Corrections Nursing

At 1300 hours I felt my belt clip for the steel ring that held my 186 key, chit, and whistle. I checked my coat pockets for anything that might be considered contraband. I discarded the papers that revealed my home address or phone number. I drove cautiously on narrow country roads alert for frightened wildlife that threatened to unnerve my disposition. I smiled impishly to myself when I garnered a parking spot vacated by the day shift officer. Certain the car doors were locked, I began the long walk toward my work site.

The loud buzzer indicated that the Sergeant had unlocked the Main Gate electronically from behind his protective, steel enclosure. I pulled the door open. It closed with a loud, hollow echo behind me. I cleared the metal detector and drug scan. Another loud buzz indicated the Sergeant had opened a second door. I proceeded under the razor wire to the next gate. The tower guard recognized me and with the touch of a button allowed the heavy steel gate to slide open. I stopped at the Control Center and passed my key-chit through a barred window to an officer who exchanged it for a heavy set of institutional keys. I fell in pace with the dozens of convicts seeking access to the gymnasium, commissary, library, school, medication window, or work detail.

I reached my final destination, the Infirmary Area of an 1800 maximum security male prison. There I would receive my assignment from the shift Supervisor. Perhaps I would deliver medication to the inmates in the Restricted Housing Unit; administer insulin to the diabetics who were restricted from handling syringes, administer medication medication at the "pill line" to the inmates who were restricted from the Self-Med Program, tend to the geriatric inmates housed with the Infirmary Area, provide sub acute care to the inmates discharged from the community hospital, or provide routine physical exams in compliance with the state mandates. Whatever the assignment it was certain to be interrupted by a "block call," "P.V. return," "lock-up," "lock-down," "recount," or any number of jail house crises.

The hours would literally fly by. By 2200 house (that's 10:00 Military Time) I would find myself scrambling to compose my harried self in preparation for the change of shift routine.

When asked by my family, friends, and colleagues, "What do you do there?" I would proudly reply, "Everything from file reports to pronounce people dead!"

My job description has changed since I began my correctional career in 1994 as a Registered Nurse. My enthusiasm for the work I perform has been strengthened by my decision to proceed from labor to management. Now I am frequently asked, "Do you like it there?" And I respond with profound integrity, "I wouldn't want to work anywhere else!"

I have been institutionalized! I use phrases such as "Key Up," RHU," "POC," "ODR," and "The Hole" to access restricted housing areas and communicate management issues to administrative staff. Occasionally stand in front of doors to public buildings waiting to be "buzzed". I check doors to be sure they are locked before I open them, and I check them after I lock them to make sure they are locked! When asked, "Are you ever afraid at work?" I respond, "Only of the Superintendent!"

A correctional setting is an inter-dependent working community. Industry and vocational programming provide employment opportunities for inmates. Educational programs promote literacy. Psychological services promote social stability and decrease recidivism.

Inmate idleness is further reduced through participation in recreational activities and volunteer programming. Family relationships are maintained, to varying degrees, via on-site visits, phone calls and letter writing. For confidentiality and security reasons, medical staff use extreme discretion and caution in fielding concerns generated by inmate family members.

Every health care issue represented in the free community is represented in a correctional setting. In addition, modern medical technology, the diagnosis and treatment of new disease, managed care, and cost containment must all be realized within the parameters of strict security. This security component can often times conflict with learned medical models and nursing protocols. The greatest challenge for correctional medical professionals is finding the balance between "treatment and security" that will promote the quality of health care reflected in the Department of Corrections (Health Care) Mission Statement.

Health care for the prison population is guided by policies that are now consistent with community standards. The courts have played a significant role toward improving prison health care that, until recently, was considered primitive and inadequate. The National Commission of Correctional Health Care and American Correctional Association are two organizations that promote quality health care by establishing standards of practice and monitoring adherence. The NCH acknowledges the special skills required of correctional health care professionals by offering special certification for accomplishments and resources for self improvement.

New employees are introduced to [Pennsylvania] Department of Corrections policies and procedures at mandated training that is provided at the Elizabethtown Academy near Harrisburg, PA. Medical staff require three (3) weeks of basic training. In addition, each institution is required to provide 40 hours/year of additional in-service. Annual training in Tool Control, Key Control, Defensive Tactics, and Professional Ethics reinforce quality security practices that prevent complacency in this unique work environment.

Pennsylvania administrates 25 states prisons. Registered Nurses (Diploma, A.D., or B.S.N. prepared) and Licensed Practical Nurses are employed at each institution. The varying nurse backgrounds contribute to a well rounded labor force that promotes quality care in a composite system of primary (emergency response), secondary (sub acute), and tertiary (palliative) nursing care.

The R.N. and L.P.N. labor units are represented by Service Employees International Union (SEIU) 1199 and the American Federation of State, County, and Municipal Employees (AFSCME), respectively. Salaries are comparable to civilian wages and include an attractive state paid benefit package. Persons interested in pursuing a correctional health care career should contact the State Civil Service Commission [in Pennsylvania, call 1-717-772-2685] and request an application.

The Department of Corrections offers a unique challenge for nurses committed to effecting health care. I am confident that staff efforts toward improving the health care for inmates have absolute ramifications for correctional staff, inmate families, and the public at large.

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