The parent study was cross-sectional in design, using an online Research Electronic Data Capture (REDCap) survey (Harris et al., 2019) to establish how organizational characteristics impact correctional nurse job stress and wellbeing levels. A recruitment flyer was shared with U.S. correctional nurses, who completed the survey at a time of their choosing. Using a convenience sampling method, the researchers recruited correctional nurses in the summer of 2022 from the American Correctional Nurses Association and the National Commission on Correctional Health Care. The survey was also shared via snowball sampling.

To participate in the survey, participants needed to be 18 years of age or older, with work experience for at least three months in a U.S. correctional facility and have a nurse licensure as an Advanced Practice Nurse (APN), Licensed Vocational Nurse (LVN)/Licensed Practical Nurse (LPN), or Registered Nurse (RN). The University of Cincinnati Institutional Review Board (IRB) approved this study. After the online recruitment flyer was shared, participants could answer screening questions and read the Information Sheet, because the signing of an informed consent document was waived. Those who submitted a completed survey received a $25 Amazon electronic gift card as a thank you for their time. Quantitative results from this survey can be found in the International Journal of Nursing Studies (Keller et al., 2023).

The parent survey, informed by the Total Worker Health ® approach, included 58 questions that took approximately 20 minutes to complete. The survey was comprised of valid and reliable tools (see parent study Keller et al., 2023) and three optional write-in questions. Informed in collaboration with nurses experienced in correctional work, the following were asked:

All data were collected and stored on the REDCap software at the university of the researchers. Once recruitment was complete, the researchers examined the socio-demographic data and compiled results into a table. The qualitative data were transformed into a concise and organized summary of key results (Erlingsson & Brysiewicz, 2017). Using manifest content analysis, two researchers read and re-read the qualitative data for each of the three questions. They divided up the text into meaning units, condensed the meaning units into codes after discussion, created categories, and then themes emerged in an iterative process.

Participants who answered the qualitative questions mainly identified as female (n = 90, 81%). Most were non Hispanic or Latino (n = 94, 88.7%) and White (n = 85, 77.3%). On average they were 47.6 years old, ranging from 25–75 years old. Most worked in corrections for 10.9 years (from 8 months to 26 years). Participants were RNs (n = 77, 70%), APNs (n = 18, 16.7%), and LPNS/LVNs (n = 15, 13.6%), employed in prisons (n = 73, 65.8%), jails (n = 36, 32.4%), and other (n = 2, 1.8%). Most were employed through the state (n = 67, 63.8%), and some were employed through a private agency (n = 38, 36.2%), working from all regions of the U.S. See Supplemental Digital Content 1 for a display comparing socio-demographics of parent study and current study.

Three major themes emerged: 1) personal impact: increased stress and burnout, overwhelming work hours, emotional and physical effects; 2) social relationships and family impacts: withdrawn, strained homelife, uncertainty; and 3) need for change: improved staffing, reduced mandatory overtime, better support from management. A summarization of the primary themes and meaning units are presented in Table 1.

Correctional organizations may want to consider the importance of safe staffing and adequate nurse-patient ratios, hiring and training nurse managers well for their roles on the correctional team, along with offering adequate supports to their nurses. The American Nurses’ Association and National Nurses United have offered recommendations for safe nurse-patient ratios in various nursing settings. For example, the state of California legally defines safe nurse-to-patient ratios in the emergency department as one nurse to every four patients, and in the intensive or critical care units one nurse to every two patients (Wolters Kluwer, 2016). However, correctional environments do not have clear outlined ratios, and the staffing is ultimately determined by the Responsible Health Authority within an organization (American Nurses Association, n.d.; Blair et al., 2014; National Nurses United, n.d.-a, n.d.-b).

Safe staffing not only needs to be considered and determined at the correctional organizational level, but also sustained through adequate nurse retention. Correctional-specific nurse training and mentorship, for example, has been shown to improve nurse retention in this environment (Chafin & Biddle, 2013; Flanagan & Flanagan, 2001; Sánchez-Roig & Coll-Cámara, 2016). Moreover, shorter working periods could be considered as more advantageous to reduce personal impacts and spillover effects on nurses’ health and families.

Among this sample of correctional nurses, beneficial managers were found to play a particularly vital role in the success of nurse’s health at their organization. Conversely, managers could be a source of stress when they were unsupportive. Aligned with the literature, sufficient resources and effective nurse managers were found to play an important role influencing nurse retention in hospitals and leading to favorable patient outcomes (Naud & McCabe, 2005; Twigg & McCullough, 2014). Other previous study findings among correctional nurses have underscored the importance of strong leadership and clinical supervision for personal and professional growth (i.e., increased communication skills) (Almost et al., 2020; Newman et al., 2023). Thus, more correctional facilities may consider employing effective leaders and providing them with the appropriate training so that they can remain sources of support to the nurses in this workplace.

Correctional organizations should ultimately look to the Correctional Nursing: Scope and Standards of Practice (3^rd edition), reviewed and revised by a volunteer group of the American Nurses Association (2018). The description of standards provides a detailed context for the scope and practice of correctional nurses, including education and training requirements for nurses, along with the ethical, legal, and social considerations for this specialty. As nurses in this study mentioned their desire for more education and orientation, organizations can look to these standards to ensure they are offering nurses the appropriate guidance and training. Many participants also mentioned the emotional toll of their work, being “hardened” (participants 11, 27, 31, 41, 49, 50, 51, 60, 70, 84, 100, 104) and “less trusting” (participants 50, 54, 68). Therefore, correctional organizations can further consider offering their nurses counseling resources and personal coping skills to manage the exposure to trauma from patients and coworkers (Munger et al., 2015).

There were several limitations of this study to note. First, the researchers were not able to follow up on questions due to the structured survey questions, limiting the in-depth description and opportunity for the researchers to confirm their findings with participants (i.e., member checking), potentially threatening credibility (Cypress, 2017). Second, the design itself was a limitation, because the participants were sampled in a convenience method, and there were only three qualitative questions that were optional to the parent study population. Additional research with more robust qualitative methods is needed to explore the complex aspects influencing correctional nurse health. Third, there is the threat to validity from implicit researcher bias and the influence of their philosophical underpinnings to extrapolate findings (Cypress, 2017; Guba & Lincoln, 1982). However, the researchers were diligent in staying close to the meaning units and words of the participants to minimize inference of results.

As a strength, the researchers established confirmability by having two nurse researchers (one with correctional nursing experiences) review the transcripts, code the data, and discuss themes for agreement (Cypress, 2017; Guba & Lincoln, 1982). They also aimed for transferability by sampling from the population of interest, recruiting from two professional organizations and through colleague connections (Guba & Lincoln, 1982). Next, the questions were informed in collaboration with the research team, a previous literature review (Keller et al., 2022), and current correctional nurse professionals. Saturation was met while reviewing participant answers where codes and themes were reinforced by participants, without new data being found during analysis (Saunders et al., 2018). Overall, this exploratory study provides a current and unique snapshot of how occupational stressors spill over onto correctional nurses in the U.S.