DiversityNursing Blog

Nurses at Brigham & Women’s Hospital in Boston are threatening a walk-out next Monday, June 27, 2016. The Massachusetts Nurses Union and management at the hospital have been in negotiations and cannot agree on their contract. What are your thoughts about it?

Brigham and Women’s Hospital and the union representing its registered nurses are at an impasse.

Negotiators from Brigham and the Massachusetts Nurses Association have met 20 times to hash out a new contract, but after the latest session on Friday, the dispute seemed only further from resolution.

The union has threatened a one-day strike on June 27, and patient care is likely to be disrupted as hospital leaders scale down operations and hire temporary replacement nurses. The hospital says nurses will be locked out for five days if they walk out.

“In response to what the union said was their greatest concern, we worked hard to develop a generous wage and benefit package for every one of our nurses, despite the tremendous financial pressure in healthcare,” Dr. Ron M. Walls, Brigham’s chief operating officer, said in a statement. “We are disappointed that the union rejected our most recent proposal.”

Brigham is owned by Partners HealthCare, the state’s largest health care provider network.

Union negotiators said in a statement that “nurses are prepared to strike unless Partners offers a fair settlement that values patients over profits… Every patient deserves safe care and every nurse deserves a fair wage and equal benefits.”

So, what’s preventing an agreement? As hospital and union leaders prepared to continue talks Monday, they shared details of their latest proposals with the Globe:

Wages

Brigham nurses receive 5 percent annual raises for their first 18 years on the job. The hospital proposed keeping those step raises and adding a new step at the top of the pay scale. Those at the top would receive a 4 percent increase, plus a $500 bonus, over three years, bringing pay for full-time nurses at the top of the scale to $148,616. The average Brigham nurse currently makes $106,000 a year. The hospital also offered $1.4 million in bonuses, but after the union rejected its offer, it directed that money to hiring temporary nurses to work in case of a strike.

The union also wanted to keep step raises in place and add a top step to the scale. But it wanted bigger raises than the hospital proposed: a 5 percent raise for nurses at the top of the scale, and an additional 4 percent increase for all nurses over two years.

Benefits

Brigham wants to place newly hired nurses into a “flex” insurance plan already offered to other Brigham and Partners employees. The hospital calls it a comprehensive plan with a wide range of options, which many union nurses have voluntarily selected in the past. Brigham officials said they offered to set a maximum employee premium contribution rate so they wouldn’t be able to increase what nurses pay without future negotiations.

But the union says the hospital is forcing newly hired nurses into “lesser benefits.” Officials say the hospital has already “lured” many nurses into its preferred insurance plan only to increase employee costs over time. They want new nurses to be able to choose from the same health insurance options that existing nurses have.

Staffing

The union says Brigham has been cutting nurse staffing in one unit of the hospital, where patients are recovering from major thoracic procedures, such as lung transplants. Union officials say the unit was historically staffed with 15 nurses at a time, and they want to keep staffing at that level.

Hospital officials maintain that staffing in that unit is “comparable to or better than similar units within the hospital and at other hospitals throughout the state.” They want to set staffing levels according to the number of patients in the unit at a given time, and how sick the patients are. On Friday, the hospital asked the union to agree to a plan for submitting complaints about staffing to senior nursing officials, but the union said this was “unacceptable” because nurses already complain when they have concerns about staffing and “nothing is done.”

1. Nurses, Make Time For Stress Relief

   
   

2. The Importance of Humor in Nursing
   
   

3. Diversity In The Nursing Field
   
   
   

4. Homeless Veteran Became VA Nurse To Help Others
   
   

5. Important Questions Regarding Your Diversity, Inclusion and Cultural Proficiency

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As we are all still grieving the horrific shootings in Orlando, this article points out the hospitals and medical teams who took care of the victims. As staff called co-workers at home and asked them to come in and help with the overwhelming number of patients coming in to the emergency room, the response was “I’ll be right there”. We know our Nurses across the country would respond the same way.

Things started out fairly well, by a busy emergency room’s standards. The Orlando Regional Medical Center had been warned that gunshot victims would be arriving from a nearby gay nightclub, and the first one was conscious, talking and medically stable.

“We didn’t know exactly how many we were going to get,” Dr. Kathryn Bondani recalled Tuesday. “We thought maybe they’re all gonna be like this, and that would be great.”

