After Transition to RN-Led Care, ACH Reports Major Improvements in Care Quality and Legal Costs
(Franklin, Tennessee) — Following a multi-year transition from predominantly LPN-based staffing models to Registered Nurse (RN) leadership in its correctional healthcare sites, Advanced Correctional Healthcare (ACH) is reporting significant improvements in patient care and county financial performance, marking one of the most substantial operational shifts the company has undertaken. ACH leaders said the transition, completed across partnered counties despite budget constraints and staffing shortages nationwide, has already reshaped clinical practice inside jails.
“This was not an easy shift,” said Jessica Young, President and CEO of Advanced Correctional Healthcare. “Counties faced wage increases, workforce shortages, and years of precedent built around LPN-only staffing. But the results speak for themselves.”
According to ACH’s internal review of sites from 2016–2023, facilities staffed with RNs instead of LPNs saw a 95% reduction in legal costs and an 84% reduction in claims. These figures, displayed across the company’s RN impact materials, reflect the largest measurable gains ACH has documented following a workforce transition. Leaders say the improvements align with what state licensing boards and federal courts have increasingly emphasized: correctional environments demand the higher-level assessment skills and clinical judgment of RNs.
The move toward RN-led care began after a series of national warning signs. In Shadrick v. Hopkins County (2015), the court concluded it was “predictable” that placing an LPN in a jail setting without RN-level tools or training would lead to constitutional violations. By 2018, Iowa formally rewrote its nursing scope of practice to require RN oversight and RN-performed initial assessments for any LPN care delivered in correctional facilities. More recent litigation in Michigan has echoed the same allegations, challenging the adequacy of LPN-only staffing in jails. These developments, combined with growing public scrutiny of jail healthcare systems nationally, accelerated ACH’s decision to move its facilities to RN-centered models even before regulatory requirements demanded it.
RNs bring expanded clinical training, critical thinking responsibilities, and the ability to independently perform assessments - duties central to jail healthcare, where patients often present with acute withdrawal, unmanaged chronic conditions, and mental health instability. ACH leaders say the result has been more reliable clinical assessments, faster identification of medical needs, and fewer breakdowns in communication during intake and medication administration.
“RNs are trained for the kind of rapid judgment calls that happen in jails every day,” stated David Tharp, Chief Nursing Officer. “We’re seeing better documentation, fewer escalations, and improved continuity of care.”
While counties initially expressed concern about increased wages, the cost-benefit analysis has turned decisively in favor of RN models. The 95% reduction in legal costs, documented across multiple years, represents millions saved in avoidable litigation and claim defense. Counties that once hesitated can now see the shift as a fiscal win, particularly as state legislatures and insurers increasingly examine jail medical staffing for compliance.
The company acknowledged that the transformation required cultural, financial, and staffing adjustments, especially for rural jails long accustomed to LPN-centered care. But ACH said the successful implementation across sites proves the viability of the model.
“This wasn’t a simple policy update,” said Dr. Angela Moriarity, Chief Human Resources Officer. “It asked counties to rethink decades of hiring habits. But our data shows that making the harder choice upfront led to improved care and dramatically lower risk.”
ACH plans to continue publishing outcome data and supporting LPN-to-RN bridge opportunities for team members interested in advancing their licensure, noting that many LPNs have taken advantage of scholarship and transition programs during the shift. Company leaders said they expect more states to adopt regulations similar to Iowa’s and more counties to seek RN-based staffing models even outside ACH-operated sites.
“The correctional healthcare landscape has changed,” Jessica Young, Esq. states. “We’re grateful to lead this work and to see the fruits of choosing the harder, higher road in every county we serve.”
About Advanced Correctional Healthcare, Inc.
Advanced Correctional Healthcare, Inc. is a family-owned, values-led, contract management company that offers ethical, comprehensive services tailored to populations nationwide. ACH has been awarded two Better Business Bureau Torch Awards for Ethics, honored at Music City's Community Choice Awards for having the Best Employee Recognition Program, and named “Best Hospital & Health Care Business of the Year” in the Global 100 Awards for 2025 and 2026. In 2025, ACH was also certified as a Great Place to Work for the 10th consecutive year. In 2024, ACH saved over $15.5 million in taxpayer dollars through bill scrubbing. From 2019 to 2024, over 105% of contracted nursing hours were met nationwide, and more than 120 patient lives were saved.
