“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

Part Three of a Three-Part Series

Sherry Cameron, a medical recruiter for correctional facilities across the US, recently wrote a post for DailyNurse as the first part in this Three-part series. (For part Two, see What to Expect as a Correctional Care Nurse). Now, she’s starring in the latest DailyNurse podcast, “What is it like to be a Correctional Nurse?”

Sherry Cameron, correctional facility recruiter for CoreCivic

Nurses in correctional facilities work so closely with other members of the healthcare team that Sherry describes it as a “family-oriented environment.” Often looking after inmates who have never received regular medical care, these nurses perform the usual nursing tasks such as administering medications, blood sugar checks, and tending to injuries incurred in the kitchen or carpentry shop.

Also, correctional facilities offer the opportunity to experience one of the most gratifying aspects of nursing. Corrections nurses act as educators for people who have rarely had any sort of relationship with a healthcare provider. Sherry recalls, “one nurse said to me that ‘it’s a very special moment when you see a patient come to tears because someone took the time to finally talk with them and educate them about their health.’ That to me is a true nurse at heart”.

In this episode of the DailyNurse podcast, you will hear Sherry discuss the character traits that she looks for in potential correctional nurses, the concerns they have when they first consider a career as healthcare providers in a correctional facility, advice for those interested in correctional nursing, and much more.

Certification is not required to be a nurse in correctional facilities, but getting certified always helps! Visit the National Commission on Correctional Healthcare to learn more about the field, and for details on how to become a Certified Correctional Health Professional [CCHP-RN].

Click the arrow button to hear the latest DailyNurse podcast!
What to Expect as a Correctional Care Nurse

What to Expect as a Correctional Care Nurse

Part Two of a Three-Part Series

With more than 2.1 million adults incarcerated in America’s prisons and jails, (PDF, 543 KB), there is a great need for correctional care providers to support this underserved population. Many people taken into custody are experiencing serious and preexisting health issues, while others will need medical attention to address illness and injury that occurs during incarceration.

The demand for health care professionals, especially nurses, is high and expected to grow. According to the Bureau of Labor Statistics, employment of registered nurses is expected to increase 15 percent between 2016 and 2026, while employment of nurse practitioners is set to increase 36 percent. Correctional care is no exception to this trend.

Health care is a field that requires compassion — but this is especially true for those working in correctional care. It requires the ability to see beyond someone’s criminal record and provide the best possible support for every patient, many of whom did not have access to health care prior to being brought into custody.

Understanding the Correctional System Population

Working in a correctional setting means working with a vulnerable and underserved population. A 2016 report from the Bureau of Justice Statistics on the health issues in American prisons and jails (PDF, 910 KB) found that incarcerated individuals were more likely than the general population to experience chronic conditions and infectious disease. Of those surveyed, 40 percent reported having a current chronic medical condition, while 21 percent of individuals in prison and 14 percent of individuals in jail reported a history of tuberculosis, hepatitis B or C, or other STDs (excluding HIV or AIDS). 

The prominence of health issues in correctional facilities is compounded by the fact that many incarcerated people do not have consistent access to treatment, meaning they arrive with undiagnosed conditions.

“We see our patients at their worst,” said Richard Hammel, the nursing program manager for the Denver Sheriff Department.

When an individual arrives for the intake process, Hammel and his colleagues are tasked with performing an initial medical exam. He said that many of his patients find out for the first time that they have an existing condition like hypertension or that they have contracted an infectious disease. Others may show signs of substance abuse, in which case they are taken through a detox process. Many incarcerated patients also show symptoms of mental illness, (PDF, 454 KB) which necessitates further care from clinicians.

What Is the Role of a Correctional Nurse?

Nurses are critical in the continuum of care for people who are incarcerated. While procedures can vary from facility to facility, nurses are typically the first point of contact. Correctional nurses perform intake exams, distribute daily medications and assess when a patient may need to see a specialist for further observation.

