Working within correctional healthcare means navigating a dual role: caring for incarcerated patients and collaborating closely with the facility’s security and administrative custody staff. While seemingly obvious, the critical nature of a strong working relationship between healthcare professionals and custody personnel is often underestimated. It’s surprising how frequently healthcare providers in correctional settings miss the opportunity to build and nurture these essential connections.
Civilian healthcare staff frequently enter the unique world of corrections with limited preparation for its specific environment. This can unfortunately foster an “us vs. them” dynamic between custody and healthcare teams. However, it’s vital to recognize that both healthcare and custody staff are integral parts of the same team, working towards shared objectives. Effective collaboration ultimately benefits everyone, most importantly, the health and well-being of the incarcerated patient population.
The significance of this collaborative approach is explicitly highlighted in the NCCHC Standard A-03 Medical Autonomy, which emphasizes, “The delivery of health care in a correctional facility is a joint effort of custody and health staffs and is best achieved through trust and cooperation.”
Understanding the Custody Mindset
Effective communication hinges on mutual understanding. For healthcare professionals, whose primary focus is patient care and saving lives, it can be challenging, especially for newcomers to corrections, to grasp the distinct yet complementary priorities of custody staff. Custody’s paramount concern is maintaining the safety and security of incarcerated individuals, staff, and the facility itself.
Correctional officers, sheriff’s deputies, or private security personnel – regardless of their specific title, custody staff are law enforcement professionals. Their structure, training, tactics, and professional conduct are aligned with law enforcement norms. They operate under strict procedures, protocols, and orders. Familiarizing yourself with the orders governing procedures within your facility, particularly concerning inmate movement, can significantly streamline your department’s workflow and simplify the tasks of custody staff in your area. For instance, requesting patient escorts to the medical department or clinic during count times is generally disruptive and should be avoided.
Direct communication is key with custody officers. Always maintain a respectful, polite, and concise demeanor. Address them by their rank and surname, such as “Warden Smith.” Avoid language that could be perceived as commanding or demanding. Demonstrating respect and acknowledging the demands of their role is crucial for building trust and fostering a positive working relationship.
Navigating the Chain of Command
The chain of command is a cornerstone of any law enforcement organization. Adhering to this structure is essential for maintaining positive relationships with custody staff.
In the event of a departmental issue, the initial step should be to address it with the officer directly involved. If unresolved, the next step is to escalate to their superior – typically the sergeant, followed by the lieutenant, captain, and major, in hierarchical order. Only after exhausting the chain of command should you bring the matter to the warden or facility administrator. Bypassing the chain of command can erode the trust custody staff has in you and your department, analogous to a nurse bypassing the director of nursing and health services administrator to contact a regional manager directly. Always respect and follow the established chain of command.
Healthcare administrators should proactively clarify with the warden or facility administrator the appropriate contact person for various situations. Some administrators prefer to handle all issues directly, while others designate a major or captain as the primary point of contact. Regardless of the preferred protocol, consistent communication is vital. Schedule regular meetings with the designated individuals, be responsive to their concerns, and provide timely updates between meetings.
Custody as a Valued Partner
It’s crucial for civilian contractors in correctional healthcare to recognize that they are guests within the facility. This concept can be a significant adjustment for healthcare professionals, especially those new to the field. Adopting a customer service approach towards custody staff can significantly strengthen these working relationships.
When a custody officer from a housing unit contacts you with a question or request, prioritize providing assistance. Similarly, if the warden or administrator requires information or has a concern, respond promptly and accurately. Addressing requests and concerns efficiently enhances not only your professional reputation but also the reputation of your organization.
Healthcare administration must set the tone by embodying this customer service philosophy. This approach doesn’t diminish your authority but rather strengthens your leadership.
While prioritizing collaboration, it is also your professional duty to advocate for your patients. If a custody request conflicts with a patient’s best medical interests, you have the right and responsibility to voice your concerns and propose alternative solutions. However, this advocacy should always be conducted respectfully and within the established chain of command. By approaching custody staff as allies in patient well-being, you increase the likelihood of them being receptive to your recommendations.
The Power of Listening
Listening is a simple yet profoundly effective tool for building strong working relationships, and it can even be life-saving. Custody staff maintain constant interaction with the incarcerated population and are often the first to notice subtle changes in an individual’s demeanor or health status that might be missed by healthcare staff occupied with clinic duties. When a custody staff member expresses a concern, listen attentively and take it seriously. If an officer reports that an incarcerated individual appears unwell or is acting differently, that individual should be promptly assessed by healthcare. Investing a few minutes in a patient evaluation is always preferable to risking a negative health outcome. This practice not only enhances patient care but also validates the officer’s observations, encouraging them to continue proactively monitoring the population for signs of medical or mental health distress.
Pro-tip: To gain valuable insights into recent events or potential issues within the facility, engage in conversation with the custody staff working in your area. Their perspectives can be invaluable.
Communication: The Cornerstone of Collaboration
While camaraderie with custody staff is acceptable, maintaining professionalism is paramount. As licensed healthcare professionals, your conduct should always reflect your professional standing. Adhere to these guidelines for effective communication:
Avoid overly casual communication in any form. Reserve emojis and informal language for personal contexts.
Refrain from engaging in gallows humor.
Reputations are quickly established in correctional settings. Ensure yours is exemplary.
Managers should lead by example, explicitly demonstrating to their staff that they value and respect custody personnel, their roles, and their contributions to patient care.
Prioritize transparency. Be proactive in communicating issues to custody; avoid them hearing about problems from secondary sources. Issues inevitably arise; proactively addressing them and collaborating on solutions builds trust.
When corrective action is necessary, present your plan clearly, monitor progress diligently, and ensure consistent follow-up.
Incorporate custody staff in medical emergency and disaster drills to foster teamwork and preparedness.
Invite custody staff to healthcare meetings and actively solicit their opinions and ideas to promote inclusivity and shared problem-solving.
Encourage custody participation in Continuous Quality Improvement (CQI) or performance improvement projects to foster a collaborative approach to enhancing services.
Above all, actively prevent the development of an “us vs. them” mentality between healthcare and custody teams. Remember, the goal is to work with each other, not merely alongside each other.
Whether in pretrial detention, prison, or reentry settings, these strategies for collaboration are invaluable for civilian healthcare professionals in corrections. For civilians, adapting to the unique correctional environment and functioning effectively within a law enforcement framework are often the primary challenges.
By understanding the custody role, respecting the chain of command, adopting a customer service mindset, and maintaining professional communication, you can cultivate a collaborative and cooperative relationship with custody staff. This, in turn, will improve your work environment and facilitate the overarching goal: providing the highest quality care possible to your patient population.
Michael Teasdale, RN, CCHP, is a regional nurse manager with Rutgers University Correctional Health Care, which provides medical, mental health, dental, and sex offender treatment services to individuals involved in the New Jersey criminal and juvenile justice systems.
