Can RNs Help with the Corrections Nurse Shortage?

• A corrections nurse shortage has resulted in negative outcomes for some inmates who receive inadequate treatment, investigations have found.
• One state’s corrections system has a 53% vacancy rate for LPNs and 40% for RNs. 
• Adding RNs to prison staff could help improve conditions for inmates as well as nurses. 

Treating beyond their scope of practice. Vacant positions. Harm to patients. 

These situations have all occurred in prison systems over the past few years due to a lack of corrections nurse staff, many of whom are licensed practical nurses (LPNs) rather than registered nurses (RNs). 

The South Dakota correctional system, for example, has a vacancy rate of 53% for LPNs and 40% for RNs, according to South Dakota Searchlight. The independent publication reported last month that Kellie Wasko, the state’s Department of Corrections secretary, said the reason is due to safety concerns and competition with the private sector. 

“No one wants to go somewhere they don’t feel safe,” Wasko said. “And this goes for the correctional staff as well. Nobody wants to be verbally demeaned or have feces and urine thrown on them. Our current environment creates that.” 

What’s happening in South Dakota is a microcosm of what other prison systems are experiencing nationwide. But there are steps facilities can take to not only improve the quality of care but increase staffing. 

States With Correctional Nurse Shortages

Writing for the Detroit Metro Times last October, a former medical provider for the Michigan Department of Corrections said nurses are the “backbone of healthcare services” in the prison system and provide services ranging from basic care to mental health needs. 

“But with staffing levels at dangerously low thresholds, these nurses are being stretched to their limits. I personally saw critical care being delayed,” wrote Kristen Austin, RN. “Some of our cancer patients were unable to receive their pain medication in a timely manner because there was no nurse available to administer the medicine. Infections that should have been treated in under 24 hours were left to linger. The list goes on.” 

In Washington state, an NBC-affiliate KING 5 investigation found that in multiple state facilities “low-level nurses who lack the qualifications and legal authority to assess patients are making pivotal medical decisions about inmates.” A former state department of corrections leader told the outlet that they witnessed several instances of LPNs working beyond their scope of practice. 

While certification isn’t required to work as a nurse in the corrections system, the option is available through the National Commission on Correctional Health Care. 

The Argument for RNs in Correctional Facilities

Spark Training, a training and compliance organization, argued in a recent Corrections 1 article that correctional facilities would benefit from hiring RNs. In addition to preferring LPNs due to lower salaries, which they believe can appeal to local officials, Spark Training stated that some facilities “operate without any RNs on staff at all.” 

“While many correctional facilities employ some of the brightest, most experienced and most hardworking LPNs, the reality is that correctional facilities should be staffed (and funded) according to state licensing and accreditation boards,” they stated. 

The authors of a study published in the October 2023 edition of the Journal of General Internal Medicine conducted surveys with county jail personnel in the Carolinas, Georgia, and Alabama, finding that nearly 30% of those surveyed either “routinely lacked on-site healthcare providers” or had only a modest healthcare presence. 

“Jails relied heavily on LPNs and officers for care, resulting in missed opportunities for care and potentially endangering incarcerated persons,” the authors stated. 

How to Improve Nurse Retention in Correctional Facilities

A study from the Journal of Forensic Nursing looked at how working in a correctional facility effects nurses. Three themes emerged: Personal impact, social relationships and family impact; and need for change. 

“Results from this study provide evidence that correctional nursing harms both the nurses and their family units by contributing to personal impacts and negative social relationships and family impacts, which underscore correctional organizational need for change.” 

Through its survey of more than 200 correctional nurses, they determined facilities should consider supporting their nurses’ wellbeing “through adequate staffing, flexible scheduling, decreased mandatory overtime, and hiring effective nurse managers.” 

The Bottom Line

Prison systems throughout the United States have been grappling with nurse shortages, much like private healthcare systems. However, because many rely on LPNs, who have a limited scope of practice compared to RNs, some inmates are not receiving proper care. Increasing the number of RNs on staff could help address these concerns. 

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