~~RN~~

Thank you both edgaroso and katkonk! I will check into both programs. We continue on the project, which now looks like it will be housed in a "Free-world" building previously used as an Assisted Living facility. This requires renovation, so it is a "hurry up and wait"situation :), which is probably good in the long-run, as it gives us time to plan our operation and learn from others. I appreciate all the feedback and suggestions!

Thanks! It is very helpful. The more I can learn from others' best practice the better!

Thank you very much! I have looked them up on the web, and I will be calling them for more information.

I have worked many different places and under many different contracts....it is not the environment or the "mentality"....it is the leadership! Maritesa stated it - "...although the RNs were strict...we had a real good staff, teamwork..." That really is the name of the game. Staff need structure and knowledge of expected outcomes, and they need to know the consequences if they fail to do their part....and THEN they need to be held accountable. I have found that most staff want to do a good job, but they resent when they perceive others are not doing their share and there are no consequences. It then becomes a game to see who can do the least! I have also worked under contract companies where it was very difficult to terminate someone, but that just meant the manager had to be very diligent about documenting the issues. Again, most people want job satisfaction, and those that could care less will leave when they realize management is serious about disciplinary action and that they will be held accountable (but I will admit sometimes it is a true battle of the wills to see who "gives up" first!). In the long run, though, it is worth the effort to get a team in place like Maritesa's that will work well together....and it IS possible!

I am working on a project to develop a program to care for elderly inmates needing nursing care, help with ADLs and terminally ill inmates. I know that many states now have medical reprieve programs and/or hospice programs within the walls. Could anyone who has a special program/unit/facility for the aging/infirmed population please share their program? I am interested in learning about your criteria for acceptance into the program, staffing, anything that you think might be helpful when starting a program. Are there any prison skilled nursing facilities that are separate from the regular facilities? Thanks for any information you can share!

Hello, I am not a recovering nurse, but I have worked in many correctional facilities. None allow anyone with a felony conviction of any type to be "cleared" to work in the facility, and misdemeanors were evaluated carefully before the individual was allowed clearance to work there. I have worked with a nurse who was practicing on a restricted license (no contact with narcotics), but I believe she was never arrested,etc. so it did not show on her clearance check. She was very up front about the issues, and she worked in a CQI capacity, so never had any reason to be around the medications. She did not share her past with anyone (staff or inmates) to my knowledge. Anyone previously incarcerated at a facility would not be allowed to work there. That being said, I have also worked in a facility where there were ex-offenders working as counselors in a specific drug program, but that was under the auspices of the state, not the medical program. In corrections, nurses must be very careful not to become too "familiar" with the inmates, as it can be easily misinterpreted, or worse, it can lead to inappropriate relationships. Sharing insights with inmates should be left to specific therapeutic programs.

The issue of using restraints (handcuffs/shackles) on pregnant and laboring inmates has been in the public eye recently due to various states passing legislation against it. There are inmate advocate groups lobbying to forbid their use after hearing stories of horrible situations - women being in leg irons when ready to deliver and the officer not removing them, so delivery occurred with them on, etc. While I truly do not believe this is the norm, I do believe there needs to be legislation/policy and procedures/etc. to mandate this. The American Correctional Health Services Association (ACHSA) has written a draft Position Paper on this topic, and it is now out to members for comment. It will be voted on at the next Board meeting in July. It basically supports the banning of the shackles/restraints in these circumstances, but also acknowledges that the security aspects (level, escape risk, risk of self -harm, etc) must be considered. It further recommends that female officers accompany a laboring inmate if at all possible. I am not sure if the draft is posted on the website (http://www.achsa.org), but if not, I will ask that they do so today. We would be happy to hear from anyone who wants to provide feedback!

I do not know where your location is, or how large a facility your Sheriff's Office manages, but I ASSURE you that your nursing skills need to be excellent! As the RN, you would be responsible (with any other RN on duty) for the other LPNs, MAs, etc. working your shift. You must be comfortable in decision making, based upon facts and your evaluation of a situation. Usually the RN handles the clinic/walk-in/Nurse Sick Call/Infirmary area - all of which require sharp assessment skills and great documentation. I am certainly not saying that a new grad could not do the job; I have hired new grads who have been great on the job...what I am saying is that there is a necessary level of maturity and (skill/job/nursing) self-confidence that is mandatory for success in Corrections. Your patients will test you .....often. If you liked the Community health part of your nursing education, you will like Correctional Nursing, as your patients inside the wall mimic those seen in the larger community. There is great opportunity for patient education. If you are so-motivated, there are opportunities for you to increase your knowledge as well. Good luck in whatever you decide your path will be...if your chose the Sheriff's Office, let us know in 3 months or so how you are doing :).

Crystalwomn - Really well put! I also have found that calmly speaking to the inmate and taking the time to explain the "whats" and "whys" of the situation usually gets them to reconsider, or at the very least they will then explain to me what their rationale is for refusing...sometimes they do have a valid concern, that can then either be addressed or another plan of care can be decided upon that is good for all. Objective documentation of what you did and the inmate's response, and your assessment of the inmate (even with no VS much can be assessed about this inmate - affect, behavior, general appearance, etc) should always be done for every encounter.

