Correctional Nursing Offers Rewards and Challenges

Correctional Nursing Offers Rewards and Challenges

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.

“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.

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.

Correctional Facility Nursing

With more than two million men and women in custody in American jails and prisons, there’s a great need for nurses to care for the correctional population. Nurses who can cast off their biases and follow strict security rules while helping inmates restore and maintain health could find an ideal career in correctional nursing, says Mary Muse, Director of Nursing for the Wisconsin Department of Corrections. “Correctional nursing allows you to really focus on what nursing is: caring for people,” she says. “If nurses want to be autonomous in their position, there’s probably no better setting than correctional nursing.”

Muse, a nurse for three decades, faced common misconceptions and stereotypes early in her career. Many perceive that correctional nurses aren’t held to the same standards as nurses in other health care settings, such as hospitals and doctors’ offices. “It was a job you took when you didn’t necessarily have something else,” Muse says. “This was a nontraditional health care setting.” Vowing to ignore the stigma, Muse made it her mission to enhance correctional health delivery and help eliminate disparities, while making the fi eld more visible. “Nurses who practice in correctional settings have really been absent from the larger landscape of nursing,” she says.

Of the many ways correctional nursing differs from nursing in a health care setting, the most obvious might be the “challenge of caring versus custody,” says Ginette Ferszt, associate professor of nursing at the University of Rhode Island. While nurses come to their work from a caring science perspective, she says, the primary goal in U.S. prisons is custody and safety.

That disconnect makes the role of a correctional nurse even more important, says Pat Voermans, a correctional nurse consultant and nurse practitioner with the Wisconsin Department of Corrections. “What’s so striking to me is the need of the people in these systems,” she says. Inmates can’t choose their providers, and correctional nurses are the gatekeepers to getting prisoners the health care they need. And, she adds, “We can’t choose who we get. Sometimes we get patients who don’t have the best handle on their decision making and how they interact with others. They’re angry and you have to try to work with them. Trust is a really hard thing to establish with an inmate because they often see us as part of security.”

A day in the life of a correctional nurse

Every day is different for a correctional nurse, but many of the nurse’s duties are the same at jails and prisons across the country. In Connecticut, where the Department of Corrections oversees jails and prisons, intake screening is a major responsibility for nurses, says Dr. Connie Weiskopf, Director of Nursing and Patient Care Services for Correctional Managed Health Care at the University of Connecticut Health Center. Correctional nurses in the state perform about 35,000 intake screenings every year, she says, filling out a four-page document on each inmate’s physical and mental health status.

In addition, correctional nurses in Connecticut administer more than one million doses of medication each year, Weiskopf says. “Many of the inmates in the system are on medication. The nurses administer medication to all the patients.” Inmates who were recently released from the hospital are cared for by nurses in the prison infirmary. Other nursing duties include coordinating outside services for inmates and overseeing care management for HIV-positive patients.

When it’s time for an inmate to leave prison, Weiskopf says nurses coordinate with the correctional department to facilitate the patient’s discharge and arrange for continued care and medications on the outside. Nurses also run hospice units within some correctional facilities, and they can play a role in decisions on early release for ailing inmates. “Sometimes there’s a great deal of effort put into compassionate releases,” she adds.

Voermans, who has spent 25 years working in correctional facilities, deals with programs and policies and provides chronic disease management care to male inmates in minimum security settings. The population, often disproportionately minorities, faces chronic conditions such as obesity, diabetes, and liver disease. Lab work is done on-site, and medications are provided by the state pharmacy. With several inmates sometimes crowded into the same cell, infection control is key, Voermans says. “If you get a transmissible disease like H1N1, you’ve got a crisis on your hands.”

Ferszt says some correctional nurses also try to help patients with mental health issues. “They also do a lot of psychosocial support,” she says. Many of the women prisoners Ferszt works with in Rhode Island put in requests to get medical treatment for reasons other than physical concerns, such as anxiety related to the death of a family member.

Correctional vs. health care nursing

Nurses accustomed to working in hospitals or doctors’ offices might fi nd a correctional setting takes some acclimation. Correctional nurses work closely with security officers, Muse says, in an environment much more regimented than the outside. Sometimes, nurses are prohibited from even bringing a cell phone into the prison clinic. “One of the primary differences is the work environment,” she adds. “It’s not necessarily a warm, bright environment. It tends to be dark.

