist of many security officials that possess different ranks, many specialists that offer specialized services to the inmates and the stakeholders to support the activities in the department. The nursing leaders ought to involve all these groups to see their priorities taken in. This is done by seeking the administrative support as well as seeking the support from the members. Through this approach to the desired changes, the ideas will gain overwhelming support from members while at the same time lead to the change of operations and culture to the unit to the best practices.
Impact of multiculturalism and diversity on organizational and systems structure and leadership
The multiculturalism and diversity within the prison setting have been the center of various innovations as well as the origin of various practices. This change can be attributed to the tolerance and sharing of various aspects of cultures thus their togetherness and feeling of oneness. Through the multiculturalism, various considerations have been made from the administrative as well as the various department thus decision made are staff and clients-centered as they are culturally sensitive. These moves have allowed for the attainment of needs and competencies for not only the staff members but also the inmates.
The diversity has assisted the correctional unit in keeping the biases of all the prison staffs on the check. According to Falender, Shafranske & Falicov, (2014), such moves have enabled majority to work together and support various ideas and plans presented for consideration by the members because the majority are geared towards tolerance that makes them get in line with the various assumptions that exist in the diverse setting. Also, the diversity has given room within the organization to monitor and observe the inclusiveness that is made to each person engaging in unit’s activities. With the nursing priorities in place, the diversity offers an avenue for the nurse leader to seek views and opinions from the staff members concerning the issues which when put into consideration, a quick adoption is enhanced due to its sensitivity as well as support from the members.
Theoretical ideas and practices of power concerning health care organizational structure, behavior, and systems leadership
The Elitist theory of power puts into consideration the presence of a class of rulers within the public service organizations who are mandated with the duty of conductive specific essential functions as well as a large class who are on the receiving end of the services being provided with the class of rulers. This idea is in line with the nursing leadership within a prison set up thus alludes the critical nature of the position as it comes along with responsibilities as illustrated by Garner, Ferdinand & Lawson, (2016). The nursing leadership can apply the theory in rallying the staff members and the inmates behind the priorities identified. The theory can also be used in any instance the nurse leadership identifies any problems that need change to get support from the grass root level.
About Paul’s conception of power, the nurse leadership can use the practice to ensure all the nursing priorities are taken care of by various individuals. According to this practice of power, certain practices are perceived to guard the believers from the dominion of the powers while at the same time there exist others who are exposed to work of the powers (Richardson, 2015). In applying this, the nurse leadership can delegate various duties to either the nursing staff members as well as the other professional officers to ensure all the needs of the organization are met. This practice allows for the inclusion of theory in the process of adopting a change in an organization.
Prison nursing leadership is a position promoting care among inmates and need to be given sufficient attention due to the uniqueness of the setting. Indeed leading care provision in an area that comes along with other roles such as security and correctional aspects makes the role challenging. Through the priorities of nursing leadership such as staff retention, recognition of multiculturalism and diversity, promotion of patients’ confidentiality, working with other staff members as well as enhancing the safety of staffs and patients, the nurse can enhance the care that the inmates receive. The nursing leadership can then employ various theoretical and practice issues such as the elitist theory to rally the entire prison staff members behind them, in achieving the nursing priorities.
Bruya, B. (2017). Ethnocentrism and Multiculturalism in Contemporary Philosophy. Philosophy
East and West, 67(4), 991-1018.
Dhaliwal, K., & Hirst, S. (2016). Caring in correctional nursing: A systematic search and
narrative synthesis. Journal of forensic nursing, 12(1), 5-12.
Garner, R., Ferdinand, P., & Lawson, S. (2016). Introduction to politics. Oxford University
Richardson, P. (2015). Practices of Power: Revisiting the Principalities and Powers in the
Pauline Letters. By Robert Ewusie Moses. Emerging Scholars. Minneapolis, MN:
Fortress Press, 2014. Pp. xi+ 293. Paper, $59.00. Religious Studies Review, 41(4),
Sasso, L., Delogu, B., Carrozzino, R., Aleo, G., & Bagnasco, A. (2016). Ethical issues of prison
nursing: A qualitative study in Northern Italy. Nursing ethics, 0969733016639760.
Sue, D. W., Rasheed, M. N., & Rasheed, J. M. (2015). Multicultural social work practice: A
competency-based approach to diversity and social justice. John Wiley & Sons.
Twigg, D., & McCullough, K. (2014). Nurse retention: a review of strategies to create and
enhance positive practice environments in clinical settings. International journal of
nursing studies, 51(1), 85-92.
Weiss, S. A., & Tappen, R. M. (2014). Essentials of nursing leadership and management. FA
Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: state of the
science. Journal of nursing management, 23(3), 275-278.
van de Mortel, T. F., Needham, J., Barnewall, K., Djachenko, A., & Patrick, J. (2017). Student
nurses’ perceptions of clinical placements in Australian Prison Health Services: A mixed
methods study. Nurse education in practice, 24, 55-61.