Correctional Nurse . Net

Lorry Schoenly, PhD, RN, CCHP

What’s It Like to Be a Correctional Nurse?

Gina over at the CodeBlog recently interviewed me about correctional nursing. She asked some interesting questions about what we do in corrections and how care is organized. Check out the post for the full interview. She is interviewing nurses working in unusual specialties for an ongoing series.

Correctional Nursing does qualify as an unusual specialty. Very few children say something like “I want to be a nurse and take care of prisoners when I grow up”. Yet 1 in 100 Americans is behind bars today, making the need for correctional nurses ever present.

What’s it like being a correctional nurse? We need to get the news out to the world that this challenging specialty is in need of good nurses. I hope you will join me in my efforts to make the world of correctional nursing more visible in 2011.

How would you have answered Gina’s questions about correctional nursing? If you have a response different from my own, include it in a comment to this post.

January 3, 2011 Posted by | Getting Started - Interviewing, Nursing Practice | , , , | 1 Comment

Interview Guide – Part II

Potential Interview Questions

Earlier I posted on what you should look for when interviewing for a correctional nursing job. Here in Part II, I’ll help you prepare for the interview by developing responses to some common interview questions. These questions were suggested by members of the Specialty Forum for Correctional Nurses at the All Nurses web community. I highly recommend that website and forum for more interview help.

How do you feel about providing care for inmates?

This is a good question to ponder before you apply for a position in corrections. The environment is challenging and you want to be sure there is a good match. Many who thrive in the corrections specialty consider their role in caring for the disadvantaged or their impact on public health.

Why do you want to work in a correctional facility?

Develop some positive and constructive answers to this question. Some possibilities might be enjoying a challenge, desiring to work in a close-knit team, enjoying variety in the type of care delivered and making an impact on a needy and disadvantaged population. Choose one or two reasons and develop a 3-4 sentence response.

Describe your background in nursing and how this will compliment the duties for a Correctional Health Nurse.

Working in corrections involves medication administration, patient teaching, ambulatory care visits, emergency response, therapeutic communication and dealing with behavior and psychiatric issues. Think carefully through your past nursing experiences and have a story or two to share about your background that highlights one or more of these areas.

Manipulative behavior is very common among the inmate population. What are some nursing skills that are helpful in dealing with this behavior?

Do some reading about manipulative behavior such as this article on Medscape. Develop ideas for responding to this behavior from inmates – it is pervasive. Generally, combat manipulative behavior by being alert to it and responding in a firm, fair, and consistent manner. Also, treat all inmate-patients with professional respect.

Nursing in a correctional facility requires specialized skills, knowledge and work behaviors. Describe what you think they are.

Skills might include excellent objective assessment, communication, emergency response, and organization skills to shift gears quickly while still getting required work done. Knowledge might include understanding of communicable diseases, the health needs of the inmate population, and safety procedures. Work behaviors would include being reliable, always letting team member know where you are, good follow-through, and being firm, fair and consistent with inmates and staff.

How would you do patient teaching for an inmate on how to manage diabetes?

In answering any question about patient teaching, be sure to mention the need to present the material in easy-to-understand language. In addition, be sure to note that some patients may not be able to read, making written material less helpful.

What would you do if you found an inmate down?

The important concern in corrections is always safety. Therefore, your response would be to summon help and proceed only after custody officers indicate that it is safe to begin care. It seems counter-intuitive to wait, but with the inmate population you need to be sure you are secure before assisting someone. Of course, once safety has been established you would initiate all the standard emergency medical assessments and procedures like airway, breathing, circulation, etc.

General Nursing Questions

Other general nursing questions may be asked such as the 5 rights of medication administration, infection control procedures, assessment and emergency situations. These are some of the main areas of correctional nursing. The same principles used in acute care or other healthcare settings would apply to the correctional setting.