Given the responsibilities of a correctional nurse, paired with the range of health issues they encounter, it’s important to have a broad skill set that includes dealing with chronic medical conditions, substance abuse, mental health, infectious disease and injuries. Having experience in an emergency room setting, for example, may help a nurse more easily transition to working in a correctional setting.

Correctional nurses are also expected to work autonomously in most cases, which can be a desirable aspect of the job to many in the nursing profession.

As for specialized training, there is no universal standard for experience or certifications for nurses in order to be hired to work in a correctional facility. Most facilities instead institute on-the-job training to prepare their health care staff  according to the International Association of Forensic Nurses.

Correctional nurses do have the option of earning certifications from the National Commission on Correctional Health Care  or the American Correctional Association  to hone their specialized skills.

Health Care in Correctional Facilities

It takes a team to care for an incarcerated population. Below are some examples of the points care providers offer to meet the physical and psychological needs of those in correctional facilities.

Intake Exams

When individuals are incarcerated, they undergo an initial physical assessment to determine what needs they will have during their time in custody, including chronic health issues, mental health and substance abuse.

Who provides this service: nursing staff, including registered nurses, nurse practitioners

Medication Administration

Patients with chronic conditions may need daily medications, which are distributed by a provider to ensure adherence.

Who provides this service: licensed nursing practitioners, registered nurses

Chronic Care

Some chronic conditions, such as asthma or hypertension, require additional treatments and monitoring.

Who provides this service: registered nurses and specialists, including nurse practitioners

Inpatient Care

Incarcerated individuals who have sustained an acute injury or serious illness may need specialized treatment from an inpatient facility, such as a hospital.

Who provides this service: radiologists, respiratory therapists, phlebotomists, pharmacists, physical and occupational therapists, registered nurses and nurse practitioners and specialists such as surgeons, gynecologists and oncologists

Mental Health

Patients may have existing conditions such as schizophrenia or bipolar disorder or may need aid if they experience trauma within a correctional facility.

Who provides this service: behavioral health care specialists, counselors, nurse case managers, social workers, psychiatrists

How Does Working in Correctional Care Differ from Traditional Settings?

While the mission of a correctional nurse is the same as any nurse—to provide the best possible care for every patient—working in a correctional facility has some distinct differences from traditional health care settings. 

Correctional facility protocols are, in a word, strict. Because the presence of a deputy or corrections officer is required during exams, for instance, it can be difficult to maintain patient-provider confidentiality. Also, when an individual knows someone else is listening, they may feel uncomfortable or even be unwilling to speak openly about their health problems.

While the safety and security measures of a correctional facility may be unfamiliar to those who have only worked in traditional health care environments, correctional nurses can still provide compassionate care for their patients. For example, Hammel said that he and his staff are trained to assess whether it is safe to ask the officer on watch to step out briefly during an exam. This helps build trust with a patient, and makes him/her less likely to withhold any relevant information that may impede their care plan. 

The need to be vigilant and protective of one’s personal information is another aspect of the job that may feel foreign to health care providers outside of the correctional environment. Providers are advised not to share any details about their life outside of work with patients who are incarcerated, which can create some barriers for building trust and showing empathy. 

“Sometimes nurses like to use themselves as a tool in treatment and share stories [to empathize]. That is just something you can’t do here,” Hammel said. 

Instead, Hammel implements the following strategies when building rapport with his patients:

  • Ask questions to gauge a patient’s fears, concerns and general thoughts about their health issues.
  • Take time to appreciate a patient’s perspective.
  • Follow through with what you say you can do for a patient.

There is also a common perception that treating individuals in a correctional setting is less safe than working in a traditional environment. Hammel, though, says that in his experience, this perception is largely a myth.

