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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

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