But then another victim from the mass shooting early Sunday at the Pulse nightclub arrived, and another, and another, in critical condition with devastating injuries. Four or five of the earliest patients died. And then victims kept coming – not always arriving in ambulances, but sometimes in the backs of trucks, sometimes seemingly just appearing in the halls of the hospital, awaiting treatment.

Gunshot victims aren’t an unusual sight at the 75-bed facility in downtown Orlando, nor are they for any trauma center handling the daily chaos of a major American city.

ut on Tuesday, staff at the hospital described what it was like to confront the aftermath of the deadliest mass shooting in modern American history, with one staffer likening it to a “war scene.” Forty-nine victims were killed.

Nine of those victims died “in the first few minutes” after arriving at the Orlando Regional Medical Center, which received 44 victims from the shooting, according to Dr. Michael Cheatham, the hospital’s chief surgeon. 

Six of the 27 victims still being treated at the hospital Tuesday were in critical condition, and doctors warned that some may die. Twelve victims were also treated at Florida Hospital in Orlando, where six remained in fair condition.

The victims arrived at Orlando Regional Medical Center in two waves over the course of Sunday morning. There was an initial batch of almost two dozen who arrived shortly after shooting began at 2 a.m. A second group arrived after police confronted and killed the gunman.

Some of the wounds were small, looking like they were from the shooter’s handgun; others were much larger, probably from the shooter’s .223-caliber semiautomatic rifle, according to Joseph Ibrahim, the center’s trauma director.

Some victims looked like they’d been shot from close range. Some looked like they’d been shot while running away. One victim had 11 gunshot wounds; another had four surgeries after arriving Sunday, doctors said. Many of those who died suffered head wounds, they said.

One of the victims taken to the hospital was clubgoer Angel Colon, who was shot three times in the left leg as he ran away from the gunman, and then was trampled by other club patrons trying to escape.

Speaking at Tuesday’s news conference, Colon said his left leg was “shattered” and he couldn’t run, so he lay down and played dead as the gunman began “shooting everyone that’s already dead on the floor.”

“I can just see him shooting at everyone, I can hear the [shots getting] closer, and I look over and he shoots the girl next to me,” Colon said.

“I’m next – I’m dead,” he recalled thinking as the gunman approached.

The gunman shot him in the hip and hand and moved on as Colon tried to show no reaction.

Soon the police arrived, and Colon said he could hear officers trading gunfire with the assailant. Colon saw an officer, and the officer grabbed his hand, saying, “This is the only way I can take you out.” He then dragged Colon out – as broken glass cut Colon’s back and his legs.

“I don’t feel pain, but I just feel all this blood on me, from myself, from my other people,” Colon said. “He just drops me off across the street” – outside a Wendy’s  restaurant -- “and I look over, and there’s just bodies everywhere, we’re all in pain.” There, an ambulance took Colon to the safety, and the chaos, of the Orlando Regional Medical Center.

he hospital normally gets alerts from a “very advanced” emergency medical service system that lets hospital workers know when certain patients are headed their way, said Medical Director Gary Parrish. This time, “there was really no advance notice at all.”

As more patients arrived, the on-duty staff began calling more doctors, and more nurses and other staffers, who answered their phones in the middle of the night with a common answer: “I’ll be right there,” according to surgical intensive-care unit director Chadwick Smith.

An army of nurses arrived – dozens who were supposed to be off-duty – along with X-ray and blood technicians as doctors set up a triage to treat the most gravely injured patients, said Bondani. Workers speedily cleaned up operating rooms after the end of one surgery so doctors could immediately begin another. Coordinators responded immediately whenever supplies ran low.

The scene was emotional, with “people in pain, people worrying about their loved ones, people not knowing where their loved ones are,” said Smith.

But doctors said that despite the chaos, the hospital’s emergency plan worked smoothly and efficiently. Aside from the initial patients who died immediately after the shooting, no one else at the hospital had died in the 48 hours since the attack, doctors said.

Smith got emotional at Tuesday’s news conference as he talked about watching hospital staffers arrive in tears to do their jobs.

“It was singularly the worst day of my career, and the best day of my career,” Smith told reporters. “I would think this is probably the same for every person you see standing up here.”

