Written by Nurse Addie
When you think of nursing specialties, what comes to mind? Med/Surg, ICU, Surgical, ED? Correctional nursing probably isn’t one of them. With the increase in number of incarcerations, the need for correctional nursing is exponentially growing but still forgotten within the medical field. So, what do nurses even do in corrections? The better question is, what DON’T we do. Let me back track and start from the beginning. Nurses have been working in corrections since the 1970s. Since day one, correctional nursing involved chronic, acute, and emergent care. To this day, it still encompasses all of that and now release coordination. Let’s go back to what exactly is it we do on a day-to-day basis.
Facilities vary but, typically, they are somewhat similar in how our days are structured.
At the county detention center, if your facility has 24 hour medical staff, you receive report. Sometimes there’s infirmary inmates or inmates placed in medical observation. These inmates require care similar to Med/Surg.
Sharps and narcotics are counted with two nurses. I’m sure you can imagine the importance of keeping these numbers accurate at all times. Put it this way, if a sharp’s count is missing at least one, the facility is placed on lockdown and everyone and their bunks are searched until it’s found. The main reason for this is pretty straight forward: safety.
Booking/ Intake Nurses
Booking/intake are the nurses who make first contact with an inmate being brought into the facility. This post deals with the most urgent/emergent situations due to the instability of the people being brought on. Many are under the influence of drugs, alcohol, or both.
Patients may range from noncompliant diabetics to pregnant patients with no prenatal care. We’ve seen just about everything both imaginable and unimaginable. I’ve seen people swallow bags of drugs, or place the bag in their rectum, and they wind up over dosing because the bag ruptures within their Gl tract. I’ve seen people hide drugs and weapons in matted hair, under wings, in prosthetic limbs… I can write a tell-all book with the creativity we’ve seen over the years.
Booking/intake nurses do initial assessments and if we determine the detainee is too unstable, we can refuse them and tell the arresting officer they need to take them to the hospital for further treatment prior to them being able to remain at the detention facility. The arresting officer can request us to collect evidence with the detainee’s consent, such as blood draws or urine collection. Once the inmate is able to be booked, we do a full medical intake on them, which includes: vital signs, physical assessment, medical history, current treatment/medications, any chronic care problems, substance abuse history/use, and outside providers. Based on what we find or what’s reported, we set up tasks such as verifying medication with pharmacies, requesting records from their providers, vital signs for those in unstable conditions, blood glucose checks for diabetics, ordering special diets, mental health recommendations, etc.
Depending on your shift, you may have 1-2 medical nurses. The medical nurse performs nurse sick calls. If you have two medical nurses, one nurse assists the doctor with his visits and the other is the one performing nurse visits. This is more like an outpatient clinic. Examinations are performed, medications are ordered, referrals are made. Nurse sick call is performed 7 days a week at the detention facility.
Pill Cart Nurses
Pill cart nurses are primarily responsible for medication handling. They pack the medications to be administered to inmates according to their MAR, organize and administer medications, order refills either from the facility’s pharmacy or the inmate’s outside pharmacy, coordinate with family members if the inmate is unable to contact them, and notify the family members of pending refills at the pharmacy.
If anyone is appearing unstable to officers, the medical department is immediately radioed and called to respond.
We handle mostly overdoses, myocardial infarctions, and cardiac arrests. We attempt to stabilize the person until EMS arrives and give report to the hospital. Every shift, we call to get an update to make sure we’re following the inmate’s care and status closely.
These are facilities where inmates are cleared to go out to work Monday through Friday. The nurse is only on site on business days. We still perform nurse sick calls when requested, intake screenings, and medical histories when transfers come in. Because populations are much smaller at these sites, doctor visits are only performed on a weekly basis. We don’t have an infirmary, and we contact the physician to obtain orders and referrals for anything needed outside of our scope of practice.
Urgent/emergent situations are very few and far between because this population has already been stabilized in detention centers. Inmates are allowed to keep their medications on their person, so I don’t need to administer daily medications. I order medication refills, schedule outside provider appointments, and place medical transfer requests if there is anyone who has medical concerns that will interfere with their ability to work.
Why is correctional nursing often overlooked?
We provide care for those who don’t have resources available to them, don’t have supportive environments, and aren’t educated in how to care for themselves or their conditions. We care for those who are fearful of judgment and would rather suffer than seek treatment. We care for those who have been mistreated by medical staff previously and are jaded.
I have seen the difference in thousands of people by being nonjudgmental and genuinely caring. When you think about it, sometimes we ARE the only ones expressing care and concern over them, and they may not know what that feels like. We save numerous lives day in and day out, tell those who have no hope to get up just one more time and keep going, and educate them and provide them with resources to be able to take those first steps in self-care. I wouldn’t change working in this specialty and when I say I love what I do here, I mean every word.
Hi, l’m Addie and l’m a correctional nurse. I’ve been working in corrections since 2019. I have also worked in pain management, internal medicine, podiatry, and endoscopy. Currently, I’m a Health Services Coordinator in a prison and a shift nurse at a county jail. I have two boys and way too many cats and dogs (I love rescuing). I’m a Georgia native and in my scarce free time, I love being outside with my boys and dogs. Hiking calms my soul. Coffee and tattoos are my thing, and I am trying to help change the negative view the medical field has had on visible tattoos.
Edited by Shannon McPeek