Nurse practitioners in correction system

Kikumaru · Nov 18, 2000

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.

sa48sh · Feb 13, 2001

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.

jmallenwood · Oct 9, 2003

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 The formulary is way out of date using older generics that have more side effects and more difficult dosing schedules that at the same time the jail demands only bid dosing.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.

Orca, ADN, ASN, RN · Oct 11, 2003

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.

jmallenwood · Oct 11, 2003

Orca,

What general statements would you make about health care in prison?

Orca, ADN, ASN, RN · Oct 12, 2003

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.

jmallenwood · Oct 12, 2003

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?

Orca, ADN, ASN, RN · Oct 14, 2003

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.

jmallenwood · Oct 14, 2003

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 !

Doris Faye · Dec 5, 2003

I am also in the process of completing my NP with the goal of working within corrections. I am curently working parttime as a RN in a 400 all male prison. I asked my supervisor (the Health Service Administrator/Director of Nursing) concerning employment opportunities upon my graduation and she almost jumped up and down and licked my face (she acted like my dachshund puppy)!!! She made the statement "I would love that and although we currently have a Doctor I would love to have you here fulltime as the nurse practitioner." She furthermore stated that the only reason why we currently did not have any nurse practitoners on staff is because she was unable to recruit any. I have also touched base with a couple of the state prisons here in my area and they were also very receptive to my being employed with them as a Nurse Practitioner. I think that I will attempt to go with the federal government however only because of the benefits...AND ONE DAY I WOULD LIKE TO RETIRE!!!!!!!!

jmallenwood · Dec 6, 2003

Well, good for you! I certainly applaud your enthusiasm. And I mean enthusiasm in the real meaning of the word! Certainly, the scriptural admonition is very clear!

I think NPs may be the very best providers for this group of people - inmates are, to a great extent, people who have not listened to, who have not had their concerns paid attention to and are in an environment which does not tend to bring out the best in them - and yet, of course, have all the same risk factors and illnesses that get the rest of us. Very often, there is a psychlogical overlay that calls for the best sorting out capabilities

we have.

What I found most difficult was the prevailing mindset of the (I hate to say it) nursing staff and the jailers that inmates are somehow less than human and don't deserve good care...

My wife is a therapist who works with-among others-addicts and HIV positive individuals. One of her clients will be enetering the system for a short time to serve a sentence for DWI. He is HIV + and on meds for many years. It is the policy of the local jail to refuse any meds brought in by inmates...I further know from working there and being on call, that the nursing staff may not pick up on his intake the fact that this man is on meds that need to be continued without break...the meds will need to be ordered from a local pharmacy and picked up and brought in...If there are several complicated intakes that day I can bet there will be a lapse...So, in this case, a sentence of a week may in fact be a death sentence...

I worked for a private for profit agency - PrimeCare Medical- which has a very strong but unwritten policy - " do the least you can". This was stressed to me several times and consequently, I no longer work there...all the worst aspects of managed care - be slow to refer out, always put off treating if you can and a very outdated inadequate formulary that did not meet the standard of care...

So, I wish you well; be strong and pay attention to that still small voice of calm.