This week is Men’s Health Week and this article serves as a reminder about the importance of men paying attention to their health. As a Nurse, you are in the perfect position to remind your male and female patients to take care of themselves, exercise, eat healthy, listen to their bodies and get help if they notice any persistent changes.

Men’s Health Week is being recognized across the U.S. during the week leading up to and including Father’s Day (June 13-19). And while I have said it before, it bears repeating, this is not just a men’s issue — we all need to be aware and support our men’s (young to old) good health and prevention of health problems. To that end, I am sharing key information in three parts to help spotlight Men’s Health. There are many medical and social factors that impact the physical, social, emotional and spiritual health and wellbeing of all our men and boys.

Studies show that culturally women surpass men in asking for help with their health and too, our boys and men have been raised in a culture “to be emotionally restrained, keeping things close to the vest, being in control, independent, competitive and to endure pain.” Research shows that many men only seek medical counsel when under duress from a family member or when their condition has deteriorated to a severe state. This in itself is an issue but add to this, these staggering statistics:

• Men die at much higher rates from the most common forms of cancers that affect both sexes
• Experts agree there is a focus on women’s health with multiple commissions – but the same lags for men with substantial amount of health disparities in men/boy’s health research

The purpose of Men’s Health Week is to heighten the awareness of preventable health problems and encourage early detection and treatment of disease among our men and boys. This Part 2 (of 3) spotlights some additional key concerns while underscoring that having an awareness of preventable health problems along with early detection and treatment of chronic illnesses are imperative to improving men’s health. (Part 1 is here.)

Dr. Nina’s What You Need to Know: About Men’s Health Part 2

Depression While depression in men is common, they often times do not gain the relief needed as they believe they have to be strong and in control of their emotions at all times. And mental health can also affect our physical health; depression can increase the risk for heart disease and other serious medical problems.

Research shows, too, that when feeling hopeless, helpless, or overwhelmed by despair, men and boys tend to deny it or cover it up by physical pain, reckless behavior, anger, or drinking too much. While a key step to recovery is to understand that there’s no reason to feel ashamed – that is more convoluted for men as a result of our culture.

And unfortunately, depression in our men can be overlooked—they can find it difficult to “open up” to talk about their feelings. This can result in the underlying depression going untreated, which can have serious consequences—men suffering from depression are four times more likely to commit suicide than women. It is important for any man to seek help with depression before feelings of despair become feelings of suicide.

Depression is not a sign of emotional weakness or failing of masculinity. It is a treatable health condition that affects millions of men of all ages and backgrounds, as well as those who care about them—spouses, partners, friends, and family. If you (or someone you know) is dealing with depression – talk honestly with a friend, loved one, or doctor about what’s going on in your mind as well as your body. Once correctly diagnosed, there is plenty you can do to successfully treat and manage depression.

Connecting and Isolation: I am currently reading a book by therapist, psychiatrist Dr. Rob Garfield (2015), titled: “Breaking the Male Code: Unlocking the Power of Friendship” about the “connecting” breakthroughs and valuable benefits from men that had personally felt disconnected – and an insightful introspect of what, as a culture, we reinforce in our men “boy code” – “guy code.”

Research shows men may have as many friendships as women have but the quality is often very different. If a guy has a good friend, he may see them once every 3 to 5 years. Social relationships and connection for men are equally vital to men’s wellbeing, as to women’s. Loneliness can send both men and women down a path toward bad health, and even more intense loneliness, studies have shown. We want to encourage healthy connections and examine our views and related behaviors on “guy codes.”

Decrease alcohol use According to The Centers for Disease Control and Prevention, men are more likely than women to drink excessively: 58% report drinking alcohol in the last 30 days and 23% report binge drinking 5 times a month (equates to 8 drinks). In addition to the numerous illnesses that chronic heavy alcohol use increases the risk for—liver disease, heart problems, dementia, cancer—being intoxicated has also been shown to elevate the risk for aggression, accidents, injuries, and deaths.

The Federal Dietary Guidelines on Alcohol Consumption state the following regarding drinking in moderation: For men 65 years of age and younger, no more than two drinks per day and for men who are older than 65 years, no more than one drink a day. They even recommend that some should not drink alcoholic beverages at all including those who cannot restrict their drinking to moderate levels; plan to drive or operate machinery; are taking prescription or over-the-counter medications that can interact with alcohol; have certain medical conditions; and are recovering from alcoholism.

