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
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
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
"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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