Nursing Behind the Wall

When non medical people ask me what I do for a living the usual response is "...that's interesting?!" When nurses ask the most common response is "Why?" I am a corrections nurse, and over the years I have found that the general nursing community has no idea what we do. This article will hopefully grant some insight. Specialties Correctional Article

Nursing Behind the Wall

Most nurses rarely consider corrections as a specialty, if they even realize that jails/prisons employ nurses. Of course, when you think about it, it makes sense right? The inmates can't just call and make an appointment with their PCP, or go to the hospital. I actually fell into corrections because another nurse I met during a clinic suggested that I would be a good fit, it sounded interesting to me so I sent my resume to the jail, and they hired me. Now five years later, I am still interested in the field, but find that most nurses have no idea what I do for a living. Unfortunately our failures are front page news, and our successes are never heard of especially by the general public. So as I stated in my intro, the intention of this article is to shed some light on what it means to be a corrections nurse, and possibly improve on any stereotypes, or misgivings that people may have.

Working in a correctional setting is very challenging, and rewarding. As nurses we are given a great deal of autonomy, more so than in any other specialty. Usually the providers are there only a couple of days a week in small institutions, and in larger ones they are only there during day shift and on call at night, so the nurses keep everything going. We provide care for hundreds if not thousands of inmates with only a staff in the double digits if we are lucky. The buck stops with us. For example, I work nights in a busy inner city county jail with a census usually between 1500-1700 inmates, during the 12am to 8am shift I am the only RN with 2 LPNs and 1 MA (if I'm lucky). We rely on strong assessment skills, and sound clinical decision making. Which leads me to the first misgiving about corrections nurses, that we are all hospital rejects who couldn't nurse our way out of a paper bag.

Sadly, this specialty is looked down on by many nurses. Most likely because you never hear in the news about the corrections nurse who diagnosed the inmate with DM, or saved the inmate from brain death, you only hear about the bad stuff, some type of negligence which had a bad outcome. I won't get on a soap box about that type of thing, but the media never gets the full story. The truth of the matter is I have met some of the best nurses while being "locked up." They can assess their butts off, because unlike any other area of practice, our population manipulates for a living, and I'm not just talking about simple drug seeking behavior. I could write a book about inmates and motivations for manipulation, but that is not the purpose of this article.

What I love about working behind bars is the fact that I get to be so many kinds of nurse. One minute I'm an ER nurse dealing with a traumatic head injury after an altercation, the next I am an L&D nurse assessing contractions, then I'm a psych nurse talking the kid who just got locked up for the first time down from a ledge of despair/suicide. You really never know what will walk, or be dragged through the door by 12 angry corrections officers next.

Now a word about the population. They range in age from juvenile to geriatric, come from every social economical class, and are in jail for everything from unpaid fines to murder. And I treat them all. They come in with chronic illness, or get diagnosed while under my care. Most of my patients have some type of mental illness or substance abuse history, and come in having not had any medical care since the last time they were in jail. I don't deal with just one kind of patient, which means I have to keep up on all of my skills. This leads me to my next point, just because I work in a jail doesn't mean I can't start an IV or place a foley. I do everything from tube feeds to EKGs and usually don't have a tech to help out.

Does it bother you to take care of the really bad guys? No, I try never to find out what they have done. It doesn't change my job, which is to render quality medical care within my scope of practice, and in accordance with my company policy. Sometimes that cannot be avoided, I turn on the news and find out who my new patient is. This isn't the specialty for the nurse who wants to have a deep connection with their patients. That's not to say that I don't care for the people I treat, but it is on another level, and my satisfaction comes from realizing that I am taking care of the people that society wants to forget. Almost a blessing (for those of you who are religious). Also, I don't want to sound like I am defending what crime they committed, it's not about them, it's about me and my practice.

One of the best things about my job is the amount of teaching that I do. My patients don't go on the web and try to teach me about a disease they spent five minutes looking up. Most of them have had very little education at all let alone know the first thing about health maintenance, or disease prevention. I spend a lot of time trying to educate these guys, so that when they are back "on the street" they can control their HTN or DM. That is part of the rewards.