“I have never felt afraid or been attacked [in the workplace],” he said, because “there are deputies close by to step in and make sure everyone is safe, both the patient and the health care worker.”  Other correctional nurses have voiced similar sentiments, saying that working in a correctional facility often feels safer than in a hospital. There is not current data to compare the experiences of correctional nurses to those in traditional settings, but safety and security are top priorities for correctional facilities. The presence of correctional officers, the access to call buttons in every room, and training to identify the early signs of escalating and agitated behavior are all factors in preventing incidents between patients and providers.

Correctional Health Care and Employee Burnout

While compassion fatigue is a common term known among health care providers, clinicians and other correctional care providers may experience a more specific feeling known as corrections fatigue.

Corrections fatigue is “the cumulative negative change over time of corrections professionals’ personality, health and functioning” that results from poor coping strategies or a lack of resources necessary for the requirements specific to working in correctional care, said Caterina Spinaris, executive director of Desert Waters Correctional Outreach in Florence, Colorado.

When someone experiences a series of stressors during their day-to-day life, as a result, “these stressors interact,” Spinaris said. “They are cumulative.”

How to Avoid Correctional Burnout

Build your support system
This can include your partner, family members, fellow colleagues and friends.

Practice mindfulness
Find activities that help ease your stress and process your feelings. This can include journaling, meditation, exercise and other calming activities.

Find activities that don’t intersect with work
Finding a balance and separating your personal life from your work life can help avoid burnout. Hiking and outdoor activities, for example, put you in an environment that is completely different from your job.

Get help
If serious symptoms such as depression, panic attacks or substance abuse begin to manifest, consider seeking help from a mental health professional.

For more details, visit https://nursing.usc.edu/blog/correctional-nurse-career/

Be sure to tune in for Andrew Bennie’s podcast with Sherry Cameron on the world of correctional healthcare–available on Spotify November 5!

From [email protected], the online FNP program from the University of Southern California

Breaking IN to Correctional Healthcare

Breaking IN to Correctional Healthcare

Part One of a Three-Part Series

A career in correctional nursing could challenge your preconceptions.

When asked by others about my career, I typically respond by stating that I am a medical recruiter for correctional and detention facilities. After the initial confusion wears off, I am then faced with numerous questions such as, “What is it like working in a prison and is it safe,” or “I never knew there was a medical department in a prison!” Explaining what I do to those who have never worked in correctional healthcare can be quite challenging.

Prior to starting my corrections career in 2009, I asked some of those same questions. I was hired as a Human Resources Manager for a new prison and was responsible for the recruitment and hiring of more than 400 positions.  The positions involved areas such as security, academic and vocational instructors, faith-based programs, substance abuse and mental health counselors, and multiple other healthcare positions. At that point in my career, I was unaware of the resources available to inmates in support of their rehabilitation, treatment and education.  These were tools that could provide them hope and prepare them to be successful upon release.

In correctional healthcare there are many opportunities to provide a helping hand, but the benefits of that help extend beyond just the recipient. Correctional nurses find this field very gratifying because of the immediate impact they can have on an inmates’ health. Our nurses are able to educate and inspire inmates to make positive changes to their health because for some the treatment received at a facility is the first medical care they have received in some time.  For this reason, inmates are appreciative of the care and have a high respect for the nursing staff.

Correctional nursing is not for everyone, but those that venture into this field discover just how fulfilling it can be and that they could not imagine doing anything else. I recently spoke to some of my nursing colleagues about their experiences.  It was gratifying to hear statements such as, “We work side by side with security to meet our daily medical goals and take care of our patients;” “There’s always a new experience each day and it’s never boring;” and “We’re able to continually learn and enhance our skills and gain new ones that help us in overcoming obstacles.” Hearing this it dawned on me that although the correctional environment is unique, our goal as medical professionals is the same – to provide a high level of patient care to those entrusted to us.

As a medical recruiter in the correctional healthcare industry, I am aware of the challenges we face in finding the right candidate to fill a need. Therefore, I keep the following in mind:

WE start with one person to help make a change, WE treat others as WE want to be treated, WE show kindness and compassion toward others, WE expand on someone’s strengths instead of their weaknesses, WE educate and teach those who crave personal growth and WE celebrate when someone overcomes hardships and finds success.

