Raising the Bars: Re-Imagining Nursing Education Through Partnerships With Prisons

The system of health care in the United States is in crisis as it attempts to find more efficient and effective ways to improve the delivery of health care while ensuring quality and safety for those receiving that care. Consumerism is changing how health care is being defined and delivered, resulting in dramatic changes in health care and health care policy including a shift from acute care, focused on disease and treatment delivered in hospital-centric environments, to primary and community-based care, focused on coordinating care and managing transitions across providers and settings of care (Bouchaud, Swan, Gerolamo, et al, 2016; Fortier, Fountain, Vargas et al., 2015). To adequately address the current failings of the United States’ health care system, including fiscal constraints, disparity related to access to health care, and quality of care issues, a strategical shift in nursing education and practice must occur, from individual to population-focused care (Bouchaud, 2011; Bouchaud & Gurenlian, 2013; Fisher Robertson, 2004). A culture change among nurse educators and administrators and in nursing education is needed to prepare a competent interprofessional health care workforce capable of practicing from a health promotion, disease prevention, community and population focused construct in caring for a population of patients who are presenting health problems and conditions that persist across decades and/or lifetimes. As a result, RNs, now and in the future, will need to be prepared with a broader scope of knowledge, skills, and competencies (Fortier, Fountain, Vargas et al., 2015; Fraher, Spetz, & Naylor, 2015) which translates into new, emerging, and unprecedented opportunities for nurses across the care continuum (Bouchaud, Swan, Gerolamo, et al, 2016; Bouchaud & Swan, 2016). Yet many baccalaureate nursing programs continue to prepare new RN’s as generalists who function best in hospital-centric environments, despite and in light of the prediction by Houle and Fleece (2011) that one-third of all hospitals will be closed by 2020. A need for re-envisioning nursing education and practice, improving patient care and outcomes, and promoting patient health and wellness from a community and population focused perspective is prompting the need for nurse educators and administrators to re-define and prepare a new nursing workforce for the 21^st century (Bouchaud, 2011; Bouchaud, Brown, & Swan, 2017 Bouchaud & Gurenlian, 2013).

While healthcare delivery is moving from hospital to ambulatory and community settings, community-based educational opportunities for nursing students are shrinking due to increased regulatory requirements, the presence of competing numbers of nursing schools, increasing student enrollment, and decreasing availability of community resources capable and willing to precept students in all-day interactive learning environments (Bouchaud & Swan, 2016). Prisons, as microcosms of society, provide an ideal learning experience for not only technical nursing skills, but more importantly, for reinforcing key learning goals and the new 21^st century skills set in community and population-based care, cultural awareness and sensitivity, and interprofessional efforts aimed at engaging patients in the management of chronic conditions (Bouchaud & Gurenlian, 2014; Bouchaud & Swan,2017). A prison clinical rotation offers a new avenue through which to prepare population-focused nurses who can function in a rapidly changing health care landscape. One urban college of nursing has been placing BSN students in maximum security prisons at the state and federal level as well as juvenile detention centers for the past 11 years. Student interest in prison as a clinical site has become a sought after immersion experience resulting in waiting lists starting on orientation day. More recently, the prison program has expanded to include students in the graduate FNP program. Though evidence has demonstrated that prison and correctional health is an innovative and viable resource to educate senior prelicensure baccalaureate nursing students in the new model of healthcare delivery and practice (Bouchaud & Swan, 2016), there is a need in the literature to know what students think of this clinical experience.

This presentation will describe how one urban college of nursing has and continues to use correctional prison facilities as an innovative clinical setting to educate BSN students about community/public health nursing, correctional health nursing, population health and the new health care model of practice. It will describe how the use of private, state, and federally run prisons can serve to implement a redesigned baccalaureate nursing curriculum and ignite student interest in working with and in the community, outside the hospital setting. This presentation will discuss how educating nursing students in an all-male maximum prison setting can reinforce key learning goals and the new soft and hard skills set needed for nursing practice in the 21^st century that includes community-based care skills, population-based care awareness, cultural sensitivity and awareness, empathy, therapeutic communication, the impact of social determinants on health, and strategies to implement health care and nursing practice through a health promotion and disease prevention model especially for stigmatized and marginalized populations. The authors will accomplish these aims by sharing a qualitative and quantitative analysis of eleven years of collected student feedback regarding their perceptions and experiences of a community clinical rotation in a maximum security prison setting. Finally, the presentation will conclude with additional knowledge gained from this 11 year study including one finding that not only did nursing students request to complete their community clinical rotation in an all-male maximum-security prison despite its accompanying restrictive regulations, especially as it relates to their access to personal technology devices, had to travel the farthest, start their clinical day the earliest, and complete more clinical hours in the day than their classmates in other clinical sites, but there was an unknown desire for a unique clinical experience that was only satisfied by this prison rotation.