Vulnerable population: COVID-19 pandemic in provincial institutions and correctional centres

We continue our focus on vulnerable populations – how they are faring under the COVID-19 pandemic and what are the challenges of health providers taking care of them. The following report focuses on the pandemic in provincial institutions and correctional centres. We are hugely appreciative to Angela Di Marco, RN, BScN, MA, President of RNAO’s Ontario Correctional Nurses Interest Group (OCNIG), for her contribution.

As the pandemic progresses into months, new and emerging themes continue to arise that impact our practice setting.

The novel feature of the virus results in daily changes to screening and assessments, which are communicated and implemented within short timelines. This pandemic experience highlights the critical need for a co-ordinated strategy to address staffing in general and also staffing ratios. Flattening the curve is necessary, and how does that look in a correctional setting?

The answer: challenging, to say the least.

Admissions processes: Enhancements have been made to symptom screening prior to building entry and during the admission assessment. This includes isolation for symptomatic patients. Those who test positive do not return to the general population until further testing results in two negative swabs. Positive cases are tracked and reported to Corporate Health Care. These numbers remain low, according to media reports. Each change to the admissions process results in additional nursing duties that are added to already heavy assignments. There is an impact at all levels, including management. Nurse Managers are provided with minimal resources and limited information. The result is long work hours and overtime in an already fast-paced and quickly changing environment.

Phone access for patients in custody: The Correctional Reform Coalition sent a letter to Solicitor General Sylvia Jones and Deputy Solicitor General Deborah Richardson to acknowledge the provision of improved phone access for patients in custody. This is not only important from a health perspective, it is also critical that patients have phone access to maintain contact with supports, access to justice, and safe planning post-release. Diverting and de-carcerating are promoted as strategies to prevent the spread of COVID-19.

Staffing levels: The most critical factor in implementing safe staffing levels is to ensure the workforce has the tools and the capacity to implement policies and processes. Several correctional institutions rely on agency staffing. Nursing staff are impacted by absences, which create last-minute additions to already heavy work assignments. Short scheduling is disruptive to staff and delays care to patients. When several staff members are absent simultaneously, the work assignments become heavy and staffing ratios are also affected. For example, there could be (at times) double the number of patients for a med pass and contingency planning. Or there could be limited trained staff available to complete necessary screenings and admission assessments. This creates a stressful work environment. The strain can potentially lead to increased absenteeism and turnover. Both of these de-stabilize the workforce capacity to provide consistent care within a strict institutional daily schedule. Front-line workload issues continue to be challenging and recruitment and retention of staff is an ongoing issue. This was already a challenge prior to the pandemic.

Health and safety: The availability and use of PPE is an ongoing discussion. The media has reported that some health providers have refused to work at some institutions as the number of positive cases (both staff and patients) continues to climb. There are unconfirmed reports that suppliers allocate more PPE to hospitals and other health-care settings, and don't consider corrections a priority. Every effort is being made to source PPE.

Social distancing: For those in custody, the opportunities for social distancing are comparable to other institutional environments. There are a number of challenges. Correctional operations and processes are greatly impacted, resulting in the need to increase staff numbers as well as review assignments on a daily basis. Protecting health-care workers with PPE in the institutional setting becomes integral in order to prevent spread.

Lessons are being learned each day and with each new directive, policy and screening direction. Correctional nurses are staying connected through social media and by sharing new and emerging information. The struggle to manage day-to-day is real. Together, we must continue to work towards advocating for resources to ensure our patient population receives the high quality health care they deserve. Front-line nurses and nurse managers continue to strive for sustainable processes.

RNAO: Again, our thanks to Angela Di Marco for this important update. There have already been COVID-19 outbreaks in correctional institutes across the U.S., British Columbia and Quebec. In Ontario, the largest outbreak has centred on the Ontario Correctional Institute (OCI), where of 109 inmates, 80 have tested positive, as well as 21 correctional officers. But it’s not just inside the jails and prisons, as the government is letting many low-risk offenders out to ease the burden on the system, and many are entering a different world, with less post-release support facilities in place.

The Correctional Reform Coalition (CRC), a group of organizations dedicated to improvements in corrections in Ontario, wrote on April 24 to the Ontario Solicitor General to support the “efforts to safely reduce the number of provincial prisoners in Ontario…; diverting and decarcerating as many prisoners as is safely possible to do is critical to preventing the spread of COVID-19 behind and beyond bars at this time. When combined with appropriate community supports where they are required, these measures… are also critical to promoting family connectedness and enhancing public safety.” Among other requests, the Coalition asks to “Invest further in community re-entry supports, the most essential of which is safe, affordable, and in some cases supportive housing that is readily available to people experiencing homelessness post-release…” See here full letter.