and cruel experimentation with incarcerated individuals are long gone. These are welcome and overdue changes for individuals who are incarcerated and for activists of social justice. The idea that people served inside secure settings are deserving of and obliged health care has created opportunities, while at the same time, uncertainties. A system of coordinated, high-quality health care, though envisioned, has not yet emerged. For years, nursing research has identified barriers to nursing care in forensic settings. However, nurses have endeavored to meet the needs of these patients. Progress in decreasing barriers to care has been by way of champions in the field rather than sweeping system change. System change requires creation of a plan to navigate organizational context including a comprehensive review of program history, motivation for change, social context, and political ramifications. Taking on each of these topics requires thoughtfulness, organization, and leadership. Building a shared vision across the disciplines within corrections appears impossible at first glance. However, throughout history nurses have cultivated interdisciplinary relationships. Nurses as leaders of change are effective based on their ability to meet people where they are and set measurable goals. Nurses’ influence on health policy is made possible by the public’s trust in nurses (Norman, 2016) and is an integral aspect of the nursing ethics (American Nurses Association, 2015). The concept of networking to support system change is one intervention proposed in this article. Through networking of forensic nurses and creation of nursing leaders, change can Cultivating Change 6 emerge. The nursing profession has an obligation to advance nursing in all roles and settings through scholarly inquiry, professional standards development, and the generation of nursing and health policy. This article provides the organizational context, sociopolitical factors impacting forensic nursing, and motivators for change within this specialty practice. The history of forensic settings, especially as it relates to nursing care, provides the organizational context. History Forensic Setting Providing health care in nontraditional settings can be challenging; forensic settings are no exception and have additional unique characteristics. Elementary standards for health care in forensic settings were devised over 50 years ago to meet the most basic human rights. In the United States, the American Public Health Association, the Federal Bureau of Prisons, the National Commission on Correctional Health Care, and the American Correctional Association continue to publish standards for prisons and jails (American Correctional Association (ACA), 2014; Federal Bureau of Prisons (BOP), 2015; National Commission on Correctional Health Care (NCCHC), 2014). Other forensic settings, such as programs for people who are civilly committed, psychiatric hospitals, and juvenile programs, have additional rules according to their state licensing. Standards of care are directive and essential to establishing basic quality measures. However, differences from traditional healthcare settings exist in both content and implementation. Forensic nurses face several factors contributing to this difference including a complex patient population, a culture of custody rather than caring, and a lack of a traditional healthcare team. Patient population. Patients in jails and prisons have higher morbidity and are less likely to have the ability to maintain their health (Flanagan & Flanagan, 2001; Maroney, 2005). Cultivating Change 7 When comparing difficult patients in forensic settings with those also labeled as ‘difficult patients’ in traditional healthcare settings, individuals from forensic settings are more likely to exaggerate their symptoms, seek drugs, and display less reason in their requests for medication (Kistler, 2011). Patients who are involuntarily placed are more likely to have perpetrated heinous crimes, failed outpatient treatment, and suffer mental illness. Custody versus care. The conflict of punishment versus rehabilitation is often in the forefront whenever discussing corrections. A ‘nothing works’ dogma has been embedded in corrections policy since the 1970s (Richeson, 2014). Research has documented conflict between nursing and correctional officers, notably security disregarding nursing decisions, and corrections officers making derogatory remarks about nursing functions (Almost et al., 2013; Chafin & Biddle, 2013; Jacob, 2012; Jacob, 2014; Perron & Holmes, 2011; Weiskopf, 2005). Basic nursing tasks common in hospital settings are often deemed risky and unethical. Nurses describe the need to eliminate basic nursing behaviors such as meeting in an office or comforting with touch (Perron & Holmes, 2011). In general, correctional staff have focused on punishment and viewed caring behaviors negatively. Lack of a traditional healthcare team. A lack of a traditional healthcare team has been the norm in forensics. Healthcare professionals have rarely been included in the administration of forensic settings. This has contributed to nurses’ lack of support and professional alienation. Rural forensic nurses are especially susceptible to alienation (Williams, 2012). Many secure facilities were built in rural areas in the name of economic growth. Data demonstrates in rural areas have fewer