According to a statement from an editor of American Journal of Men’s Health, “facts are that men put their health last and it has been researched to find that most men’s thinking is, if they can live up to their roles in society, then they’re healthy.” From infancy to old age, women are simply healthier than men. Out of the 15 leading causes of death, men lead women in all of them except Alzheimer’s disease, which many men don’t live long enough to develop.

Our men deserve better – their health needs all our attention, on every front — at home; in our communities; and the national level (as we advance more research as well as commission additional understandings to break through the health gap). Let’s rally to help make a difference!!

• Classes:  Although classes in the summer are not usually work related, there are many that can help with relaxation.  There are classes available from Feng Shui and Tai Chi to crocheting, woodworking or pottery making.   If you live in or near a fairly large city, you should have literally hundreds of choices. Anything that involves learning something new, movement or concentration is good to relieve stress.
  
  
• Hobbies:  Already have a hobby?  Summer is a great time to pursue them.  Hiking, gardening, camping and rock collecting are all good summertime hobbies. These are all outdoor, fresh air pursuits.  Some for indoors include reading, stamp or coin collecting, knitting, baking or cooking, making jewelry or scrapbooking. 
  Starting an aquarium is fun and watching the fish is very soothing.  Learn to play a musical instrument like the piano.  The right type of music can be very relaxing.
  
  
• Meditation: Learning to meditate is terrific for stress relief.  There are CD's you can buy or get from the library that can teach you meditation. There are also music CD's available for meditation.  Meditation also helps to lower blood pressure and relieve anxiety. Tai Chi is an active meditation and it's highly recommended to help deal with stress.

• Exercise: Bicycling, walking, yoga and swimming are all good stress relievers along with most other forms of exercise. Take a dance class or Zumba. Get out in the sunshine with boating, fishing, water skiing, flea markets and garage sales. Go antiquing or to auctions. Plenty of sun and vitamin D are great for stress.  Be sure to wear a sunscreen!

Want more tips on dealing with stress in the Nursing field? Just ask one of our Nurse Leaders, they will be glad to help! Just click below! 

In honor of LGBTQ – Pride Month, this article touches upon the struggles this community deals with in their personal and professional lives. We all know how important support is from family and friends particularly for teenagers who are questioning who they are attracted to and sometimes, their sexual identity.

As Nurses dealing with the public all the time, this article talks about the importance of listening, accepting and guiding your family, friends and patients to the right resources. We hope you find it helpful.

While LGBTQ people have enjoyed the benefits of more acceptance from society, LGBT youth remain vulnerable to suicide, homelessness and negative health outcomes. This is largely due to their lack of acceptance from their parent or guardians. In our own practice and in numerous studies, it has been proven that more than anything else, the love and support from parents and families are critical to the health and success of LGBTQ youth.

One of the most tragic cases we have seen was Manuel’s (names and other identifying details have been changed), a 16-year-old Puerto Rican teen who was raised in the South Bronx by his mother. All his life he was taught by his family, culture and society that his future would be defined by a wife and kids, by his ability to support his own family and become the “man” of his house. However, while everyone was telling him who and what he should be doing, he had already started to dream of a very different life. From an early age, he knew he was attracted to men – but he kept his feelings buried for fear his family would disown him if they found out or that his sexuality would bring shame to his family. 

One day, his mother went through his cell phone and found text messages from his "best friend" describing how in love they were. His mother put all of her son’s belongings into garbage bags, put them on the curb and told him, “never come back until you like girls!” Manuel became homeless at 16, and with nowhere else to go, he began exchanging sex for money to live. Three years later, he was diagnosed with HIV. When he finally got help, he told his social worker he had two wishes: “That I had been born straight so none of this would have happened, and that my mother believed that I didn’t choose to be this way.”

Now meet Wanda, a 15-year-old African American teen born and raised in Brooklyn by two parents who were actively involved in their church. Every Sunday after church, Wanda and her parents had dinner together and used the time as an informal family meeting where everyone was encouraged to talk openly about their week. While she was sometimes attracted to boys, there was a girl on Wanda’s soccer team that she couldn’t stop thinking about. She tried to ignore her feelings for this girl and put more energy into dating a boy in her class who liked her a lot. One day after church, Wanda’s mother asked her how serious she was about the boy she was dating. 