” Even the equipment available to correctional nurses might be different than in a hospital, Voermans says. While nurses in health care settings can often access state-of-the-art tools and the skills and input of other providers, that’s not always the case in a correctional facility. And, in some ways, the extent of care provided might be different in a prison. “The care you give here is medically necessary care,” she adds. “It’s not elective care.”

Weiskopf says interactions between correctional nurses and patients can take on a new quality within prison walls. While a hospital nurse wouldn’t hesitate to tell a patient with a broken leg about her own similar experience, discussing such details is inappropriate in a correctional facility. “You really do not divulge anything personal to prisoners at all,” she says. And while a hospital nurse might hug a patient with dementia, Weiskopf says, a correctional nurse wouldn’t hug an inmate. “You really need to just focus on the care.”

Correctional nurses need to maintain boundaries because of the potential for an inmate to take advantage of a health care provider, Muse says. “You have to be aware that someone might say, ‘I’m really concerned about my mom. I haven’t heard from my mom in a while,'” she says. While a hospital nurse might help the patient reach out to a relative, correctional nurses would be ill advised to accept a request that could lead to more demands from the inmate. Even when it comes to discussing an inmate’s upcoming surgery, correctional nurses should only give family members vague details, since the inmate could be planning an escape attempt. “You have to clearly present yourself as a professional nurse,” she says.

The differences between correctional nursing and nursing in health care settings can lead to challenges. When nurses can’t hug or touch patients, it might be difficult to show empathy, says Arleen Lewis, a nurse consultant for infection control at the University of Connecticut Health Center Correctional Managed Health Care. Instead, correctional nurses can verbally empathize with patients grieving the loss of a loved one or reeling from a disease diagnosis. “We’ll bring that patient to an area where we can maintain confidentiality,” Lewis says, “and we’ll allow that inmate to verbalize his or her feelings.” Patients are encouraged to discuss their fears while nurses express their support and, if needed, bring in mental health clinicians.

Even routine patient interaction can prove challenging in a correctional setting, Ferszt says. When prison nurses perform tuberculosis or fl u clinics, inmates are lined up for vaccinations. But if a patient wants to speak to the provider, there’s not always time for counseling. While the nurse can request for the inmate to be brought back to the clinic for a later discussion, everything moves more slowly due to facility rules and inmates’ tight schedules. “You just can’t be as spontaneous in your teaching,” Ferszt says, “and in communicating with a woman or man when you’re providing health care.”

Patient privacy and safety

Patient privacy is another potential hurdle for correctional nurses. In private practice, Ferszt says, a quiet, calm setting is the most amenable to counseling a patient. But in a correctional facility, it can be tough to find a private room. Even then, other staff members sometimes walk in and out during a session. “You don’t have the same total privacy you would in another setting,” Ferszt says. The same goes for physical assessments, Voermans adds, which sometimes take place in noisy cells as patients wears chains or shackles.

Because correctional nurses work in a security setting, rather than a health care environment, they follow a different set of rules. “You’re basically in the house of the department of corrections,” Weiskopf says. “That means we need to obey their rules around safety.” For instance, while nurses in health care settings might leave needles on the counter in a patient room, she says, correctional nurses are “constantly counting sharps.”

Muse, who hasn’t experienced any safety issues on the job, says it’s important to be mindful of what nurses leave unattended in exam rooms. Even a seemingly innocuous roll of tape, she says, could be used as a weapon. “It doesn’t mean that weapon is to be used on you. For many people, it’s so they have something to protect themselves should they get in trouble.”

As for Muse, she didn’t consider the potential safety hazards of correctional nursing before she started the job. Walking through the correctional facility during her fi rst week, a supervisor mentioned gang activity there, surprising Muse that such affiliations existed behind bars. The supervisor also noted that nurses should greet passing inmates. “They remember the people who were kind and respectful of them,” Muse says. “If you treat people with respect, generally you get that back.”

Diversity in correctional facilities

Despite the challenges of correctional nursing, the compliance rate, at least anecdotally, is sometimes better among the prison population, says Michael Ajayi, a prison administrator and regional nurse manager, and clinical faculty member at the University of Medicine and Dentistry of New Jersey. “I’m sure many of them know they get good care,” he says. “They respond better to therapy than patients who are on the outside.”

