Business Case for Quality


The purpose of this paper is to develop and implement a Continuing Education Online Program (CEOP) for nurses working in correctional facilities by focusing on the nurses’ Emotional Intelligence Quotient (EQ) adaptive to the stressful prison setting and supportive of evidence-based care practices. According to Lambert, Barton-Bellessa, & Hogan (2015), EQ is a person’s ability to accurately perceive and express own emotions, use such feelings to foster free-thinking, and to control our emotions and others’. Currently, the existing competency training offered to correctional nurses focuses primarily on handling and use of patient care equipment or technology. However, no practice teaching plan addresses EQ training to assist correctional nurses to adapt and cope with the unique ethical facets associated with the prison environment. The organizational culture of the prisons system can impact the practice of the medical staff working in that setting significantly. Therefore, it is necessary for health care services within prisons to establish a comprehensive understanding of the nature of the reformatory milieu, its ethos, and obligations of practicing nurses. That said, EQ training improves correctional nurses’ interpersonal and intrapersonal skills, adaptability, and stress management, hence increasing their retention rates and reducing hiring costs.

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Current Situation

The effect of psychosocial work conditions on the health of workers is prevalent among various professionals, including soldiers and teachers. Work-related trauma is also pervasive among correctional nurses because of the nature of their job. Mainly, those nurses who have direct contact with inmates are susceptible to work-related stress because of a variety of reasons. For instance, these nurses are exposed regularly to insults, intimidations, and belligerence from convicts, who often suffer from mental illnesses. Thus, the current prison environment in the United States is characterized by increased contact with psychosocial risk factors, and correctional nurses are at high risk of developing stress-related health complications. An anonymous survey conducted by Spinaris in 2011 found that at least 33% of correctional staff, including officers and nurses, suffer from post-traumatic stress disorder (PTSD) (Lisitsina, 2015).

Besides, a report by the New Jersey Police Department revealed that the suicide rate among corrections officers is twice as high as that of both police officers and civilians. Also, an evidence-based study found that the suicide rate among prison staff was 40% higher than all other professions combined (Sarkar, & Ray, 2017). That said, the multifaceted health needs of prisoners necessitate that nurses acquire expert knowledge with a comprehensive evaluation and clinical decision-making skills to care for a client who may be in dire need of special medical attention, but maybe devious and violent. Therefore, it is necessary for penitentiary health care providers to impart essential knowledge and expertise needed to optimize nursing practice and the scope of practice within these settings. However, some discrepancies such as heavy workloads, poor time maintenance, and insufficient staffing have limited the provision of specialized training or education to correctional nurses necessary to provide evidence-informed care within their work purview. A recent study has shown that about 41% of nurses in provincial prisons in the U.S. reported not discharging their services adequately because of emotional and psychological distress (Almost, Gifford, Doran, Ogilvie, Miller, Rose, & Squires, 2013).

Proposed Solution

This paper proposes the implementation of the Continuing Education Online Program (CEOP) for correctional nurses with a focus on EQ training to assist them to acclimatize and cope with the unique ethical facets of the prison environment. The concept of EQ has expanded significantly over the last twenty years, impacting both social and professional aspects of life. According to Foster, McCloughen, Delgado, Kefalas, & Harkness, (2015), the ability to manage one’s emotions is essential in establishing a viable interpersonal relationship between nurses and their patients, and between nurses and other members of the medical group. Even though it is necessary for nurse educators to impart knowledge in the area of different practical skills, there is a need to incorporate EQ to improve patient outcomes adequately. Furthermore, nurse educators should understand the educational changes necessary to expand and develop nursing students’ EQ. Educators must foster personal skill development in the context of correctional nurse self-regulation, self-awareness, self-motivation, social awareness, and social skills to promote the development of correctional nurses’ EQ. Even so, imparting these skills will occur through internet-based exchange programs, face-time dialogues, and online debates among others.

That said, curricular development of EQ among correctional nurses must incorporate the key indispensable pillars for the scientific treatment of EQ. These key pillars include theory, measurement, and application necessary to facilitate the implementation of EI to nursing (Nair & Lee, 2016). The three essentials must be incorporated into an online nursing education framework in a variety of ways. Firstly, the theoretical aspect necessitates that nurse educators can foster the integration of EQ into the nursing curriculum to prepare correctional nurses to adapt and cope with the realities of dealing with convicted persons. Moreover, fundamental theories can be retrieved online through mobile applications or via trusted electronic healthcare databases (Choi, Song, Oh, 2015). Secondly, the element of measurement compels the nurse educators to integrate the domain into the assessment structure, particularly the functional areas and medical examinations. This integration helps in the exact measurement of the application of EQ. Lastly, the practical use of EQ can be demonstrated and evaluated through properly articulated circumstances and experimental simulation in nursing, and this constitutes the application domain. For example, educators can use PowerPoint presentations to describe correctional nurses’ while discharging their services in penitentiary facilities.

