Leaving hospital to correction facility?

it's hot in phoenix · Jan 16, 2012

I have worked in a hospital setting as a cna/lpn and rn for over 15yrs and I have been doing corrections the same time for 5yrs and have to say, ironically with a state budget as a train wreck, rarely am I concerned about the "money" aspect. In the hospital setting, that is a diferent story. I am oddly comfortable in both settings. I think you will like the change and there is alot of sick patients in our systems, so you wont loose your skills! Good luck!

Multicollinearity, BSN, RN · Jan 16, 2012

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!

chulada77, ADN, BSN, MSN, APRN · Jan 16, 2012

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?

I started out at a hospital and within six months was sick and tired of hearing about customer satisfaction ratings!! I worked nights and was on my feet all night long but never seemed to be enough to DON, etc, so I decided to do prn at the prison. Of course working with inmates is kinda my "comfort zone" since I have experience with it. Within the first month my prn nursing job at the prison turned into fulltime and I completely dreaded returning to work at the hospital.

Money wise, the hospital was better paying but I wouldn't trade money for that type of work ever again! At the prison we deal with mass amounts of chronic illness: AIDS/HIV, hepatitis, dialysis pts, TB, MRSA, etc. I have learned to triage better and weed out the BS vs. true emergencies. The only time I ve ever been assaulted was at the hospital not at the prison.

The prison is a relief compared to the hospital environment. Give it a try, worse case scenario, you don't enjoy it and go back to the hospital.

MIKALA68 · Jan 25, 2012

Don't know which state your from. I worked in 3 prisons in CA. The pay starts at $8,000- with good benefits and PERS retirement. Guaranteed hrs. you don't get sent home for a low census/acuity. However there is mandated OT work per union contract. Some prisons have in patient hospitals, other clinics. For example vacaville California medical facility has an ER (TTA triage tx area), B-1 urgent care huge insuline line. Hospice, Medsurg flr, in pt. longterm care etc.

No sophiciticated equipment like an ICU. Beware of the negative environment on both sides inmate/employee. Also management can make or break a work environment. Can be lots of favortism, nepotism. So if job securtiy is what you need corrections can be good. You need to have a strong personality & be firm. Don't let the inmates manipulate you. Good luck

simonsmom · Sep 10, 2013

Hi-

Do you know if you are a new grad and apply for a prison nurse position if it is difficult to transition to a hospital setting? I am just wondering if in the future I will have the opportunity to move on to a hospital ER position as I hope.

Orca, ADN, ASN, RN · Sep 10, 2013

Hi-
Do you know if you are a new grad and apply for a prison nurse position if it is difficult to transition to a hospital setting? I am just wondering if in the future I will have the opportunity to move on to a hospital ER position as I hope.

It might be an issue. We do a lot of different things, just not enough of any of them to get really proficient at them if correctional nursing is all you have done. I am glad that I started out in a hospital, and I recommend it to anyone planning to go into corrections. Correctional nursing is a great job, just not a great first job, IMO.

Orca, ADN, ASN, RN · Sep 10, 2013

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?

I moved over 12 years ago and I have no plans to return.

Some of the great things about it:

1. Never called off for low census.

2. Position is essentially permanent once you complete probation.

3. Will never be closed, bought out or merged.

4. You don't have to take crap off your patients because they are paying customers. An inmate pops off to you, you end the visit, problem solved. See you next time, thank you for playing.

5. Much safer environment than most of the hospitals I've worked in. To those who have never worked in a prison environment, you may believe that I'm nuts for saying that, but think about this: I am 99.9% sure that the people walking past me are not carrying firearms. Many of the people keeping watch over me from above are. If an inmate makes a move toward me in the clinic, he is kissing linoleum in a split second. I'm much less likely to be assaulted inside the fences.

6. Most of the people you treat are very grateful for whatever you do for them. You generally don't have to put up with their families/GF/BF/friends, because that takes place in visiting.

7. Anything gets serious, it's out to the hospital. If in doubt, ship him/her out.

DesertRN2009 · Sep 11, 2013

It depends on the prison system and medical level of the facility. Some have medical units. Some just have pill line sick call and true emergency care only. Ask what the prison is security level and medical level

OfficerRNBSN · Sep 12, 2013

I went from street level law enforcement, LE administration, RNdom and hospital work, to jail nursing (and grad school, lol). Frankly, I didn't fit in with the hospital setting. I didn't mind the work, but I couldn't stand the longterm or recurring patient and patient's family encounters. I mean by that I've assessed the patient, given meds, checked on them, they're doing fine, but they keep calling for something, lol. "You don't need any freakin' juice! Go to bed!!"

I believe in quality healthcare but not pampering. In the jail, when I give meds, I walk to the door, open the bean hole, call the name, have them initial, watch them swallow the pill, get swarmed with 30 questions from a pod of inmates, ignore the questions, close the bean hole, and move on. I have sick call one day per week, and I must have a written request before sick call in order to see the inmate. This is the policy I have implemented since I'm the administrator of all things health related. If I deem their complaints to be valid I arrange for them to see the visiting doctor the following day. They get to share their written concerns with the doctor and nothing else. They can't interject extras. In the hospital I could get someone in for MI and have to tend to gout, some kind of skin sore, and who knows what else. In actuality, I have very little direct contact with inmates. I'm around and amongst them all the time, but nursing-wise most of my job is more administration and case management related.

I'm not required to attend to anything that isn't life threatening. If you're fairly new to nursing or even overly accustomed to the hospital setting the big thing to know in jail and prison work is that the facility exists to separate the inmates from society. They're not there for any other reason, and you're not working in a hospital. You'll have situations where you think, "I can't do anything about this inmate's problem." Own that. It'll pop up a lot. In a hospital you could incidentally tend to a variety of problems and other health concerns that pop up while hospitalized. In corrections that's not true, and it's not meant to be.

Keep them alive and well so they can serve their time.

Leaving hospital to correction facility?

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