It’s estimated that African American and Hispanic prisoners account for more than 60% of the inmates in jails and prisons, according to the Bureau of Justice Statistics. Although the prison population is quite diverse, that isn’t always the case with the staff of correctional nurses. “You see more minority inmates,” Ajayi says, “but almost all the nurses working with them are Caucasian.”

Correctional nurses should be conscious of this diversity and treat all inmates with respect. “With people from so many different places immigrating to our country,” Ferszt says, “we really need to work on becoming culturally aware.” Patients with certain cultural backgrounds might resist taking medication due to their beliefs, while others turn to herbs for healing. Just as in a traditional health care facility, nurses working in corrections should make an effort to understand those beliefs and find ways to work with patients. “It requires a nurse to be proactive and comfortable seeking out individuals from different backgrounds.”

Health risks and challenges

Because correctional nurses work with a disproportionate number of incarcerated minorities, Voermans says health issues particular to the groups might be more likely inside prisons than on the outside. The correctional population sometimes faces higher rates of HIV/AIDS, hepatitis C, MRSA, and even infectious diseases. Working with minorities means correctional nurses can serve as advocates, shining a light on health issues that afflict certain populations more frequently. One example she mentions is sickle cell disease in black patients. Muse also encourages correctional health care providers to consider the unique needs of female prisoners who are sometimes forgotten in the male-focused field. “For a patient to see a minority nurse they can connect to that might advocate for their health is helpful,” she says.

Since language is sometimes a barrier, Weiskopf says health education materials are often available in English and Spanish. Many correctional nurses have access to a language translation line and chaplains of various religions. Her unit has mandatory diversity training for staff. “We try to be culturally sensitive,” she adds.

Not everyone is cut out for correctional nursing. “It’s important to be someone who wants to serve that population,” Ferszt says. “Nurses need to, like anyone, examine their own potential biases toward that population.” Voermans adds that patients can experience bad medical outcomes when their complaints aren’t taken seriously by medical personnel. And as for the nurses, “If they don’t like the disadvantaged and the poorest, they shouldn’t be there,” Ferszt says.

Correctional nurses should be generalists, Muse says, but also ready to cross over into specialty areas. “In correctional nursing, you never know how your patient is going to present.” Correctional nurses should be poised to leap from oncology to mental health at a moment’s notice, Muse adds. Critical-thinking skills and a strong background in nursing assessment are also key. Ferszt says there are other important traits for correctional nurses, including flexibility and the ability to maintain good working relationships with correctional officers and administrators. “The system can be very frustrating because of its structure. You need someone who can be really flexible.”

It’s sometimes tough to recruit new nurses to corrections. But despite the challenge, Muse says, it’s just as important to recruit the right type of nurse, especially to correctional leadership positions. “There is a need to have minorities in more leadership roles,” she adds. Opportunities within the correctional nursing field include positions for advanced practice providers, nurse practitioners, managers, quality assurance personnel, juvenile nurses, and more. For nurses who feel ready for the challenge of practicing in a correctional facility, Ferszt says there’s an unending opportunity to do good for patients. “By realizing the issues they deal with, we can become better advocates for them in the community and change health care,” she says. “There’s an opportunity to make a real, significant impact.”

Correctional Facility Nurses: Spirits in the Dark

They may have been convicted of burglary, drug trafficking, kidnapping or even murder. But to nurses who work in the specialty of correctional nursing, prison inmates are simply patients who need compassionate, expert care. “The correctional environment is really just a microcosm of society in a controlled setting,” says CAPT. Beverly Dandridge, RN, MSN, a nurse recruiter for the Federal Bureau of Prisons (BOP), Health Services Division, based in Washington, D.C.

There are emergencies, chronic diseases and even mental health issues that occur within the prison environment–just like those found in the traditional hospital setting–and they all require medical attention. The difference is that these patients are cared for behind well-guarded prison walls. But it’s this combination of unusual work surroundings and a unique patient population that makes correctional nursing an interesting and rewarding career, especially for nurses who specialize in mental health care.