Market Analysis

This section assesses the weaknesses, threats, strengths, and opportunities that define the current situation of the competency training among correctional nurses to help them acclimatize with the unique setting of prisons. That said, the EQ training provided to correctional nurses in many U.S. prisons is less self-efficacious. Besides, other weaknesses include a shortage of staff, devalued nursing image in the society, as well as the lack of recognition of emotional and psychological dimensions of care. The strength of the intervention lies in the effectiveness of the care provided (see Appendix A)


This educational curriculum will take 12 months to implement. The first four months will involve educating the prison nurses concerning the psychosocial conditions of their work. This training will help to familiarize the correctional nurses with the general psychological disorders affecting detainees, including PTSD and mental breakdowns due to isolation. The primary modes of content delivery will include templates, circulars, and presentations. After that, the next four months will involve providing counseling sessions to the nurses. These sessions will incorporate psychoanalysis techniques to prepare nurses to deal with mental issues related to their line of work. During this period, correctional nurses will undergo cognitive training to enable them to cope with the distinctive prison milieu. Finally, self-administered questionnaires will be given to the participants to assess their understanding of the significance of participating in competency training. This will take one month. Besides, these questionnaires will gauge their willingness to embrace EQ training to enhance their interactive skills, adaptability, and stress management, thus increasing their retention rates.

This curriculum will be implemented first in any selected county jail because the population will permit a small-scale study, thereby generating minimal disparities. Furthermore, there is a need to purchase essential resources like learning and presentation materials like books and placards. Moreover, key stakeholders will be involved in the implementation process. They include the government, pharmaceutical firms, penitentiaries, insurance companies, and the American Nurse Association (ANA). Moreover, a special team will be created to monitor and report the mental and emotional status of correctional nurses. Besides, the creation of a group will necessitate the introduction of new job descriptions to identify the healthcare officials caring for detainees. Examples of the job titles will include correctional nurse supervisor and nurse educators. This policy may have some flaws hence it requires regular revision and update. Also, I will consult with the Correctional Institution Inspection Committee (CIIC) to receive its expert recommendations and approvals for operational improvements.


A report by the Institute of Medicine’s (IOM’s) revealed that medical errors are the leading cause of death in the U.S. (Barnhorst, Matinez, & Gershengorn, 2015). Therefore, evidence-informed care and performance improvement are essential to reduce cases of mortality in hospice settings, including correctional facilities. This section offers guidance in selecting appropriate measures for quality initiatives in a penitentiary setting. The first step in appraising this education strategy involves identifying the essential dynamics to measure. Tangible outcomes such as morbidity are common metrics used for quality initiatives (Hale, Haley, Jones, Brennan, & Brewer, 2015). For instance, emotional distress experienced by a correctional nurse is an accurate measure of the quality of life.

Nevertheless, the chosen metric should be relevant to the caregiver, the receiver of care, and the prison health care organization. Another appropriate parameter, in this case, may include the control of PTSD. This metric is tracked and reported because PTSDs are prevalent among prison staff, and are related to increased indisposition, death, medical expenses, and length of stay (LOS). Also, the selected metric must highlight the clinical outcome measures. Some of these measures include suicide rates, illness pervasiveness, readmission rates, patient satisfaction, and LOS. That said, by utilizing this plan, LOS in hospitals as a result of mental distress would be decreased by two days. The cost of a hospital stay for one day at my chosen facility is $1500, or $4500 for the two-day reduction in LOS. A total of 20 correctional nurses will benefit from the plan within three months. That is a savings or benefit of $90,000. The cost to implement this plan is $30,000 over three months. Consider the formula for the Return of Investment (ROI) (Finkler, Jones, & Kovner, 2013).

ROI = Net returns from improvement actions/Investment in improvement actions

ROI = $90,000-30,000/3000 = 3×100

ROI = 300%


The budget will contain expenditures such as the cost to educate staff, equipment, marketing, and advocacy. These expenses are either direct or indirect cost (see Appendix B).


The low nursing retention rate in the correctional facility system reflects the complexity of challenges faced by correctional nurses in some facilities. Currently, there exists a significant number of prison staff suffering from an emotional burden. However, they do not receive the necessary training and education to improve their level of emotional intelligence. Hence, this lack of proper intervention makes them vulnerable to morbidities like PTSD and psychological distress among others. Implementing CEOP and fostering evidence-based care in health care facilities found in penitentiaries can alleviate these complications. Implementing a viable business plan is challenging. Some of the weaknesses of this plan include a shortage of staff and extended hospital stays, while its primary strength includes allowing nurses to practice care independently.