Wanda shrugged that it wasn’t serious, but then she built up the courage to ask her parents: “What would happen if I liked girls, too?” Her parents sat in silence for a few seconds before her father replied, “We would love you no matter who you like.” “Of course we will always love you,” Wanda’s mother said, “but are you sure about this? This is very new for me, so you’re going to have to help us understand this.” 

How do you think you would react if your child told you they were LGBTQ? Parents play an extremely important positive or negative role in the lives of their children, especially when children are becoming aware of who they are attracted to or love (sexual orientation) or if they feel themselves to be a male, female or somewhere in between (gender identity). In fact research shows that children whose parents belittle or shame them are more likely to suffer from depression, attempt suicide and have poorer health than children whose parents are supportive. 

While you might be afraid that talking about LGBTQ issues with your child will encourage them to be gay or transgender, who they are or who they love is inherent to each person and emerges over time. The best thing for you to do is talk openly and love unconditionally. Don’t be hurt if your child discloses their feelings to someone else first. Most children who are exploring their sexual orientation or gender identity tell a friend, family member or health/mental health professional before they tell their parents because they would rather know for sure before they risk telling their parents. 

As a parent, you can emphasize that there's no risk in talking about these things, because you will love your child regardless of their sexual orientation or gender identity – and that you're there for them when they are ready to talk. Being LGBTQ no longer means your child will automatically get HIV or will have a limited life. With pills to prevent HIV and the full range of family options (including marriage) increasingly available to LGBTQ youth, your support is crucial in supporting and accepting your child to emerge as a healthy teen and adult who can achieve their full potential.

While it can be difficult for young people and their families to speak about issues like sex, sexuality and sexual orientation, you are not alone. Many resources exist, such as PFLAG.org (Parents and Friends of Lesbians and Gays), GLSEN.org (Gay, Lesbian and Straight Education Network), Family Acceptance Project (FAP.org) and our program, adolescentaids.org, which provides care for LGBTQ youth as well as HIV care and prevention services. If you know or think your child is LGBTQ, we hope you will use this year’s Pride Month as an opportunity to proudly celebrate your child and help them navigate this wonderful and challenging time known as adolescence.

Related Article: LGBT People In Rural Areas Struggle To Find Good Medical Care

Nursing assistant Tom Alligood wears camouflage scrubs during his emergency room shifts at the Dorn VA hospital because he says it helps other veteran patients realize they've "walked over the same dirt," the 62-year-old former Army tanker says.

And he doesn't just mean the desert sands of Iraq.

Alligood means homelessness, job loss and the mental anguish of being a long-time military veteran trying to adjust to the trials of a dog-eat-dog, backstabbing civilian world he says nearly ate him alive.

"I need to be around veterans like me. That's where I get my strength, my 'positiveness' from," says the burly former first sergeant who now sports a long, gray braid on his back.

Alligood says he has found a new mission - working in the sprawling Columbia VA hospital and helping as many of his one-time brothers and sisters in arms as he can.

And the VA is looking for more people like Alligood.

In an attempt to respond to the crisis of lengthy patient wait-times and a malfunctioning bureaucracy, VA Secretary Robert McDonald told Congress the agency hired about 14,000 health care workers last year, including 1,300 doctors and 3,600 nurses.

At Dorn, nursing administrator Ruth Mustard said the hospital hired an average of 85 nurses as well as 25 licensed practical nurses and 25 nursing assistants each year for the past two years.

Alligood's background as a military veteran is a plus, she says, and they can always use more like him.

"Veterans know what it takes to serve and what sacrifices they've endured and what some of their challenges have been that have affected their health," the nurse supervisor says.

Alligood said he can relate to his veteran-patients because the route he took from being a VA patient to VA caregiver has been a challenging one.

After leaving the Army, he took a job managing a concrete block plant. The job was eliminated when the plant was sold. Falling deep in debt, Alligood said he took to sleeping in abandoned buildings after losing his car and his home. Life in homeless shelters didn't sit right, either.

