Nurse practitioners in correction system

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    Dear correctional nurses,
    I plan to start my BSN soon, but my long term goal is to become nurse practitioner. I am thinking about working in corrections. What are job prospects as correctional nurse practitioner? What specialties are needed the most? And what is pay range?
    Thanks to everybody, who'll reply.
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  4. 0
    Recently, when working the mens prison, I asked the same question and found amazingly, from one of the state nurses that they don't use NP's...I just heard from one nurse and she may not be accurate!
    Originally posted by Tashka:
    Dear correctional nurses,
    I plan to start my BSN soon, but my long term goal is to become nurse practitioner. I am thinking about working in corrections. What are job prospects as correctional nurse practitioner? What specialties are needed the most? And what is pay range?
    Thanks to everybody, who'll reply.
  5. 0
    Originally posted by Tashka:
    Dear correctional nurses,
    I plan to start my BSN soon, but my long term goal is to become nurse practitioner. I am thinking about working in corrections. What are job prospects as correctional nurse practitioner? What specialties are needed the most? And what is pay range?
    Thanks to everybody, who'll reply.
    At the prison where I work in Florida we use NP's as physicians. They diagnose,treat and prescribe. We also use PA's who have less authority,and must have all their work co-signed by a physician. I'm not sure about the saleries but I believe our PA makes 78,000 a year. We have no NP's now but have in the past. No one has applied.

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    I'm a family NP and have been working in 2 local jails for the past 6 months...here in NH it makes sense to use NPs because we have a a progressive Nurse Practice Act that bestows a great deal of independence...and , of course, we are cheaper than physicians and do largely the same job. I suspect there is a wide variability in employment due to the wide variability in different state"s laws.
    I find the work very interesting and fulfilling in terms of patient interaction but the real challenge is working for an agency and in fact, a whole system that says, " these people are in jail so they must be bad and therefore they don't deserve good care". In fact, the man who hired me told that the first thing I should say when an inmate sits down is, "No!". The formulary is way out of date using older generics that have more side effects and more difficult dosing schedules that at the same time the jail demands only bid dosing.
    We, as a society, have chosen to have jails rather than mental hospitals and drug treatment centers and so have a huge proportion of inmates who have serious and chronic psychiatric problems - depression and anxiety, Bipolar Affective Disorder, ADHD as well as shizophrenia.These illnesses often lead to self medication with what's easily available on the street. Then stupid, impulsive behaviors result that wind up being dealt with by police !
    "Corrections" in my limited experience, is a total misnomer.
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    Nevada uses Nurse Practitioners in the prison system. Our NP carries a big share of the load in our infirmary. Before coming to Nevada DOC, he worked for several years in the Federal Bureau of Prisons.
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    Orca,

    What general statements would you make about health care in prison?
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    I can only speak for the system I work in. I would say that the quality of care is generally quite good. Despite the complaining some inmates do about the system, they have much greater access to health care than they do on the outside. Many of them have not gone to doctors in the community despite having health problems. Referral to specialists is a bit slow, but then in these days of managed health care, it isn't exactly quick in the outside health community either. Inmates get medication inside that they will not continue once they leave, because of expense. Nevada started a policy within the past week that inmates will pay nothing for prescriptions, but will pay $8 for doctor visits (a much lower deductible than I get, for sure). The hospital we contract with for those times that inmates must go to the hospital is Nevada's only Level I trauma center.

    I don't believe that our inmates have any gripes coming.
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    Prisons and jails are different in a lot of ways, I imagine.

    A small proportion of our inmates are on work release that pays so that they could pay for visits- which sounds like a good way to encourage inmates to value healthcare and in fact invest in it.

    I also have found that most of the men I see have not had consistant healthcare - partly no doubt access problems but also to a large extent, because they come from a culture that does not place a priority on preventive care but rather utilizes urgent or emergency care in a crisis-driven fashion.

    Access to meds on the outside after release certainly is huge issue....do you do any kind of discharge planning in your facility?
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    In terms of medication and medical care, no. Inmates who are leaving get two weeks worth of gate meds. For diabetics, this includes insulin syringes and new bottles of whatever types of insulin they were on. They also get to keep the glucometer they were issued, and we make sure that they have two weeks worth of test strips and lancets.

    In some ways, I believe that we are doing inmates a disservice, especially in psychiatry. Our psychiatrist is fond of using very expensive brand-name medication (particularly Zyprexa and Seroquel), which inmates are highly unlikely to continue once they are released.
  12. 0
    Ah, psychiatry!
    We haven't had a psychiatrist in the 6 mos I've been working.
    Prescribing for the seriously mentally ill is way out of my scope, of course, and the family doc who is medical director feels the same...we think it's because our for profit agency just won't pay enough...also, we both feel rsomewhat resentful about being put in the position of taking care of these folks -our formulary is quite limited to the old drugs that are known for side effects and depakene which is the bipolar med of choice really needs tid dosing for tolerability which goes against the preferred bid scheduling...
    I agree about the disservice of starting expensive drugs in the joint if they can't be accessed outside - that's why some sort of transitioning to the community mental health centers would be good - if those centers could cooperate. People with psychotic disorders should be on medicaid and get their drugs and continuing care that way - otherwise they decompensate and just come back !


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