N560 Module 8 assignment: paper on the correctional nurse's role between custody and care, a full sample

Caregiver, Not Custodian: Dual Loyalty and the Correctional Nurse's Place Between Custody and Care

Student Name

Master of Science in Nursing Program, Aspen University

N560: Forensic Nursing

Instructor Name

Month Day, Year

Caregiver, Not Custodian: Dual Loyalty and the Correctional Nurse's Place Between Custody and Care

On a single night shift at a composite 600-bed county jail, the only registered nurse on duty, a composite nurse with six years in corrections, receives three requests from custody staff. An officer asks the nurse to draw blood from a newly booked man for a driving-under-the-influence investigation. A sergeant asks the nurse to sign a form clearing a detainee with schizophrenia for placement in segregation. And a lieutenant asks the nurse to hold sick call requests until the morning because the housing units are short of officers. Each request comes from colleagues the nurse works beside every day, and each would be easier to grant than to refuse.

Correctional nursing is one of the nontraditional settings Aspen includes in this course, and it tests the forensic nurse's core principle, that the patient comes first, more directly than any other. This paper describes the correctional health setting, explains the concept of dual loyalty, applies it to the three requests, and proposes practices that protect both patients and nurses.

The Setting

Jails hold people awaiting trial or serving short sentences, and many arrive with acute problems: intoxication and withdrawal, untreated mental illness, chronic diseases that have gone without care, and injuries from arrest or violence. Health care must be delivered inside an institution whose first purpose is security. A report prepared for the National Institute of Justice on reducing deaths in correctional facilities identified high-priority needs across intake screening, medical and mental health care, communication between health and custody staff, and staffing (Russo et al., 2017). The report's framing reflects the setting's central tension: health outcomes depend on cooperation with custody staff, whose priorities are different.

Dual Loyalty

Dual loyalty describes the conflict health professionals face when they owe obligations both to their patients and to a third party, here the correctional institution. Pont et al. (2012) observed that health care professionals in prisons around the world continue to violate principles of medical ethics because of perceived or real dual loyalty to patients and prison authorities. They recommended that health workers in prisons act exclusively as caregivers and that tasks required by prosecutors, courts or security be carried out by professionals who are not involved in the prisoners' care.

Nursing's own ethics point the same way. The code of ethics commits the nurse's primary obligation to the patient and to the patient's dignity and rights, whatever the setting (American Nurses Association, 2025). Maroney (2005) described caring and custody in correctional nursing as two faces of the same reality: the nurse works within custody but must not become part of it. The practical question is where the line falls.

Applying the Principle to the Three Requests

The blood draw for a criminal investigation is a forensic task for the prosecution, not care for the patient. Under the principle Pont et al. (2012) describe, the treating nurse should not perform it. If evidence collection is legally authorized, by consent or warrant, it should be performed by a separate forensic examiner or a contracted phlebotomist following the jurisdiction's procedures. The nurse can explain this boundary to the officer respectfully and document the request and the response.

Clearing a detainee for segregation asks the nurse to certify that a disciplinary or security measure is medically acceptable. Segregation can worsen serious mental illness, and signing the form would make the nurse part of the decision to confine. The appropriate response is a clinical assessment of the patient's current mental health status and risk, documented and communicated to the mental health team, with the decision about housing remaining a custody decision. If the assessment shows the patient is at risk, the nurse's duty is to say so clearly and escalate.

Holding sick call requests delays access to care for security convenience. Some adjustment of timing may be unavoidable in a short-staffed facility, but requests must still be triaged by a nurse on receipt so that urgent symptoms, such as chest pain, withdrawal or suicidal thoughts, are seen promptly. The nurse should decline to hold requests unread, document the staffing problem, and notify the health services administrator.

Practices That Protect Patients and Nurses

Individual courage is not enough; systems must make the right choice the easy one. Correctional health programs should adopt written policies that separate forensic and security-related medical tasks from clinical care, specifying who performs evidence collection and fitness-for-confinement evaluations. Health and custody staff should train together on these boundaries and on the signs of medical emergencies, since communication failures between them are a recurring feature of deaths in custody. Nurses should have a clear escalation path to the health services administrator and an outside medical director when custody requests conflict with care, and documentation of such conflicts should be routine rather than exceptional. Finally, staffing must be adequate for triage of every sick call request, because delayed access is itself a form of harm.

Nurses also need support after refusing a custody request. A nurse who declines to perform a forensic blood draw or to sign a segregation clearance may face pressure or resentment from officers the nurse depends on for safety during the shift. Health services leadership should back such decisions publicly, meet with custody leadership to explain the boundary, and review any retaliation as a serious matter. Regular joint meetings between health and custody supervisors, where difficult cases are discussed before they become conflicts, can reduce friction over time. Documenting each conflict, the request, the nurse's response and the outcome, builds the record that leaders need to fix system problems rather than leaving individual nurses to resolve them alone each night.

Conclusion

The correctional nurse practices forensic nursing in its most demanding form: inside an institution of custody, with patients who have few other options and colleagues whose goals differ. Dual loyalty is not a theoretical problem there but a nightly one. The ethical principle is clear, that the nurse is a caregiver and not a custodian, and applying it requires both personal judgment and institutional policy. For the jail nurse with three requests in one night, holding that line protects the patients' rights, the nurse's license and the trust that makes health care in custody possible at all.

References

American Nurses Association. (2025). Code of ethics for nurses. https://codeofethics.ana.org/

Maroney, M. K. (2005). Caring and custody: Two faces of the same reality. Journal of Correctional Health Care, 11(2), 157-169. https://doi.org/10.1177/107834580401100204

Pont, J., Stöver, H., & Wolff, H. (2012). Dual loyalty in prison health care. American Journal of Public Health, 102(3), 475-480. https://doi.org/10.2105/AJPH.2011.300374

Russo, J., Woods, D., Shaffer, J. S., & Jackson, B. A. (2017). Caring for those in custody: Identifying high-priority needs to reduce mortality in correctional facilities. RAND Corporation. https://doi.org/10.7249/RR1967