"I wasn't in the best of shape, mentally and physically," he said, his rumbling voice catching. "That was the lowest I've ever been."

Alligood said counselors told him about a VA program that put homeless veterans into counseling and back to work. He grabbed the chance to put in 40 hours a week transporting other veterans around the hallways of the sprawling Dorn VA Medical Center in wheelchairs and gurneys.

"It was for $5.15 an hour, minimum wage. But trust me, that $5.15 meant more to me at that time than anything," he recalls.

As he traversed the hospital's maze of corridors, Alligood said he made a point of greeting as many people as he could.

Alligood's banter with other veterans caught Mustard's ear. She told him the VA would pay for his schooling if he wanted to learn to become a certified nursing assistant and come back to help other veterans.

He went back to school and the Florida native returned to the Dorn VA Medical Center, where he's logged three years in an eldercare unit and six years in the emergency department.

"He has a fabulous rapport," Mustard said.

Emergency room nurse Karen Teal says the former first sergeant has a personal touch that put stressed-out patients "instantly at ease."

"He's our jewel," Teal says, beaming at her co-worker.

Alligood said his days in Iraq and Saudi Arabia help him understand veterans who might be dealing with post-traumatic stress disorder. He recounted one veteran he found experiencing a "flashback" in the ER.

"I was able to tell him, 'I got your back, I got your back,'" Alligood said, telling how he'd gotten down on the floor with the ailing veteran, assuring him he'd reached a safe place.

"I don't feel that this is a job for me. I feel that this is a calling, because I get to help so many people," Alligood said.

This video follows Stephane, RN, MSN, to give us a look into a day in the life of a Pediatric Nurse. 

Stephane, RN, MSN, was originally a business major but, she fell in love with Nursing while in college, and now works as a Pediatric Nurse in a small unit in Connecticut where she cares for young patients.

"What I love about pediatric nursing is the kids. Kids are just so resilient. And even though you're doing all these things that might hurt, just giving them a little bit of comfort and giving them your time can make such a big difference," said Stephane. "You have that one moment where they look at you and they give you a smile -- and it's like everything is okay. That feels really special."

Stephane also said, "You have to keep learning in any profession because things change and in healthcare in particular, things change pretty quickly." 

Check out the video below!

Correctional nursing is a specialty providing healthcare in jails, prisons and juvenile confinement facilities. But outside of the specialty, few recognize the importance of correctional nurses in treating an underserved population. 

“When I came into corrections, what I found were nurses that were not appreciated for what they did — that the profession and the community thought less of them,” said Mary Muse, nursing director at the Wisconsin Department of Corrections. “As I talked to them and as I talked about nursing practice and care delivery, people would remind me that this is a jail, not a hospital. It became my passion, not only to ensure that people got good care, but that I contributed to improving the image of correctional nursing.” 

Muse, who also sits on the board of directors for the National Commission on Correctional Health Care as the American Nurses Association representative, entered correctional nursing by chance. A former nursing school classmate introduced her to the field, later encouraging Muse to apply for her position. This opportunity led Muse to gain an appreciation of and passion for one of nursing’s least understood specialties. 

Working in Correctional Nursing 

Typical Duties and Environments 

How is correctional nursing different than other fields? “Nursing is nursing, because it’s all about supporting, caring and helping people get better and managing their health issues,” Muse said. “The difference is the environment in which you practice.” 

Getting comfortable with the work environment and patient population in corrections can take time, and it’s not for everyone. Yet, given the diverse population that correctional nurses serve, this specialty is similar to others. Muse points out that nurses with medical and surgical skills or a background in emergency medicine or public health are well-prepared for correctional nursing. 

The environment also dictates a nurse’s caseload and how work is executed. A cellblock may require seeing a group of patients at once, while other situations require one or two patients at a time. Muse emphasizes how correctional nurses must be looking for opportunities. A patient complaining about a headache may lead to an opportunity to educate that person. Or the headache could be something the patient says because there’s something else wrong, but the individual doesn’t know how to share it. 

Safety 

Safety is a natural concern for those not familiar with correctional nursing, because it involves being around and treating convicted criminals. However, this reaction may be unfounded. 