It’s also a career that’s in high demand. During the past 30 years, the prison population has grown exponentially. At federal prisons alone, the inmate population has increased from approximately 20,000 in 1970 to more than 170,000 in 2003, according to the BOP. When state prison statistics are factored in, that figure jumps to more than 1 million inmates nationwide. This rapid expansion not only represents a rise in convictions but also an increased need for health care professionals who are willing to take their expertise behind bars. Despite Hollywood-driven stereotypes of jailhouse nurses mundanely handing out medications with little else to do, correctional clinicians carry out many of the same job responsibilities as their counterparts in more conventional health care settings.

“My professors tried to discourage me from working in a prison by telling me that all I’d be doing is giving out meds,” recalls Myra Zapata, RN, BSN, who works at the Northern State Prison in Newark, N.J. “But that scenario is absolutely false, especially in the mental health specialty. This job involves the whole spectrum of nursing. We’re providing mental and physical health care to a population that normally wouldn’t have received the same services on their own or on the outside.”

“We deal with disease prevention, treat acute conditions and monitor behavioral changes,” adds Dandridge. “Nurses are also responsible for the educational, medication administration and other administrative tasks for each patient.”

A Statistically Documented Need

In 2000, then-U.S. Surgeon General Dr. David Satcher released a landmark report card on the mental health status of Americans. It stated that there was a far higher rate of incidence of mental illness than most health care professionals and laymen previously acknowledged. Specifically, “Mental Health: A Report of the Surgeon General” revealed that one in five Americans suffered from some form of mental illness, but that the majority of cases were treatable.

That same year, the American Correctional Association (ACA), an organization representing corrections professionals, released its study of the mental health status of prisoners. The findings mirrored those of the Surgeon General’s report: More than 17,000 state inmates were under 24-hour mental health care and another 137,492 were in therapy or counseling. Additionally, 105,403 prisoners were prescribed psychotropic medications, including antidepressants, stimulants, sedatives and tranquilizers.

In still another study, the Department of Justice (DOJ) examined the mental health differences between male and female inmates. Its research exposed the fact that a higher percentage of women prisoners (one in four) were in therapy or counseling and were prescribed medications more often than their male counterparts.

Over the years, departments of corrections have publicly acknowledged the need for standardized mental health care. As a result, the amount of psychological and psychiatric services available to inmates has multiplied right along with the explosion of the prison population. “There has definitely been an increase in the presence, recognition and diagnosis of mental illness in the correctional setting,” Dandridge agrees.

Indeed, according to the DOJ, there are currently 12 state facilities specifically designated for mental health or psychiatric confinement, and more than half of all state prisons provide 24-hour mental health care. Furthermore, three-fourths of all state prisons offer counseling and distribute medications, and another two-thirds help connect released inmates with community-based mental health services. This abundance of resources also means a plethora of opportunities for nurses specializing in the psychiatric field. Says Dandridge, “There’s more of a need for mental health nurses in the [correctional] system now than ever before.”

Making Cultural Connections

As with many other nursing specialties, there is also a greater need for more minority nurses in correctional nursing than ever before. It’s no secret that persons of color are disproportionately overrepresented in the nation’s prisons. The most recent U.S. Census revealed that 12% of the country’s population is African American and 13% is Hispanic. But according to the BOP, 40% of federal inmates are African American and 32% are Hispanic. Therefore, a racially and culturally diverse health care workforce is a necessity when it comes to establishing a cooperative relationship between providers and inmates.

“Nurses of color bring not only competency as clinicians but also a broader understanding of the cultural and social challenges that sometimes impact these patients–such as lack of family structure, unemployment and lack of educational opportunities,” says Mary Muse, RN, MS, CCHP, director of nursing services at Cermak Health Services in Chicago, an affiliate of the Cook County Bureau of Health Services and the largest single-site correctional health facility in the country. “[We] also tend to be more sensitive to the impact that constant exposure to violence and drugs has on a patient’s life, and to how the stress of incarceration and the environment impact mental health.”

This shared cultural understanding helps minority correctional nurses engage with patients of color and establish a sense of comfort and trust that will aid in the patients’ healing, adds Muse, who is African American. “For some people of color, there remains a stigma associated with mental illness,” she points out. “[With a minority nurse], patients may be less silent about conflicts they are experiencing and more open to sharing their struggles as well as accepting behavioral limitations and participating in the development of appropriate treatment plans. This enhanced communication ultimately results in an ongoing therapeutic relationship that will hopefully transfer into continued health care follow-up once an incarcerated patient is released.”