Correctional healthcare upholds these beliefs by providing a healthy foundation for our inmates and the surrounding community. To correctional medical staff, these characteristics are a way of life “behind the gate.” It’s not about just showing up to get a job done, it’s about fulfilling a purpose and making a difference to those around you!

Tune in for Sherry Cameron’s podcast with Andrew Bennie – available on Spotify starting November 5th!

Major Job Growth for NPs, PAs … in Prisons

Major Job Growth for NPs, PAs … in Prisons

Expect more non-physician professional hires in correctional institutions

When correctional nurse author and educator Lorry Schoenly, PhD, RN, was writing a book about nursing in prison, her publisher asked her who would buy the book. “We were trying to figure out how many correctional nurses there are,” said Schoenly who scoured state boards of nursing for the numbers of those specializing in corrections. But, unlike cardiology or obstetrics, correctional nursing was rarely listed as a specialty and Schoenly was unable to get a reliable count. “It’s an invisible field,” she said.

But even though centralized data on staffing trends in corrections healthcare is elusive, the demand for NPs and PAs is expected to grow. According to UConn Health, which currently staffs Connecticut’s correctional institutions with “half MDs and half midlevels,” increasingly more “midlevels” are being utilized. “Future job growth will most likely continue to rise as incarcerated populations rise and the age of the population rises,” a UConn Health representative told MedPage Today in an email.

Although rising rates of overall incarceration leveled off in 2006 and reversed a bit after 2015, life sentences have increased almost five-fold since 1984.

This increase in life sentences, along with longer sentences and more incarceration late in life, has contributed to a trend, often referred to as the greying of the inmates. “People are growing old in prison,” said Owen Murray, DO, MBA, vice president of offender health services at the University of Texas Medical Branch in Galveston.

UConn Health noted that inmates 50 and older are the fastest growing demographic in federal prisons. With advancing age comes an increase in chronic disease, physical disability and cognitive decline. In Texas, there is pressure to either maintain current staffing or add more providers due to this shifting demographic. Spending per state is associated with, among other factors, the percentage of individuals 55 and older who are incarcerated, according to the Pew Charitable Trusts.

Greater use of NPs and PAs is one way prisons can provide legally required standards of care at lower cost. “The real impetus to use the lowest cost practitioner is not because there is less attention to quality, but to drive down healthcare costs,” said Kamala Mallik-Kane, MPH, a researcher at the Justice Policy Center at the Urban Institute.

Murray has noticed a rising presence of NPs and PAs over the past three decades. “Certainly as it relates to both jail and prison medicine, there has been a significant increase not just within the state of Texas but pretty much every other state that I’m familiar with in terms of the growth opportunities for midlevel providers.”

According to the American Academy of Physician Assistants, the absolute number of PAs working in prisons increased from 1995 to 2015. For NPs, a survey conducted by the American Association of Nurse Practitioners demonstrated that since 1999 the estimated NP population working in corrections has grown from 550, or 0.8%, of total NPs in 1999, to 2,400, or 1.1%, in 2016.

According to UConn Health, staffing depends on the medical acuity of the inmates, the inmate population and the level of onsite infirmary services.

Predicting future workforce demand for NPs and PAs depends on many conditions beyond sentencing, policy, and crime rates, according to National Institute of Corrections, and incarceration rates could change again depending on policy of the Trump administration. Whether that means releasing low-level offenders, potentially increasing the number of immigrant detainees, diverting offenders from the criminal justice system, or rollbacks in sentencing reform is unclear.

As people enter prison with high health needs – from a lack of preventive healthcare, substance abuse, or homelessness — for some, incarceration provides stability. “There’s an expression,” said Mallik-Kane, “three hots and a cot,” meaning regular meals and shelter. “A person with medical needs might now have access to healthcare. On the other hand, there’s criticism of the quality of prisoner health services.”

