Quote from jnetrn
I just recently applied to a prison as an R.N. to hopefully get job security, better benefits, and better pay. I have always worked in acute care areas like I.C.U. and E.R. and am reluctant to leave the hospital and stop my learning.
Management has been hounding us nurses at my hospital for patient satisfaction, making money, saving money...etc. The turn over has been tremendous after management started giving write ups and eagerly firing people. Sometimes I feel like the last nurse left on my unit! I look around and everyone is new or a traveler. Basically we are not part of a union and things keep getting worse. We are not even getting raises this year. So, I decided to try for this prison job.
Does anyone know from experience if working in a prison is a bad idea or a great career choice?
If you view nursing as a top-down hierarchy with ICU at the top, ER, then med/surg, and then ambulatory environments last, you may not like correctional nursing. Acuity levels and learning are separate concepts. If you thrive on the high-tech environment of the hospital - for example - managing all those drips on a patient who is circling the drain, IABP, seeing zebras, etc, then correctional nursing is not for you. However, there's still a lot of learning in correctional nursing. I've finally learned how to spot a fake seizure with precision. I've learned how to spot a syphilis rash. I've learned how to calm down an officer who has been attacked with an inmate's dirty syringe that had been used by 100+ inmates and then counsel and offer him prophylaxis medication for HIV exposure. I had to learn what's involved with offering prophylaxis medication post exposure. It's things like that.
Keep in mind our average acuity is lower, but that does not mean you will know what to do. When we have agency nurses with acute care backgrounds come to our facility they do not know how to do the job just because they haven't been exposed to these things before. In a well-run correctional healthcare environment nurses have quite a bit of autonomy and act as primary care providers, to a significant degree. In poorly run correctional health facilities nurses give medications, fly by the seat of their pants, quality of care is low, and the crap only hits the fan if an inmate dies or sues. In these facilities there's little patient education and there's a lot of suffering, bad care, and dysfunction for the inmates.
For example, you might see a patient on nurse-line with a skin infection. You have to decide if it looks like MRSA, and you need to call an on-call provider for an abx order, or if you can give out warm compresses and order a nursing recheck to watch it. You need to be able to tell by looking with an otoscope if you need to call for abx or if a sore ear can wait. You deal with boring things like inmates asking for lower-bunk requests because they don't want to climb to the top bunk in their cell. You have to decide if they have a legitimate reason. They usually don't. It wears on you, their lies.
You might spend your morning running appointments where you inform inmates they have tested positive for hep C, and what this means to them; it's an extended counseling session about their prospects, diet, drug habits, etc. You might get called to a man-down situation in a cell block where an inmate is complaining of lower abdominal pain and says he cannot move. The patient denies any injury. An experienced correctional nurse knows to lean closely so the other inmates and officers cannot hear and ask, "do you have a weapon in your rectum?" This is so you won't cause a perforation when moving the inmate to the backboard. Yes, they hide shanks in their rectums.
In a work day you might perform audiology exams, EKGs, PFTs, treat common colds, and respond to an emergency or two. I remember the first time I performed an audiology exam; I thought to myself, don't audiologists do this? You might do lab draws because the lab person isn't there that day. You will evaluate new intakes for their needs. It's kind of a jack-of-all trades nursing gig with the emergencies and the occasional code. You decide who sees the physician when you have one. You do a lot of screening.
Another consideration is the population and security level of the prison. The greater the population and the higher the custody level, the more violence and assaults there will be. Assaults are a daily occurrence where I work. Smaller, lower custody prisons are very different than larger, higher custody institutions.
It's just very different. If you are really into the high-tech hospital environment, it might not be what you like. If you might like a lot of autonomy, lower acuity interspersed with emergencies, you might like it. Good luck with what you decide!