Purpose: In this paper, we report on the clinical care outcomes resulting from implementing a nurse competency education intervention to a nursing staff in a statewide correctional system. Background: State correctional healthcare systems face ongoing and serious challenges attracting and retaining an adequate number of qualified health professionals owing to the perceived undesirability of working in correctional facilities; high occupational stressors; and the effects of high turnover on the workloads of remaining nursing staff.

Methods: Nursing outcomes were evaluated on four most frequently used nursing protocols. The education intervention consisted of self-directed computer-based modules, hands-on clinical review of skills, and validation of learning through high-fidelity simulation tailored for the correctional environment. A multilevel random coefficient modeling approach for analysis was utilized. Records reviewed at 7 facilities comprising a sample of 736 records were compared for nursing care performance between facilities.

Findings: The education intervention as designed increased nurse competency (t= 2.591, df=729, p=0.010) on average 4% across the state system (facility range -4% to +10.8%). A four percent system change has been found to be an effective rate of change in other studies. Facilities with an overall higher RN to LPN ratio perform at a relatively high level (t=4.211, df=730, p=0.000). Increase in inmate census without change in RN/LPN nurse staffing reduced performance (t= -4.347, df=730, p=0.000).

Conclusions: This multi-component nursing education intervention improved quality of nursing care, most dramatically in the area of psychiatric care. Structural challenges related to paper charts and security suggest improvements may be seen with an electronic record system and expanded training between nursing and Correctional Officers for health care. An examination of the effectiveness of current models of care delivery may be warranted.