In an Urban Institute study of a group of people returning to a major city from prison, 80% of men and 90% of women had chronic health conditions requiring treatment or management; 15% of men and more than one-third of women reported a diagnosis of depression or mental illness.

In Texas, as the complexity of care has grown, the demand for PAs and NPs has grown. “The midlevel provider group has really become the backbone of our delivery system augmented with our physician group,” said Murray.

Yet as prisoners’ medical acuity has increased, healthcare spending in corrections has decreased from a peak in 2009. In some states, the downturn stems in part from a reduced prison population. But states with relatively larger shares of older inmates have higher per-inmate spending for these more complex patients continues to pose a fiscal challenge.

According to Maria Schiff of The Pew Charitable Trusts, outsourcing the employment of clinicians has become increasingly appealing for states to overcome the challenges of recruiting healthcare workers to remote prisons. Private entities can offer hiring incentives, student loan repayments, and bonuses where state agencies are prohibited from doing so.

Schiff said there are 50 different programs in the U.S. since each state raises its own tax money and allocates to corrections. “There’s no nurse to patient ratio that is standard among hospitals, and [corrections departments] are no different, but states do track the age, the gender and certainly the average daily census of who they’re incarcerating,” she said. Anecdotally, several states noted that their staffing ratio of NPs or PAs to physicians is about two to 2.5 to one.

Two issues that remain for any provider considering a job in corrections is their personal safety and litigation exposure.

Unlike outpatient settings, providing continuity, rapport and safety in correctional healthcare can sometimes prove impractical. Inmates are moved often and even in secured settings, the risk of violence and danger is ever present. “A big theme is always personal safety,” said Schoenly. “And the expectation is that you’re doing evidence based standard of care because it’s very litigious. We have a saying that if you haven’t been named in a lawsuit, you haven’t been in correctional healthcare very long.”

The Joint Commission’s presence is limited in correctional healthcare. Unless a health care organization is in a state that requires its accreditation or is in part of an agency such as Veteran’s Affairs or the Department of Defense, which also require accreditation, its process is voluntary. The Joint Commission doesn’t require specific staffing levels, but it does require a sufficient number and mix individuals to support safe care. The American Correctional Association (which declined to comment for this article) and National Commission on Correctional Healthcare operate in corrections and can be consulted to review their policies and procedures. Accreditation can sometimes offer a layer of protection against malpractice, but does not ensure immunity.

These risks do come with rewards, said Schoenly, who views correctional healthcare as a mission to serve the most underserved population in healthcare, and one with broad public health implications, since most inmates do return to society. “You realize that this is really a part of our society who is marginalized and who desperately needs healthcare,” said Schoenly. “And the idea that it’s a vulnerable population with great need can draw in individuals who want to possibly help and improve society.”

This story was originally posted on MedPage Today.

Major Job Growth for NPs, PAs … in Prisons

Major Job Growth for NPs, PAs … in Prisons

Expect more non-physician professional hires in correctional institutions

When correctional nurse author and educator Lorry Schoenly, PhD, RN, was writing a book about nursing in prison, her publisher asked her who would buy the book. “We were trying to figure out how many correctional nurses there are,” said Schoenly who scoured state boards of nursing for the numbers of those specializing in corrections. But, unlike cardiology or obstetrics, correctional nursing was rarely listed as a specialty and Schoenly was unable to get a reliable count. “It’s an invisible field,” she said.

But even though centralized data on staffing trends in corrections healthcare is elusive, the demand for NPs and PAs is expected to grow. According to UConn Health, which currently staffs Connecticut’s correctional institutions with “half MDs and half midlevels,” increasingly more “midlevels” are being utilized. “Future job growth will most likely continue to rise as incarcerated populations rise and the age of the population rises,” a UConn Health representative told MedPage Today in an email.