Working behind the wall is not for the faint of heart. It takes a special type of nurse to deal with what we do everyday, while avoiding becoming jaded, or institutionalized ourselves. Corrections nurses have strong assessment skills, are able to handle stress well, and thrive under pressure. We wear many hats, and play many roles to our clients. We are rarely thanked for what we do, but the thanks we get always comes from a very real place. If this sounds like you, please come and join us, you may never want to make parole.

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mikethemurse

About mikethemurse, BSN, RN

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Specializes in Community Health/School Nursing.

Kudos! I was a prison nurse in Florida for about a year. Loved my job! My husband ended up with a job transfer and we ended up moving. I am now a school nurse. My assessment skills, lie detector skills, psych skills and mothering skills (all of which I used in prison) have come in handy working with kids. They have been known to outsmart the un-out-smartable. :-) Little people running the school house! Great article!

Thanks for this article, I am currently in nursing school now transitioning from a career in Law Enforcement. I have been weighing my options as far as plans after graduation and have been heavily leaning towards a career with the Fed BOP. Your article shed some light on the specialty.

Spinmass, glad it helped. Good luck in school!

Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Thanks for this article, I am currently in nursing school now transitioning from a career in Law Enforcement. I have been weighing my options as far as plans after graduation and have been heavily leaning towards a career with the Fed BOP. Your article shed some light on the specialty.

To the OP. Thanks! I enjoyed reading about nursing inside a jail. I often wondered what the job was like.

To Spinmass: I don't anything about the BoP except this: They pay very low relitive to working for the VA. VA nurses seem to tbe highest paid civilian nurses in the government. At least in my area. Search USAjobs and compare the pay offered between the BoP and the VA.

Specializes in Corrections, Psych.

Great article!! My Dad just retired from corrections after 20-someodd years, but I never considered corrections as a specialty until I took a travel contract to a BoP contracted prison. My 13 weeks assignment became 18-ish months because I was hooked!

It's a stressful specialty at times, but also one of the most rewarding I've ever been in. It's hard to reconcile the alleged crimes with the patient in front of you sometimes, but to me, that's part of the challenge. Not everyone can do corrections, just as I would be a terrible fit in L&D or Peds, but it's an awesome area to be in if you enjoy a little dash of everything. :)

This is a fantastic article! Thank you for sharing your work life with us and setting the record straight! I can see how this specialty would be challenging and rewarding every day. That vulnerable patient population is BLESSED to have you

Thanks for this beautiful article! I always thought corrections would be interesting, and adventurous- and you made it real! I hope many yet uninformed aspirants find this post inspiring! I also hope more nurses in misunderstood, and little known specialties will take time to educate other nurses on this forum-I find that "high end" hospital nurses in particular, are more likely to dismiss "other" specialties as "real nursing," and I wish we would all be proud about how far reaching our career is! There are many people out there who would enjoy a non-hospital nursing career, and this should be eye opening!

Specializes in Med/Surg, Oncology, Corrections.

Love your description of what "we" do. I've been a corrections nurse for 12 yrs. and wouldn't change it for the world! It's everything you said and a lot more. You have to learn assessment skills that aren't taught in any nursing school. You learn to expect to be called every name in the book, and more, without showing any reaction. You see things that are funny, sad, unique, unbelievable and upsetting. I could go on and on but one thing is true -- I love every minute of it!

I started correctional nursing last year and love it! I never have the same day twice. The ability to assess and triage are key.

It is so true that there are many 'non-traditional' ways to use our nursing skills and presenting them on this forum may just help some that are experiencing bed-side burn-out, consider alternatives.

Specializes in LTC, CPR instructor, First aid instructor..

My hat is off to you. I loved your well written article. It gave me a lot of insight into what I would have loved to do. I'm much too old now and way too decrepit, but it reminded me about some of the things I performed as an EMT and team leader.

Thank you so much. I believe nursing students should be introduced to that type of nursing. It would do them a lot of good.:up:

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