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Serving those serving time.

Editor's Note: This is an edited version of the article, which was printed in the April 2007 issue of Nursing Spectrum, Midwest Edition. Copyright April 2007. Nursing Spectrum Nurse Wire ( All rights reserved. Used with permission.


Kay Northrup, RN, BSN, a certified correctional health care professional, has spent her entire nursing career defending the rights of her patients while also protecting the rights of prisoners. Prisoners are her patients.

"Their confinement is their punishment, but they deserve proper health care while serving their sentence," said Northrup, warden of the Corrections Medical Center in Columbus, Ohio, since 2004. As a registered nurse and a warden, she oversees the prison hospital, security staff and facility paperwork. She also continually raises awareness about the need for others to follow her lead to serve the growing populations of prisons in the United States.

Northrup, a corrections nurse for nearly 20 years, joined a 14-member panel of nursing colleagues from across the nation to publish an updated set of guidelines to provide direction for nurses entering this specialized vocation.

Published in March 2007 by the American Nurses Association, Corrections Nursing: Scope and Standards of Practice provides the mission and expectations of nurses who work in prisons and correctional facilities.

The 90-page report is only the third published document to offer nurses a detailed overview of what is expected of them when working in a controlled, high-risk environment, such as a prison or large population institution that requires confinement and security measures.

Rob Hofacre, RN, BSN, MCRP (master's in city and regional planning), who served as the nursing director for the Ohio Department of Youth Services for 13 years and is serving his sixth year as a Commission on Accreditation for Corrections commissioner, also served with Northrup on the panel that researched the published report.

"I'm only 43, and it's only been within my lifetime that nurses and doctors have ever even been included to provide health care and services to people serving sentences in prisons," Hofacre said.

"As amazing as this sounds, it's only been since 1976 that constitutional rights have even been granted to prisoners. It wasn't until 1976 when the United States Supreme Court established a constitutional standard for inmate health care because of the Texas case Estelle vs. Gamble," he said.


As described in the published report drafted with research by Northrup and Hofacre, it was an inmate with the last name Gamble who claimed that prison officials inflicted undue suffering on him when they failed to provide adequate care for an injury sustained in prison. The Supreme Court ruled that "deliberate indifference to serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain.'"

Prison Guidelines And Directives

Northrup, who received her nursing degree in 1970 from Capital University in Columbus, Ohio, began her corrections career as a nurse in 1989 at the Ross Correctional Institution in Chillicothe, Ohio, and was promoted to health care administrator at the prison in 1994. She was then named deputy warden of special services in 1996 at the Noble Correctional Institution in Caldwell, Ohio, before being named warden in 1997 of the Oakwood Correctional Facility in Lima, Ohio.

Today, she oversees a 239-bed specialized corrections medical facility with a staff of 53 RNs, 36 LPNs and 35 hospital aides, all part of a staff of 455, which includes 257 security staff members. She also is a member of the American Correctional Association, the Board of Trustees of the Ohio Correctional and Court Services Association, and the Ohio Wardens Association.

"When I first entered into the corrections nursing field in 1989, we had very few guidelines and directives to help us with the expectations you face when serving the medical needs of offenders," Northrup said.

In early 2006, the current census findings reported more than 7 million people were on probation, in jail, in prison or on parole, which represents more than 3 percent of all U.S. adults, or one out of every 32 people. "If you look at this report we just published, it emphasizes that today's inmates are older, are sicker and remain imprisoned longer when compared to the inmates of 20 years ago when I first started," Northrup said.

As for some of the most common questions Northrup is asked repeatedly, most people assume the responsibilities she carries out and the cases faced by her nursing staff every day are the drama-filled scenarios depicted in television shows and movies about prison life. "It's far less about handling the medical concerns following fights, violence and riots and much more about handling day-to-day medical needs, whether they are physical or even mental needs," she said. During most days, her staff primarily handle the distribution of medication to inmates while working on what both she and Hofacre emphasize is the greatest responsibility of today's corrections nurse: promoting and educating preventive health care efforts. "There is definitely a large population in today's correctional facilities who have cases of HIV/AIDS, tuberculosis and hepatitis," she said. "So we want to educate these individuals about their medical condition and prepare them to care for themselves not only while serving their sentence but also when they are released."

Hofacre, one of the nurses on the advisory panel who encouraged the publication of an updated report on guidelines for corrections nurses, said the last time any such report was published was a 2002 revision of the original Scope and Standards of Nursing Practice in Correctional Facilities, which was first released by the American Nurses Association in 1995. "In doing our research for this new report, we found that inmates suffer from age-related conditions earlier in life and their personal history of poor nutrition, lack of preventive care and high-risk behavior makes a 50-year-old inmate's health status comparable to that of a 65-year-old living in most other communities in our country," he said.