Although rising rates of overall incarceration leveled off in 2006 and reversed a bit after 2015, life sentences have increased almost five-fold since 1984.

This increase in life sentences, along with longer sentences and more incarceration late in life, has contributed to a trend, often referred to as the greying of the inmates. “People are growing old in prison,” said Owen Murray, DO, MBA, vice president of offender health services at the University of Texas Medical Branch in Galveston.

UConn Health noted that inmates 50 and older are the fastest growing demographic in federal prisons. With advancing age comes an increase in chronic disease, physical disability and cognitive decline. In Texas, there is pressure to either maintain current staffing or add more providers due to this shifting demographic. Spending per state is associated with, among other factors, the percentage of individuals 55 and older who are incarcerated, according to the Pew Charitable Trusts.

Greater use of NPs and PAs is one way prisons can provide legally required standards of care at lower cost. “The real impetus to use the lowest cost practitioner is not because there is less attention to quality, but to drive down healthcare costs,” said Kamala Mallik-Kane, MPH, a researcher at the Justice Policy Center at the Urban Institute.

Murray has noticed a rising presence of NPs and PAs over the past three decades. “Certainly as it relates to both jail and prison medicine, there has been a significant increase not just within the state of Texas but pretty much every other state that I’m familiar with in terms of the growth opportunities for midlevel providers.”

According to the American Academy of Physician Assistants, the absolute number of PAs working in prisons increased from 1995 to 2015. For NPs, a survey conducted by the American Association of Nurse Practitioners demonstrated that since 1999 the estimated NP population working in corrections has grown from 550, or 0.8%, of total NPs in 1999, to 2,400, or 1.1%, in 2016. (more…)

Major Job Growth for NPs, PAs … in Prisons

Major Job Growth for NPs, PAs … in Prisons

When correctional nurse author and educator Lorry Schoenly, PhD, RN, was writing a book about nursing in prison, her publisher asked her who would buy the book. “We were trying to figure out how many correctional nurses there are,” said Schoenly who scoured state boards of nursing for the numbers of those specializing in corrections. But, unlike cardiology or obstetrics, correctional nursing was rarely listed as a specialty and Schoenly was unable to get a reliable count. “It’s an invisible field,” she said.

But even though centralized data on staffing trends in corrections healthcare is elusive, the demand for NPs and PAs is expected to grow. According to UConn Health, which currently staffs Connecticut’s correctional institutions with “half MDs and half midlevels,” increasingly more “midlevels” are being utilized. “Future job growth will most likely continue to rise as incarcerated populations rise and the age of the population rises,” a UConn Health representative told MedPage Today in an email.

Although rising rates of overall incarceration leveled off in 2006 and reversed a bit after 2015, life sentences have increased almost five-fold since 1984.

This increase in life sentences, along with longer sentences and more incarceration late in life, has contributed to a trend, often referred to as the greying of the inmates. “People are growing old in prison,” said Owen Murray, DO, MBA, vice president of offender health services at the University of Texas Medical Branch in Galveston.

UConn Health noted that inmates 50 and older are the fastest growing demographic in federal prisons. With advancing age comes an increase in chronic disease, physical disability and cognitive decline. In Texas, there is pressure to either maintain current staffing or add more providers due to this shifting demographic. Spending per state is associated with, among other factors, the percentage of individuals 55 and older who are incarcerated, according to the Pew Charitable Trusts.

Greater use of NPs and PAs is one way prisons can provide legally required standards of care at lower cost. “The real impetus to use the lowest cost practitioner is not because there is less attention to quality, but to drive down healthcare costs,” said Kamala Mallik-Kane, MPH, a researcher at the Justice Policy Center at the Urban Institute.

Murray has noticed a rising presence of NPs and PAs over the past three decades. “Certainly as it relates to both jail and prison medicine, there has been a significant increase not just within the state of Texas but pretty much every other state that I’m familiar with in terms of the growth opportunities for midlevel providers.”

