Correctional RN: Are You Up For It?

• Correctional nursing can be a tough job, and it is not meant for everyone. 
•  The role of a correctional RN is to provide care for incarcerated people in need of health services. 

•  Do you think you have what it takes to become a correctional RN? Let’s find out! 

Correctional nursing often seems to get a bad reputation – from “subpar” nurses to “too scary” to a nasty environment. Yet, there is a good-sized army of fully committed nurses who wouldn’t want to work anywhere else and simply love their role.

The vast majority of new graduate nurses will never have had the opportunity to experience working in a jail/prison, thus many qualified nurses don’t even think about this specialty as a career.

So, before the imagination takes over and an image of “Silence of the Lambs” creeps in, let’s first look at the bigger picture. What does it take to be a correctional RN?

Who Do Correctional RNs Care for?

This might seem like a strange question to start this with.

But, it is vital to get this perspective first.

As health professionals, our role is to care for patients’ medical and psychiatric needs, not to pay any attention to their legal status.

Do you know the legal status of the patients you care for in hospitals or at home? Probably not.

We are, in essence, looking after a small subset of the community.

By looking at statistical data, the health of the incarcerated population is much poorer than the community at large:

• 40% of all incarcerated patients have a chronic medical condition.
• 64% have mental health disorders
• 65% have substance abuse or an addiction to drugs/alcohol.

Correctional healthcare has often been described as “public health intensive care.”

Deaths in jails and prisons do occur, and the correctional RN’s focus is trying to prevent as many of these as possible.

Jails and prisons differ in the statistics as to cause of death, as jails see suicide and illnesses such as heart disease and cancer followed by intoxication, whereas prisons show higher rates of illness-related deaths.

However, COVID-19 has severely impacted both prison and jail systems.

To illustrate, imagine selecting 300 people or so, bringing them into a stadium (or other close-quartered facility), and you along with a very small team of others overseeing their health needs.

Every medical condition that you have studied to date is a possibility when working as a correctional RN, and you must keep everyone safe from one another. As you can imagine, this can be increasingly difficult during a global pandemic.

Following, there is a high turnover of patients, especially in county jails where people are held for sometimes a matter of hours, and others, for years.

What Does a Correctional RN Do?

Assessing

Every person who gets booked into jail must be assessed by a nurse.

This process is called “intake” or “receiving screening.”

Identification of acute ill-health is the priority – from “are you injured?” to “are you suicidal?” but also, infectious disease – remember we must try to protect patients from each other.

Most jails do PPD tests, STD testing, and now COVID-19 testing during this initial consultation.

The assessment uses a formatting of set questions and tools such as C-SSRS (Columbia – Suicide Severity Rating Scale) and COWS (Clinical Opiate Withdrawal Scale), to name a few.

Having exceptional assessment skills is typically a requirement for a correctional RN position.

This nurse’s role is crucial in correctional facilities as it can literally be the difference between life and death.

In jails, 64% of suicides and 80% of intoxication deaths occur in the first 30 days of incarceration, thus identifying these risk factors in a patient as they arrive is vital

Care Planning

Every person who gets booked into jail must be assessed by a nurse.

This process is called “intake” or “receiving screening.”

Identification of acute ill-health is the priority – from “are you injured?” to “are you suicidal?” but also, infectious disease – remember we must try to protect patients from each other.

Most jails do PPD tests, STD testing, and now COVID-19 testing during this initial consultation.

The assessment uses a formatting of set questions and tools such as C-SSRS (Columbia – Suicide Severity Rating Scale) and COWS (Clinical Opiate Withdrawal Scale), to name a few.

Having exceptional assessment skills is typically a requirement for a correctional RN position.

This nurse’s role is crucial in correctional facilities as it can literally be the difference between life and death.

In jails, 64% of suicides and 80% of intoxication deaths occur in the first 30 days of incarceration, thus identifying these risk factors in a patient as they arrive is vital

From There on Out

Once all of the following processes have been completed, the patient is then housed inside the jail or prison facility.

From here, correctional RNs have many other hats to wear.

Medications need to be passed on time, diabetic patients need to have their blood sugars checked, and insulin administered.

Patients need to be seen by the provider for acute health issues and chronic care management. Nurses respond to any emergency that occurs. Detoxification observations need to be completed, and if there is an infirmary, patients need to be cared for in this unit.

Every aspect of your nursing skills is put to the test whilst working in corrections.

Every specialty that you had to learn for your license will be put before you and you will learn every day.

Is it hard? Can be!

Is it depressing? Absolutely not!

Developing good relationships with the wide medical and mental health team and the security staff can create a fun working environment.

For me, the biggest positive from working in corrections is the professional satisfaction you receive when making a positive impact on your patients’ health and wellbeing.

With that being said, are you up for the challenge?!

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