Having a culturally diverse nursing staff in the correctional setting has other benefits as well. For example, gang culture permeates prison walls and affects which clinicians patients will and will not respond to. Zapata says inmates seem to accept her easily because she’s Filipino.

“They think I’m Spanish, Hawaiian or Chinese,” she explains. “Because some of the gang members don’t want to talk to white or black nurses, they see me as a neutral nurse.”

Both the BOP and private correctional staffing recruiters are actively seeking out a diversified health care workforce, including racial, ethnic and gender minority nurses. In fact, it could be argued that the correctional environment seems to be well suited for male nurses. “We do focus on recruiting a diverse staff, but we don’t target male nurses specifically. However, there is a significant presence of them here, which is a good thing for us,” says Dandridge, who is African American.

Not Your Typical Nursing Career

Comparatively speaking, clinicians who have considered correctional health care as a viable career path are still a fairly small group. After all, working with people who have been convicted of a crime may not be as high-profile as working in a prestigious teaching facility or traveling the country accepting nursing assignments. But for a growing number of nurses, it’s a path that tests their clinical and managerial skills.

“I’m not surprised that people don’t know much about correctional nursing,” says Dandridge, “but the learning curve is getting smaller and with that there is definitely more interest in the specialty.”

“The type of patient population we treat makes the work interesting, but it is a totally different approach to patient care because these are inmates and you have to keep that in mind,” adds Rosario Buscar, RN, BSN, mental health supervisor of nursing at Northern State Prison.

Generally speaking, the first contact nurses have with patients is when inmates first arrive at the facility. The majority of state and federal prisons mandate that all incoming prisoners undergo a psychiatric and physical evaluation, often with nurses leading the procedures. “I check to see if they have any suicide risks, along with any history of hospitalization or mental health problems,” explains Zapata.

It’s from these assessments that the staff determines whether the new resident is suited for general housing or requires additional psychological monitoring and treatment. Not surprisingly, the latter is frequently recommended.

Although health services departments vary from prison to prison, they typically have a tiered structure, based on the extent of care required. After the incoming evaluation, the first encounter practitioners have with inmates is often in an acute-care unit. Here, guards might bring in someone demonstrating a threat to himself or others. “It’s a crisis unit, so we do get inmates who are combative and violent,” notes Zapata.

The health care team’s initial responsibility is to calm down the inmates and develop a treatment plan. Usually, the care is double-pronged, necessitating both psychological and physical attention. In fact, sometimes it’s a physical condition that brings an inmate to the unit, but the clinicians discover an underlying psychological issue that needs addressing. Whatever the reason initiating the patients’ arrival, nurses need to be skilled in both psychological and physical assessments when working in the correctional setting.

After their initial health conditions are stabilized, patients begin therapy or counseling. For many inmates, this may be the first time a name or diagnosis has been attached to their problems. For others, it’s a revamping of previous treatments. While medication usually plays a role in the program, there’s also an in-depth educational process, often led by nurses.

“The education is delivered according to the inmate’s level of understanding,” says Dandridge. “For higher-functioning patients, nurses will discuss topics like current events to get them involved. Lower- functioning patients are taught about body grooming and how to take care of themselves. During this time, the nurses are also doing behavioral observation and documenting their behavior assessments, which then get reviewed by the medical staff.”

As the patients progress, they’re usually transitioned to a residential unit before being released back into the general prison population. There, nurses continue to work as part of an interdisciplinary team that determines the focus of a prisoner’s care. “We have psychologists, social workers and occupational therapists working with the patients,” notes Buscar.

“They plan and develop programming for the patients to keep them busy and to help them develop social skills,” adds Dandridge.

Additionally, nurses facilitate group therapy sessions along with continuing the health education process. “We teach about hygiene, medication side effects and self-medication administration, because sometimes the patients are released from prison and they need to learn how to do their meds by themselves,” says Buscar.

In fact, of the average 600,000 inmates released each year from both federal and state prisons, approximately 14% have been diagnosed with a mental illness, according to the Justice Department and the ACA. Still, it’s the challenge of pushing the boundaries of their clinical, communication and psychological nursing skills that makes the job intriguing, say correctional clinicians. As Dandridge puts it, “The blending of the corrections, medical and mental health care settings is what makes this work so interesting.”