According to the American Academy of Physician Assistants, the absolute number of PAs working in prisons increased from 1995 to 2015. For NPs, a survey conducted by the American Association of Nurse Practitioners demonstrated that since 1999 the estimated NP population working in corrections has grown from 550, or 0.8%, of total NPs in 1999, to 2,400, or 1.1%, in 2016.

According to UConn Health, staffing depends on the medical acuity of the inmates, the inmate population and the level of onsite infirmary services.

Predicting future workforce demand for NPs and PAs depends on many conditions beyond sentencing, policy, and crime rates, according to National Institute of Corrections, and incarceration rates could change again depending on policy of the Trump administration. Whether that means releasing low-level offenders, potentially increasing the number of immigrant detaineesdiverting offenders from the criminal justice system, or rollbacks in sentencing reform is unclear.

As people enter prison with high health needs – from a lack of preventive healthcare, substance abuse, or homelessness — for some, incarceration provides stability. “There’s an expression,” said Mallik-Kane, “three hots and a cot,” meaning regular meals and shelter. “A person with medical needs might now have access to healthcare. On the other hand, there’s criticism of the quality of prisoner health services.”

In an Urban Institute study of a group of people returning to a major city from prison, 80% of men and 90% of women had chronic health conditions requiring treatment or management; 15% of men and more than one-third of women reported a diagnosis of depression or mental illness.

In Texas, as the complexity of care has grown, the demand for PAs and NPs has grown. “The midlevel provider group has really become the backbone of our delivery system augmented with our physician group,” said Murray.

Yet as prisoners’ medical acuity has increased, healthcare spending in corrections has decreased from a peak in 2009. In some states, the downturn stems in part from a reduced prison population. But states with relatively larger shares of older inmates have higher per-inmate spending for these more complex patients continues to pose a fiscal challenge.

According to Maria Schiff of The Pew Charitable Trusts, outsourcing the employment of clinicians has become increasingly appealing for states to overcome the challenges of recruiting healthcare workers to remote prisons. Private entities can offer hiring incentives, student loan repayments, and bonuses where state agencies are prohibited from doing so.

Schiff said there are 50 different programs in the U.S. since each state raises its own tax money and allocates to corrections. “There’s no nurse to patient ratio that is standard among hospitals, and [corrections departments] are no different, but states do track the age, the gender and certainly the average daily census of who they’re incarcerating,” she said. Anecdotally, several states noted that their staffing ratio of NPs or PAs to physicians is about two to 2.5 to one.

Two issues that remain for any provider considering a job in corrections is their personal safety and litigation exposure.

Unlike outpatient settings, providing continuity, rapport and safety in correctional healthcare can sometimes prove impractical. Inmates are moved often and even in secured settings, the risk of violence and danger is ever present. “A big theme is always personal safety,” said Schoenly. “And the expectation is that you’re doing evidence based standard of care because it’s very litigious. We have a saying that if you haven’t been named in a lawsuit, you haven’t been in correctional healthcare very long.”

The Joint Commission’s presence is limited in correctional healthcare. Unless a health care organization is in a state that requires its accreditation or is in part of an agency such as Veteran’s Affairs or the Department of Defense, which also require accreditation, its process is voluntary. The Joint Commission doesn’t require specific staffing levels, but it does require a sufficient number and mix individuals to support safe care. The American Correctional Association (which declined to comment for this article) and National Commission on Correctional Healthcare operate in corrections and can be consulted to review their policies and procedures. Accreditation can sometimes offer a layer of protection against malpractice, but does not ensure immunity.

These risks do come with rewards, said Schoenly, who views correctional healthcare as a mission to serve the most underserved population in healthcare, and one with broad public health implications, since most inmates do return to society. “You realize that this is really a part of our society who is marginalized and who desperately needs healthcare,” said Schoenly. “And the idea that it’s a vulnerable population with great need can draw in individuals who want to possibly help and improve society.”

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