I hope these sample questions will assist you in landing a correctional nurse position that will meet your career goals. As you interview for corrections positions, add new question examples and responses in the comments section of this post. You will be helping those who follow you into the specialty!

December 27, 2009 Posted by | Getting Started - Interviewing | , , , , , , , , , , , , , | 6 Comments

Correctional Nurse Interview Prep Guide – Part I

So you are thinking about correctional nursing and even have an interview set up at a local facility. How should you prepare for your interview and what questions should you ask? Of course, all the standard principles for successful interviewing apply here. Good tools for general interview preparation such as interview tips and career guides are available online.

In the specialty of corrections, however, several other things that you should keep in mind in order to prepare yourself for a productive interview.

Dress

Most correctional facilities require modest dress. Dress conservatively for your first experience inside. This means no visible cleavage, no strappy high-heeled sandals, no sleeveless tops or dresses. It is best to leave cellphones and wallets locked in your car. Bring your drivers license, keys, and any paperwork with you. You will likely go through a security process similar to airport security which may include wanding and possibly a pat down. Pat downs should only be done by a same-sex custody officer.

Facility Tour

Be sure to get a full tour of the facility including every location in which you may be working as a staff nurse. Pay attention to the number and location  of custody staff at each location. There should be an officer available at all times for security purposes. Check your own emotional response to being behind bars. It is not for everyone. Find out during your interview process if this environment will be a difficulty for you.

Correctional Officers (COs)

COs are also referred to as Custody Officers or Security Officers. Try not to refer to them as guards. This is considered a derogatory term. During your security entry take note of the diligence with which the officers perform their duties. You want to know that they follow procedure and are not lax in their position. If their focus is on chatting or other non-work activities they may be distracted from their primary role.

Questions to Ask

During the interview you will be asked for any questions you might have. Take this opportunity to find out the following:

  • Does nurse orientation include orientation to security procedures and dealing with inmates? A good orientation in corrections includes more than policy and procedure. You will want to hear that you would receive information about security procedures, how to remain safe in the facility, safety codes and rules, as well as how to deal with the inmate population.
  • Are nurses given safety alarm mechanisms? What is used in this facility? There should be a mechanism for nurses to sound an alarm if they feel they are in an unsafe situation. Generally, staff will not be out of sight and/or sound of a custody officer at any time. However, even with mirrors for ‘blind spots’ there is a small opportunity for loss of contact. A well-run facility will have a mechanism in place to alert security of an unsafe situation.
  • Is the facility accredited by NCCHC or ACA? Current accreditation with either of these independent bodies indicates that the facility meets nationally recognized quality standards. Their seal of approval is similar to a Joint Commission accreditation for hospitals. An accredited facility is more likely to have well running clinical processes and established practices.

Armed with this information you can make an informed decision about the healthcare at the facility and launching your career in correctional nursing.

Do you have other interview questions or tips for someone entering the correctional nursing field? Enter a comment below.

August 11, 2009 Posted by | Getting Started - Interviewing | , , , , , , , , | 4 Comments

Jails, Prisons – What’s the diff?

If you don’t work in corrections you might not know that there is a big difference between a jail and a prison. The type of healthcare services you provide and the patient community is varied – although there are similar components to each.

A jail is a correctional facility usually operated by the local city or county government and holds an arrestee awaiting trial and sentencing. The patient community include a large percentage withdrawing from a variety of substances and may have acute conditions related to the circumstances of their arrest. Some large urban areas regularly perform ‘sweeps’ of the neighborhoods, clearing the streets of vagrants and homeless. A health assessment is performed on all individuals booked into the jail setting. Assessments are usually performed by a nurse or nurse practitioner.

A prison, on the other hand, is a correctional facility operated by the state or federal government for those who have been tried and sentenced. Prisons have a range of security levels depending on the type of sentence of the inmate, usually based on degree of potential for violence. Leveling ranges from minimum to medium to maximum security (where death row and highly volatile/violent inmates are housed). By the time an inmate reaches the prison setting substance detoxification has taken place and acute conditions stabilized. Prison nursing usually involves management of chronic conditions and ambulatory care.