Through specific protocols and extensive training, safety takes center stage in correctional nursing. “In terms of safety, corrections usually does a very good job of educating you on how to be safe in the environment, and how not to be gullible,” Muse said. “What the nurse has to do is balance understanding these safety precautions ... with recognizing who we are serving but yet still seeing that individual as a patient.” 

Because there are always guards present, correctional nursing is “no less risky than other [nursing] environments,” Muse pointed out. This is why many believe that correctional nursing is actually safer than other specialties and environments. In her experience, Muse is aware of limited incidents of violence; in the majority of cases, patients had mental health conditions. “For me, it was actually scarier as a student when I went on the mental health unit,” she said. Psychiatric settings were identified by The Online Journal of Issues in Nursing as an area of healthcare where workplace violence is more common, along with labor and delivery and maternal-child health units. Four out of five incidents occurred in the emergency department, leading all hospital settings. Surveillance studies reveal that more than 50 percent of emergency department nurses have experienced verbal or physical violence at work. Research is limited on safety in correctional healthcare settings. In BMC Health Services Research, a three-year study of violence among correctional health professionals in Australia found that most incidents took place in a forensic hospital, a facility for inmates who are not competent to stand trial due to severe mental illness. During the study, no deaths took place, few incidents of violence led to serious physical injury, and almost all incidents were given a medium (46 percent) or low (52 percent) rating on the severity assessment code. “Compared with health care settings in the community, correctional settings are fairly safe places in which to practice,” researchers concluded. 

Resources and Population 

A lack of resources for delivering quality patient care has typically distinguished correctional nursing from other specialties. “If you're looking for ease and comfort, you might not have a nice operating room, you might not have all the tools, the most equipment,” Muse said. Although facilities weren’t built for healthcare treatment, correctional facilities are starting to improve. Nurses need to be a part of the decision-making process, Muse said, to ensure that the right types of equipment and resources are available. 

Correctional nurses see a wide range of patients. “Chronic disease is an issue for individuals in corrections. Now we are dealing with hypertension, renal disease, hepatitis, cancer, HIV,” Muse said. “Corrections really mirrors the community. But I would say that whether it’s a physician or nurse, if you really want to be able to see a variety of health issues, if you want to improve your clinical skills, there is probably no better place to work than in corrections. If you're interested in patient education, there’s no better place to work than in corrections.” 

Employment Information 

Salary 

Due to misunderstandings about correctional nursing and a lack of interest in the specialty, correctional facilities need to offer competitive salaries. “The nurse leaders I know actually benchmark against hospitals in their areas,” Muse said. Sources show the competitive nature of correctional nursing. 

• Registered nurses for the Pennsylvania State Civil Service Commission earn $54,038 to $82,058 per year, with higher pay at specific locations. 
• Registered nurses for the New York State Department of Corrections and Community Supervision earn up to $74,000, based on location, shift and experience. 
• The average salary for job postings on Indeed for “correctional nurse” is $67,000. 

Demand 

Similar to the entire nursing profession and other nursing specialties, Muse expects demand to be high for nurses in corrections. “I think the role of the advanced nursing practitioner could be huge in corrections,” she said. “I think having registered nurses is very important to the management of this population. Certainly, registered nurses can have more of an expanded role.” 

Education The 2010 Institute of Medicine landmark report, “The Future of Nursing,” called for 80 percent of registered nurses to have at least a bachelor’s degree by 2020. Since the report, hospitals across the country have begun encouraging and requiring the degree, and this applies to other nursing environments. Muse said she certainly encourages correctional nurses to earn a Bachelor of Science in Nursing, because the specialty requires a great deal of cross-sectional skills and knowledge. “Sometimes you draw more individuals who are prepared as an ADN [associate degree in nursing], and that's OK,” she said. “But in terms of what the patient needs, they need a nurse that is better educationally prepared.” 

Getting Into Correctional Nursing 

“If you really are passionate about care and you really believe that people deserve care regardless of their circumstances, then corrections is a great place to make that happen,” Muse said. “If you are interested in driving change, then corrections is a great place to practice.” Correctional nursing also offers considerable potential for career advancement. 

Alvernia University is committed to advancing healthcare across the nursing profession. The online RN to BSN Completion Program helps nurses gain the skills and knowledge they need to thrive in fields such as correctional nursing. With a flexible and convenient learning environment, students are able to reach their goals while they maintain their current work and personal schedules.