Safety First

Of course, the correctional environment does pose some risks, especially when dealing with patients suffering from mental illnesses and possible psychotic episodes. Obviously, security is a top priority and facilities provide numerous precautions, most notably an armed officer overseeing interactions between health care staff and inmates. “Safety is always a concern in the prison setting, and on the mental health unit that is heightened even more,” Dandridge stresses.

For some correctional nurses, this added security is one of the benefits of the environment. After all, even in conventional hospital emergency departments or psychiatric units, there can be an element of risk. For example, a patient under the influence of narcotics or alcohol can turn violent, as can someone suffering from hallucinations. At least in a correctional facility, there’s a trained, armed guard present at all times to intervene in case an incident occurs.

“They’re there to protect me and make sure everything’s okay,” says Buscar. “I like the fact that someone’s watching.”

Additionally, newly hired correctional nurses are usually required to attend an in-depth training session specifically designed to educate them about what to do in case a potentially dangerous situation develops. “Nurses need to be astute to changes in patients’ behaviors,” adds Dandridge.

But however beneficial constant security can be to a nurse’s comfort, it also has its drawbacks. Because prison officers witness every interaction with patients, open communication between inmate and nurse may be limited, which in turn can limit the extent of help inmates receive.

“You have to know where you are at all times and the fact that there are a lot of ears. The officers hear everything the inmates say to us and that’s a problem because they won’t be as truthful with us,” explains Zapata.

“Confidentiality is very important,” Buscar agrees. “I limit myself as to what to ask [patients] because I don’t want to disclose to the officers anything more than what’s necessary. Inmates think everyone’s against them, that society is against them, but they do seem to trust nurses for some reason.”

Room at the Top

When it comes to hiring correctional mental health nurses, diversity isn’t the only thing that recruiters are looking for. First, most prisons require nurses to be U.S. citizens, but even more importantly, officials want practitioners with previous experience in mental health care, preferably in a correctional setting. Still, given today’s nursing shortage, it’s not a deal-breaker. For instance, neither Zapata nor Buscar had worked in a prison before signing up with Correctional Medical Services, a private staffing organization that contracts with correctional institutions. Zapata, however, had been practicing in a long-term care facility on a mental health unit.

Once they have gotten their foot in the door, nurses have plenty of opportunities to advance their careers. Against all stereotypes, correctional nursing is not a dead-end job. Buscar, who is Filipino, is a good example: She started off as a staff nurse on night shifts in 1999 and within four years she’s been promoted to both a supervisor and recruiter. “Working in a prison has always intrigued me and it gives me so many different types of challenges and opportunities,” she says.

At the BOP, nurses can pursue careers as public health officers, which offers its own set of promotion opportunities and benefits. But for many correctional nurses, the true job satisfaction comes from the impact they have on their patients. “You get to observe their behavior when they first come in and then you get to watch their responses to medication and therapy,” says Dandridge. “That is very rewarding.”

Buscar has similar feelings. “I had one inmate tell me, ‘If it wasn’t for you, I wouldn’t have left that unit,’” she reports. “I saw that I really did help someone and that makes me want to go and do more for these people.”

While working in a prison may not be the career that most nursing students envision, Muse recommends her chosen specialty to other minority nurses without hesitation. “Correctional health care offers a unique opportunity for service,” she explains. “This population is hidden from society, and society has formed certain attitudes about them. Caring for this population allows nurses to demonstrate an increased level of compassion and advocacy. Correctional nurses must move out of their personal experiences and prejudices to serve without judgment of a person’s life choices.”

This career is also a unique opportunity to provide health education and care to persons who otherwise would not receive it, Muse continues. “If you make an incarcerated person healthier, you impact their community by making it healthier,” she says. “If a nurse is truly passionate about nursing, this is a place to live out that passion.”

For More Information

Federal Bureau of Prisons

American Correctional Health Services Association

National Commission on Correctional Health Care

National Institute of Corrections
(see section on “Mentally Ill Persons in Corrections Settings” under “Correctional Research Topics”), Health Care Section

Correctional Health Resources

Correctional Medical Services