Lori Roscoe, DNP, APRN, ANP-C, CCHP-RN, never expected to go into correctional nursing, but the career path has given her tremendous rewards.

“It’s the best-kept secret in nursing,” Roscoe says of correctional nursing. Nurses who are interested in community health and public health are especially drawn to correctional nursing for the direct and immediate impact they can have.

Correctional nursing is recognized as a specialty area by the American Nurses Association which also approved the scope of practice for correctional nurses.

“I actually got into correctional nursing by accident,” says Roscoe. Nursing was her second career following several years as a teacher. Early in her nursing career, Roscoe spent time as an emergency department nurse. That background provided a foundation of nursing skills she uses in her daily work now. And it also helped her recognize her affinity for working in a high-intensity, high-energy environment.

By chance, Roscoe heard a keynote address at a family member’s correctional officer academy graduation ceremony. The speaker was the Associate Commissioner for Health Services at the state Department of Corrections. Roscoe was struck with the realization that many of the regular patients she saw in the ED also had spent time in correctional facilities. Several months later, a job opportunity opened up in the department of corrections and Roscoe applied. She was motivated to work with and have an immediate impact on such a vulnerable population.

Her first job was at the Massachusetts Correctional Institution–Framingham. “It was my first experience in women’s correctional healthcare and I loved it,” she says. “I like working with people for whom I can really make a difference.” Some of the women in the prison were unfamiliar with healthcare and taking care of themselves. The reward is to see what can happen when someone who has been neglecting their health learns about what to do and is able to do it, says Roscoe. Roscoe says she’s able to get patients back on medications as needed, can monitor them, and help them get better nutrition than what they typically have access to.

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“It’s all about what nurses teach patients everywhere and it works.” says Roscoe about healthcare education. “The population we work with often has a low health literacy, so we do a lot of patient education.”Roscoe says correctional nurses must have good assessment skills. They need to be able to do a thorough physical assessment, recognize the abnormal or unexpected findings,  and address them.  It’s critical that they ask the right questions to help uncover the correct diagnosis.

“We see totally different people and drastic improvements in health,” she says. “When substance users get clean, we see a remarkable improvement in their overall well-being.”

That kind of positive effect motivates correctional nurses and it also motivates those they work with. In corrections, says Roscoe, healthcare is appreciated, but it’s also different from what other nurses see. “The biggest challenge as a nurse is I am practicing in an environment where healthcare is not the primary mission,” she says. “We are a collaborative partner, but at the end of the day, security concerns are paramount.”

Lockdowns will disrupt the most efficient schedule and unpredictability is common. And while Roscoe says that can hamper her day-to-day practice, it’s also beneficial. “It’s also a positive,” she says. “It allows us as nurses to be flexible and creative in how we provide services.”

For instance, if someone needs a finger splint, Roscoe needs to figure out how to splint a finger using materials that will be acceptable in a corrections environment. If an incarcerated individual needs a CPAP machine and it’s not allowed in the general population, Roscoe has to determine if the patient needs to be moved. “We need to determine why things are important to have or crucial to have and then advocate for the patient,” she says.

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For nurses considering this path, gaining some previous experience is especially helpful. “We used to say this is not an entry-level job,” says Roscoe, noting the complexity of navigating healthcare and a corrections environment. Nurses can earn certification as a Certified Correctional Health Professional and a Correctional Nurse Manager.

And while safety is something all corrections nurses are aware of, Roscoe points out that her time in the ED offered less reassurance about safety. “I didn’t have an officer standing at the door then,” she says, noting that nurses in all roles must be aware of their surroundings. “I’m more nervous going to the mall at Christmas time walking alone in the parking lot with all my packages.”

The patients Roscoe sees know the nurses are there to help them. “The majority of incarcerated persons are happy we are there and wouldn’t jeopardize that by harming the nurses,” she says. “I have always found that if you are firm, fair, and consistent, you will earn the respect of patients and they will act appropriately.”

To find out more about correctional nursing, look at the American Correctional Nurses Association, which formed two years ago and of which Roscoe is one of the founding members. And check out Roscoe’s blog CorrectionalNurse.Net for more information about this nursing specialty.

Julia Quinn-Szcesuil
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