Executive Summary

This section of the paper summarizes the key points presented in the plan. Moreover, the executive summary recapitulates the primary objective of the project, its significance, the
Appendix A
SWOT Matrix Analysis Template
Table A

Strengths Weaknesses
Applies facts obtained throughout history regarding the best practice in medical care. Besides, the weak identity and devalued image of the profession is another weakness of the CEOP. Nurses are being marginalized by more powerful groups in the society like engineers and doctors.
Besides, the weak identity and devalued image of the profession is another weakness of the CEOP. Nurses are being marginalized by more powerful groups in the society like engineers and doctors. Lack of professional independence among nurses impedes the implementation of the CEOP. The biomedical principle that anything not related to curative therapy is insignificant marginalizes the profession, inhibiting it from professional development corresponding to its knowledge.
Values are positive and favor the humanization of people.
Personal values dynamic and can change socially, professionally and individually.
The implementation of CEOP gives autonomy to correctional nurses, allowing them to perform functions that were hitherto prohibited by the law.
Existing theory-practice gap inhibits the execution of knowledge to practice.

Opportunities Threats
The prevalence of emotional burden among correctional nurses will permit the expansion of awareness, expertise and approaches for a professional nursing practice. Lack of prestige and social recognition is a threat to implementing the CEOP. This fact is associated with the stereotype that correctional nurses earn low wages and are vulnerable to suicide.
The changes brought about by the CEOP will result in provision of improved care quality that will contribute to the protection and improvement of the well-being of the detainees. Lack of adequate resources to implement the EQ training program. Poor funding of healthcare in prisons leads to layoffs, low retention rates, increased rotations between services, and heavy workload.
Healthcare policymakers’ mindfulness and the incipient demands of the prisoners are leading to the emergence of new nursing fields and the redefinition of some existing specialties. The issue of brain drain is a threat to the implementation of a training protocol focusing on EQ instructions. Skilled nurses tend to migrate to other countries where their work is valued and the wages are favorable.
The adoption of CEOP and will foster the development of nursing when correctional nurses are involved and participate in government agencies in which key decisions related to the health of prisoners are made. Internal criticism by colleagues can impede the process of adopting a competency training to assist correctional nurses to acclimatize with the unique custodial demography.

Appendix B

Project Budget

Table B

Equipment (tables, chairs, computer gadgets, and presentation materials e.g. placards)- d/c 4 tables, 25 chairs, 1 laptop, 1 projector, and 100 placards $10,000
Education cost – d/c 20 staff members $28,000
Advocacy fee-d/c 3 media advertisements, 2 billboards, 6 newspapers, and government gazette $8,000

Appendix C

Executive Summary

  1. This plan aims to establish and execute an ongoing internet-based learning program for correctional nurses.
  2. The plan focuses on the nurse’s EQ aligned with the work demands of their sphere of influence, such as hostile inmates and work overload
  3. Embracing this plan will ensure increased retention of correctional nurses because it offers the moral and psychological guideline to cope with the prison setting.
  4. A proper EQ training will improve their intrapersonal and interpersonal skills as well.
  5. Implementing this program will take 12 months and cost $46,000 in expenses (direct costs).
  6. The project’s estimated ROI is 300%.
    potential outcomes, and the return of investment (ROI) (see Appendix C)


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2. Barnhorst, A. B., Matinez, M., and Gershengorn, H. M. (2015). Quality improvement strategies for critical care nursing. American Journal of Critical Care, 24(1), 87-92.

3. Choi, Y., Song, E., Oh, E. (2015). Effects of teaching communication skills using a video clip on a smart phone on communication competence and emotional intelligence in nursing students. Archives of psychiatric nursing, 29(2), 90-95.

4. Finkler, S. A., Jones, C. B., and Kovner, C. T. (2013). Financial management for nurses and executives (4th Ed.) St. Louis, MO: Elsevier.

5. Foster, K., McCloughen, A., Delgado, C., Kefalas, C., and Harkness, E. (2015). Emotional intelligence education in pre-registration nursing programmes: An integrative review. Nurse Education Today, 35(5), 510-517.

6. Lambert, E. G., Barton-Bellessa, S. M., and Hogan, N. L. (2015). The consequences of emotional burnout among correctional staff. Sage Open, 5(2), 2158244015590444.

7. Lisitsina, D. (2015). ‘Prison Guards Can Never Be Weak’: The Hidden PTSD Crisis in America’s Jails. The Guardian.

8. Nair, M. A., and Lee, P. (2016). Emotional Intelligence in Nursing. IOSR Journal of Nursing and Health Science, 5(6), 38-42.

9. Sarkar, M., and Ray, A. (2017). Emotional Intelligence and Team Effectiveness. A study among Correctional Officers of West Bengal.

10. Song, M. S. (2014). Influence of emotional labor on job involvement, job satisfaction, and turnover intention of clinical nurses. Journal of the Korea Academia-Industrial Cooperation Society, 15(6), 3741-3750.

11. Song, M. S. (2014). Influence of emotional labor on job involvement, job satisfaction, and turnover intention of clinical nurses. Journal of the Korea Academia-Industrial Cooperation Society, 15(6), 3741-3750.

12. Song, M. S. (2014). Influence of emotional labor on job involvement, job satisfaction, and turnover intention of clinical nurses. Journal of the Korea Academia-Industrial Cooperation Society, 15(6), 3741-3750.

13. Lisitsina, D. (2015). ‘Prison Guards Can Never Be Weak’: The Hidden PTSD Crisis in America’s Jails. The Guardian.

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