Corrections is one of the few nursing specialties that incorporates aspects of almost all of the others - nurses deal with emergencies of all kinds, chronic illnesses, ortho, psych, wound care, geriatrics (unfortunately the population is aging in prisons, and many facilities must accommodate the "skilled" components of care), etc., etc You must be diligent with the documentation, as our population usually comes with their own legal advisor! Assessment skills are probably the most important, and are used most days by all levels of medical staff. The way you interact with the inmates sets the tone for how you will be treated - being firm, fair and respectful goes a long way in interactions anywhere...sticking by the rules and showing that you treat everyone the same will earn you a reputation of someone who cannot be manipulated, which will then actually make your interactions and your job easier. As Orca and Donald stated, patient education is a big thing in corrections, and you will be amazed that many people do not know basic health information. This is one of the big reward areas for me! This makes corrections sound like a perfect job (and for me it is!), but there are negatives. You mentioned politics and leaving them behind - there are TONS of politics in corrections. We are guests in someone else's domain, and there are those from the security side whose main focus everyday is to deny the inmate any diversion - and going to medical is certainly a pleasant change from the housing unit. There are those officers and other medical staff who are there to gossip, flirt and carry-on instead of doing their job. I have always found that the firm, fair and respectful philosophy works well with ALL individuals you come in contact with at the facility - inmates, other medical staff, Security. Once they see that you are there to do your job, and that you do it well, they will gain a respect for you that will then enable you to be even more successful in the environment. In summary, while corrections can as stressful as other environments, perhaps just in a different way, it is a job that had great satisfactions as well. On my first interview for a corrections job, when I really had no idea that there were even medical services provided behind the wall (never gave it a thought one way or the other), the person I was interviewing with told me I would either love corrections or hate it, and I would know pretty much right away....she was so right! I love it....and I hope you try it and discover that it is the right place for you to be as well.

Ditto AKNURS! That description of Correctional Nursing was absolutely right on...I believe that the general perception of Correctional Nursing is (still) that nothing goes on and it is an easy job, or one where the nurses are sub-par when it comes to their skills. This is so untrue - in fact, as AKNURS so aptly described, it is the exact opposite. I will say that there are some smaller sites that have less staff and may have a slower pace, but that means the nurse's assessment skills and judgement must be excellent. On the whole, it is a challenging career with great benefits - the knowledge that every day you have made a difference (whether the inmate or your colleagues acknowledge it or not!).

I do not work with juveniles, and I do not know what FERPA is, but under HIPPA, the individual or the Guardian (in the case of juveniles and incapacitated individuals) can give permission for the records to be shared with anyone they choose. Therefore, the question is "who is the Guardian of these juveniles?" If it is the County, then I think it is implied that all who work with the juvenile (and are agents of the County) have the permission of the Guardian to have access to the medical information. It might be worth the time to get the County's take on the whole process(and in writing), and I would also strongly recommend (annual) Confidentiality reminders/in-services so that all are aware that there is a responsibility and accountability when one has access to medical information about a client. Please let us know what you ultimately find out, as I think this is pertinent to many situations in corrections/Juvenile Justice.

TwistedAsst, and ALL who work with the women, THANK YOU for your insight, and for what you do every day! As seen by the other posts here, most correctional nurses want nothing to do with the women. When I began in corrections, I did not know the difference, and being very interested in women's health, I jumped at the chance to work at a female prison. Hahaha...what a crash course! However, I, too, found it the most rewarding time of my career. When I transferred to another facility closer to my home, some of the "regulars" actually thanked me. I found the women to be sponges when it came to health education...amazing that they knew so little about their own bodies, and it was a great opportunity to give someone a little "power" in a place where they had none. Yes, limits have to be set and yes, they are very needy, but TwistedAsst is so very right - we are there to make a difference - and we do, EVEN on the days when we THINK we didn't!

Thanks! I am glad the information was helpful, and I hope you and everyone else considers joining ACHSA...it is a way to have a voice, teach others, learn a great deal, and make a positive change in our profession.

I am a member of the ACA...they have just recently begun a certification program for correctional nurses and managers. I have heard of only a few states/programs that will give correctional nurses an increase in salary if they are certified (NCCHC), and I am assuming it is the same for the ACA certification. There is another organization for anyone working in correctional medicine (Nurses, NPs, PAs, Social Workers, etc) - it is The American Correctional Health Services Association. ACHSA's mission is "to be the voice of the correctional healthcare profession, and serve as an effective forum for communication addressing current issues and needs confronting correctional healthcare. ACHSA provides support, skill development, and education programs for healthcare personnel, organizations and decision-makers involved in correctional healthcare resulting in increased professionalism and a sense of community for correctional healthcare personnel, and positive changes in health for detained and incarcerated individuals." They have state chapters and a National organization, and they have conferences throughout the year. The Southeast chapter just had one in Chattanooga (and it was very good!), and there was one in San Diego last week. I think there is another one scheduled in October in North Carolina. Can you tell I am a member of ACHSA as well? :) I really believe that Correctional Nursing is a specialty that is recognized by the ANA, but really not recognized by the facilities/programs in which we work! It is up to us to advocate for correctional nursing and get the recognition that it deserves. Joining organizations and becoming active will help get the message out.