Which type of nursing would appeal to you?

Nurses who end up enjoying the jail environment like a fast-paced constantly changing situation. These are usually the same nurses who thrive in an urban emergency room as there are similarities in the type of conditions encountered. Jail nursing can involve interesting assessment situations and a good bit of trauma evaluation. Major conditions addressed include substance withdrawal, contagious disease, and suicide prevention.

The prison environment has more opportunity for planning and scheduling as the inmate community will be around longer, generating the ability to develop a therapeutic relationship.  There is greater involvement in medication management, patient education, and diagnostics. Nurses who value a long term relationship and the opportunity to improve health outcomes over time tend to prefer prison nursing as a correctional specialty.

May 26, 2009 Posted by | Getting Started - Interviewing | , , , , , , , | Leave a Comment

Should You Consider Correctional Nursing?

I have encountered many nurses who have never considered working in a jail or prison. In fact, very few nurses decide on a nursing career with the thought “I want to be a jail nurse”.  This patient community is fairly invisible to healthcare professionals. Once encountered, possibly by way of a job posting or meeting someone like me, there are some common questions that come to mind. Lets explore them together to demystify the corrections healthcare environment.

Question #1 – Isn’t it unsafe to work in a jail or prison?

It is true that safety is a major concern in this environment. However, many precautions are taken to allow a safe work environment including the presence of custody officers in the care area. I often liken the patient population to that of an urban emergency room. In some ways a correctional nurse is in a safer situation because the arrestee or offender is clearly identified and everyone is on alert. This is not necessarily the case in an urban ‘free world’ setting. During the orientation period most agencies provide intensive safety training to healthcare professionals. When interviewing for a position in corrections, ask questions about the safety measures in place at the facility

Question #2 Isn’t healthcare in prisons and jails substandard?

Since the ’70′s, correctional healthcare has been held to the standards of the community. Case law and advocacy groups have established a body of work which has led to improvement in medical and mental health care for the incarcerated. When considering a position at a facility, ask about accreditation. Two main accrediting bodies NCCHC (National Commission on Correctional Health Care) and ACA (American Correctional Association) are available. These two operate similar to the Joint Commission (JCAHO) in that they provide an outside source determining that quality standards are being met.

Question #3 Won’t I be working with poor practitioners – nurses and doctors who can’t get a job anywhere else?

 Nurses and physicians come to the correctional environment for many reasons. Many have a true desire to help the underserved   in our society. Some see it as a calling as well as a job. There are many truely dedicated practitioners working in jails and prisons, often in very challenging situations. Licensure, peer review, competency evaluation and credentialling are all standard requirements, just as in the ‘free world’.

Question #4 Won’t I put my family in danger with all the diseases inmates carry?

This is a surprising question to me, but I have heard it enough to know it is a concern. Due to the high level of drug and alcohol abuse among those coming into the jail environment, personal hygiene is often poor. In addition, addictions and lifestyle choices lead to increased levels of Hepatitus B & C, HIV, and tuberculosis in this population. Nurses working in corrections, however, have all of the protections of standard precautions and vaccinations as do those in other settings. Nurses in the corrections environment must be ever alert to disease transmission and must carefully adhere to infection control practices. 

Question #5 Why would I want to make a career of correctional nursing?

Correctional nursing is a specialty practice area with its own distinct body of knowledge and specialized patient population. Many nurses stubble on to this specialty by accident and continue on enjoying the many challenges and benefits. Some jokingly say they work in a ‘Gated Community’. Correctional nursing often provides a less stressful and physically demanding environment than traditional hospital nursing.

Maybe another question has come to mind as you read this blog post. Include your question (or comment) in the comment section and I will answer on a future post.

May 20, 2009 Posted by | Getting Started - Interviewing, Nursing Practice | , , , , , , , | 2 Comments