Correctional Nurse Retention

Correctional healthcare environments are among the most demanding in the medical field. Nurses and clinical staff working in jail and prison settings face complex patient populations, institutional limitations, and high stress. These challenges contribute to the ongoing problem of staff burnout and turnover—especially among healthcare staff.  Addressing retention in challenging environments requires more than financial incentives or recruitment campaigns. It demands a culture shift rooted in evidence-based engagement strategies.

One of the most validated and impactful tools for understanding and improving employee engagement is Gallup’s Q12. This simple 12-question survey measures critical components of employee satisfaction and organizational commitment. Though deceptively straightforward, the Q12 reveals profound truths about how staff members experience their roles and provides a roadmap for improving that experience in a structured, hierarchical way.

In this post, we will examine how the survey works and then explore how the first six questions in Gallup’s Q12 can transform employee engagement and retention in correctional healthcare.

Stop Turnover and Retain Staff

The Q12 Hierarchy: You Can’t Skip Steps

Gallup’s Q12 survey is not just a collection of questions—it’s a hierarchy. Each level builds upon the one before. Organizations that try to move staff toward high-level goals like innovation or leadership without first addressing the basics will struggle. This is especially true in correctional healthcare.

You cannot expect a people to contribute ideas, feel loyal to the mission, or develop professionally if they are unclear about their basic responsibilities or lack the tools to do their job. The foundation must be secure before anything higher can be built.  That is why we must start with questions 1 and 2 on the survey.

Questions 1 & 2: “I know what is expected of me at work.” / “I have the materials and equipment I need to do my work right.”

These first two questions are the base of the Q12 pyramid. And they are non-negotiable.  In jail and prison settings, ambiguity and scarcity are all too common. If a your staff doesn’t know what’s expected—who is responsible for taking off orders, when does the provider want to be called about a patient, or what the chain of command looks like—then frustration sets in fast. Couple that with a lack of tools or poor equipment (broken fax machines, outdated EMRs, or no access to reference resources), and retention drops off a cliff.

Key Point: If people do not know what is expected and do not have the tools to succeed, nothing else matters. No amount of wellness days or pizza parties will fix that.

Questions 3 & 4: “At work, I have the opportunity to do what I do best every day.” / “In the last seven days, I have received recognition or praise for doing good work.”

Here is where we begin tapping into personal identity and meaning. Staff members, especially in medical fields, do not choose this field lightly. Many are driven by a deep internal motivation to serve vulnerable populations, uphold public health, or help people turn their lives around.

When these questions score low, your staff feel unseen or that their core values are ignored. They may be required to do repetitive tasks like medication passes with no chance to use any other nursing skills. They may work overtime to help with shortages without supervisor feedback or thanks. In one facility I worked at facing a significant staffing shortage, I hand-wrote individualized thank you notes to every staff member who worked over 20 overtime hours in a pay period.  The more work it seemed like during a given pay cycle, the more I realized how thankful I should be.

Key Point: People choose careers because they find meaning in them. If we cannot connect to that meaning—or worse, if we ignore it—we will lose people. Especially in high-stress environments like jails and prisons, a sense of personal purpose is essential to staff retention.  We must remember that alignment goes both ways.  If your people do not feel that leadership is aligned with their core goals, they will leave.

Questions 5 & 6: “My supervisor, or someone at work, seems to care about me as a person.” / “There is someone at work who encourages my development.”

These questions point to the future. People need to believe they are not stuck. This doesn’t always mean promotions—though for some, it does. For others, growth may mean becoming a mentor, learning a specialty like behavioral health, or refining clinical skills.

Both development and care are critical. If staff feel invisible or replaceable, or like “just a warm body,” they will eventually leave—even if their pay is competitive. In contrast, when people are seen, coached, and encouraged, they begin to envision a long-term future in your organization.

Key Point: People need to feel that they have a future. Whether it’s becoming better at what they do or moving up, development matters deeply for whether or not your staff choose to stay.

Perception Is Reality: Don’t Dismiss the Answers

One of the most common leadership mistakes when reviewing Q12 results is dismissing them.  A leader may see the answers as untrue.  I remember a time when I made sure to recognize each of my direct reports’ hard work every week.  Some still said it did not happen when they retook the survey.  Did that mean I could auto-adjust that scale and keep moving? Absolutely not.  The survey doesn’t measure facts. It measures perceptions. In the world of employee engagement, perception is reality.  I needed to provide feedback until they noticed and remembered it.

Running a medical operation in a jail or prison is not easy, and keeping skilled medical professionals is an ongoing challenge. But Gallup’s Q12 provides a roadmap.

Focus first on clarity and tools. Then tap into meaning and motivation. Finally, invest in relationships and future development. When done systematically and respectfully, this approach can transform staff experience, improve retention, and elevate care quality in even the toughest jail and prison environments.

 

Interested in checking out more ways to improve worker satisfaction?  Check out this post on a common management mistake that can make work less satisfying for employees.

The Pitfall of Piling on Workers

Interested in the Gallup Book?  Here is a helpful link. (We receive nothing from the vendor.)