Correctional Nurses Call the Shots

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By Debra Wood, RN, contributor

While not for everyone, the autonomy and chance to work with needy patients in a correctional setting appeals to many nurses. And now the subspecialty garners more respect than in years past.

"I like the fact that it challenges me as a nurse to use all the nursing skills I have learned," said Mary Raines, RN, BSN, CCHP, a nurse manager at Oregon’s Coffee Creek Correctional Facility. "You get such a variety of things, from clinic walk-ins to acute, emergency trauma situations. You never know what the day will present. It always keeps you thinking."

Raines has worked in correctional health care for more than 13 years. The Coffee Creek intake center and women’s prison employs 25 nurses and allows nursing students to complete clinical rotations at the institution.

Correctional nurses may work in county jails, state or federal prisons, or for agencies that contract with governments to supply health services for inmates. The University of Texas Medical Branch at Galveston provides managed health care to 80 percent of inmates in the state and operates the Texas Department of Criminal Justice Hospital, a 204-bed, full-service facility.

"Inmates are getting first-rate, university medical intervention, the finest of care, while in a maximum-security prison," said Karlyn Pearl, RN, MSN, CNS, who works at the hospital. "As nurses, we are here to take care of those most in need. Grandma can’t come and fix her chicken soup for this young man or lady, so they are in need of our love and care. It’s a calling that is rather unique."

Correctional nurses typically provide the first line of care for inmates’ chronic and acute health needs, assessing patients then initiating treatment based on written protocols. They also pass meds, administer IV antibiotics and provide wound care. Nurses decide if an inmate requires transfer to a hospital or an exam by a physician.

"I was amazed at the severity of diseases that inmates present with," said Pam Steinke, RN, MA, administrator of correctional health services for Orange County, Florida. Nurses complete a medical and mental-health screening on each of the 160 inmates who arrive daily at the Orlando jail. Nurses may send the inmates to an emergency room for stabilization prior to booking.

Diabetes mellitus, hypertension, substance abuse, infectious diseases, skin wounds and mental illness are common. Female inmates may be pregnant, and nurses are treating more aging inmates these days.

"Some are so neglected, they’re like third-world patients, as far as their care," said Steinke, who believes some homeless inmates get arrested on minor charges just so they can receive food, housing and medical care.

Most inmates appear grateful for the nursing services they receive. But some, especially drug seekers, can become disgruntled. Inmates also may ask for special favors from the health-services department, such as obtaining a second pillow or blanket. Nurses must set boundaries and be prepared to confront an inmate trying to manipulate the system.

"The biggest challenge is deciphering what is real and not with the complaints, and getting to the bottom of it, because you don’t want to overlook something," said Kathy Laginess, RN, BSN, MBA, president and chief operating officer of SecureCare Inc., a Michigan firm that provides health care to correctional institutions.

During orientation, nurses learn the basics of correctional health, such as not to divulge personal information, always keep open the door to the treatment room, and never give inmates contraband, such as shoestrings or ink pens that could be used for tattoos. Guards typically stay with inmates or are present in the clinic or infirmary.

"I feel safer walking in these facilities than I do in a shopping mall parking lot, because it is a controlled environment," said Laginess, who had been held at gunpoint at a prior job in a community hospital emergency room.

At first the clanging of the cell doors and searches of her personal belongings made Pearl uncomfortable. But now she realizes it’s for her own protection.

Nurses working in correctional settings may receive additional "high-risk" pay and benefits. But that doesn’t seem the prime motivation. Laginess enjoys the "challenge of getting more creative than the inmates," for instance, improvising a dressing when Kerlix is not allowed or splinting an injury without a traditional metal splint.

Just like all nurses, those working in corrections teach patients about their conditions and plan for discharge. Inmates bonding out or being released may be referred to public-health clinics for follow-up care.

Kathy Wild, RN, health care administrator for the San Bernardino, California, Sheriff’s Department, said she has received letters from inmates after their release thanking her for the self-care knowledge they gained while in custody.

Certification as a correctional health professional (CCHP) is available to nurses through the National Commission on Correctional Health Care. Vanderbilt University, Tennessee, offers a focus area in correctional health in its nurse practitioner program.

"Nurses who work in prisons are often pioneering spirits," said Jamie S. Brodie, MSN, RN, CCHP, assistant professor and head of the correctional health program at Vanderbilt. He said nurses must ask themselves if they can care in a nonjudgmental way for a child molester or murderer, before accepting a position in a criminal-justice setting.

Some nurses, such as Wild, have stayed in the field for more than 20 years. She likes the autonomy of working in a "nurse-driven" and exciting environment where nurses make decisions and a difference.

"One of the main rewards is you are doing some good stuff for people who haven’t had access to the health care system," Wild said. "You can make a big impact on someone’s life."

For more information about correctional nurses, visit the American Correctional Health Services Association or the National Commission on Correction Health Care.

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