Tell me about the duties of correctional RNs during a shift?

A lot of it depends upon your specific assignment, and whether the facility you will be working in is an intake facility. Our nurses work 12-hour shifts. Some are assigned to work the clinic desk. They schedule appointments for the physicians and make sure that the inmates show up. Some will sit in on the actual appointments and may assist with things like pap smears. Some nurses go to intake and gather basic medical information from incoming inmates and information on current medications. Some take care of infirmary inpatients - much like a mini-hospital. Usually two nurses are assigned to the man down team, who respond to emergencies in housing units and on the yard. On occasions an RN may have to conduct pill call, although in our system the LPNs do most of the pill calls. A narcotics and sharps count is done at shift change.

As opposed to a hospital, our admission process for the infirmary is pretty simple. The medical chart is already built, so you add a progress note whenever an inmate is admitted. The pages of information you usually gather at admission in a hospital were done at intake with inmates, so all you do is write down your assessment findings.

We have a couple of different options for a shift:
1. Pharmacy nurse: count, seg med delivery, med window in two different locations, delivery of meds to medical tier, passing out kop meds, scanning in meds, count....
2. Dispensary nurse: treatments, vital signs for the Dr. and PA, and sick calls. We usually have about 25 sick calls on dayshift. Phone rings like crazy, emergencies, walk-ups, management handing you stuff that has to be done "right now", transfers, people returning from hospital stays and MD appts., etc. Crazy busy!!!!
3. Infirmary nurse: Very similar to a hospital med/surg. Report, assessments, meds, FSBS, IVs, admissions, discharges, taking off orders. We usually have two nurses with 15-17 inmates. Computer charting on a not-so-great program really slows down assessments.

Probably one of the most frustrating things in corrections is MAR changeover, it is very challenging to get MARs done correctly on thousands of inmates. Many issues with our contracted pharmacy also contribute to frustration. That being said, I probably get less stressed here than when I worked the hospitals. An infirmary would probably be the most like the hospital for you.

Correct about the intake facility. It is a place where inmates come into the state prison system from county jails and other correctional systems. We do the initial screenings and identify medical problems and current medications. An intake physical is performed by our physician within a week or less. The majority of the inmates at my facility are permanently assigned here. The intake unit is only a part of the facility.

As far as the pace, you will find it far less hectic than most hospital floors, at least the normal routine. When we have our moments they are usually big ones - stabbings, riots, shootings on the exercise yard (when somebody has to get stupid and then doesn't obey orders from the correctional staff to cease and desist). I now work in a women's facility, so we don't have nearly as many violent events. When I worked night shift at a men's prison on a few occasions I heard the shotguns going off (warning shots) as I came through the gate and I thought "This is going to be an interesting night."

Your assessment skills will be put to the test. Inmates will exaggerate and fake symptoms to try to get things out of you. Pain medications are the most popular. Even though they only get OTC stuff as a general rule, these are popular on the yard as inmates sell and trade the pills. Some just like the challenge of duping staff. You also have to be aware that we operate within a custodial environment, and security issues are top priority. One positive thing about that is that custody takes a lot of measures to ensure the safety of medical staff.

Many people have asked me if I am afraid to work in a prison environment. The truth is that I was a lot more likely to be assaulted in the hospitals I worked in than out on the yard. Treat inmates with respect and dignity and you will have no issues. The vast majority will be very respectful to you in return. If an inmate isn't, then tell the officer "Our business is done" and have him/her take the inmate away. You don't have to treat them like customers, enduring all kinds of verbal abuse like in a hospital.

You will see things that you won't see other places, and things that redefine the term "stupid" - like the inmate who was bitten by his pet sidewinder (yes, you read that right - he was keeping a poisonous snake as a pet - even had a leash for it).

I have been in correctional nursing for eight years. I would not willingly return to hospital nursing. It isn't for everyone, but for those of us who love it, correctional nursing is the best-kept secret in health care.