Hofacre describes himself as an "extreme rarity" in the nursing field. Not only does he hold the distinction of being a male nurse, but he is also a part of the much smaller segment of nurses willing to work for a correctional facility. "I had worked as a nurse with juveniles serving sentences as the nursing director for the Ohio Department of Youth Services from 1994 right up to January 2007, when I left for my new position as the ambulatory services director for the Ohio State University Medical Center," he said.

"But I'm still very involved in the corrections nursing field, and I'm always trying to work to remove the stigma that comes with that title, to encourage more nurses to enter this specialized nursing area. It's one of the most rewarding experiences I've ever had, and I think most nurses who have served in this same capacity would agree," Hofacre said.

A Look at the Inside

Jesse Warren, 28, of South Bend, Ind., is an example of just one of the many inmates grateful for the medical attention, services and dedication of nurses like Hofacre and Northrup. Warren is serving a seven-year sentence, for aggravated battery and possession of a firearm, at Westville Correctional Facility in Westville, Ind., which has a population of nearly 3,200 offenders. In March 2007, just nine months into serving his sentence, he began suffering from a severe hernia that required surgery.

"I had a lot of pain, and if it hadn't been for the medical unit here, I'd still be in pain," said Warren, who was examined by the nursing staff at the Westville Correctional Center's 18-bed infirmary and then allowed to be transported with a correctional officer to neighboring Saint Anthony's Hospital in Michigan City, Ind., where he was operated on to correct the problem.


"The [correctional officer] stayed with me the entire time, even watching during the surgery," Warren said. "But the most important thing was the nurses got me to the hospital when they knew I needed to go right away."

Cynthia Montgomery, RN, of Valparaiso, Ind., the health service administrator for the medical unit at Westville Correctional Facility, supervises a staff of 70, which includes 14 RNs and 21 LPNs. Montgomery and her department are actually a contracted medical services operation provided by a parent corporation called Correctional Medical Services, based in St. Louis, which provides nurses and medical staff to institutions and facilities in 27 states, including Ohio, Michigan and Indiana.

Montgomery said her specialized field requires her to seek a balance to serve the needs of her patients while also being required to observe the necessary directives and security precautions enforced by the department of corrections. "So much has changed in the 20 years since I first worked as a nurse," Montgomery said. "But the mission and goals remain the same. Provide for the care and medical needs of our patients while they are here, while also preparing them with the necessary education and awareness for when they leave."

Philip Potempa is a freelance writer. A copy of Corrections Nursing: Scope and Standards of Practice, published by the American Nurses Association (2007), may be obtained from the American Nurses Association for $16.95, plus shipping and handling by calling 1-800-637-0323 or visiting www.nurses You may also order this publication from ACA by calling 1-800-222-5646, ext. 0129, or visiting

RELATED ARTICLE: The Dual Standards of Corrections Nursing Practice

1. Assessment: The nurse collects comprehensive data pertinent to the patient's health, condition and situation.

2. Diagnosis: The nurse analyzes the assessment data to determine the diagnosis.

3. Outcomes identification: The nurse identifies expected outcomes for a plan individualized to the patient or the situation.

4. Planning: The nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

5. Implementation: The nurse implements the identified plan; coordinates care delivery, health teaching and promotion; and employs strategies to promote health and a safe environment.

6. Consultation: An APRN and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others, and effect change through prescriptive authority and treatment. The nurse evaluates progress toward attainment of outcomes.

7. Quality of practice: The nurse systematically enhances the quality and effectiveness of nursing practice.

8. Education: The nurse attains knowledge and competency that reflect current nursing practice.

9. Professional practice evaluation: The nurse evaluates his or her own practice in relation to professional practice standards, relevant statutes, rules and regulations.

10. Collegiality: The nurse interacts with and contributes to the professional development of colleagues.

11. Collaboration: The nurse collaborates with patients, family members and others in the conduct of nursing practice.

12. Ethics: The nurse integrates ethical provisions in all areas of practice.

13. Research: The nurse integrates research findings into practice.

14. Resource utilization: The nurse considers factors related to safety, effectiveness, cost, benefits and impact on practice in the planning and delivery of nursing services.

15. Leadership: The nurse provides leadership in the professional practice setting and the profession.

Source: As identified from Corrections Nursing: Scope and Standards of Practice, published by the American Nurses Association (2007).
COPYRIGHT 2007 American Correctional Association, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Title Annotation:CT FEATURE; nurses in corrections
Author:Potempa, Philip
Publication:Corrections Today
Geographic Code:1USA
Date:Oct 1, 2007
Previous Article:E.R. Cass Award: ACA's highest honor.
Next Article:Mental illness among juvenile offenders--identification and treatment.

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