When I first began in correctional healthcare, I really did not give any thought to the skills that I might need in that environment that I may not have used for a very long time, like administering a respiratory treatment and even turning on an oxygen tank! Thankfully, the orientation that I went through gave me enough time to shadow and ask lots of questions, and I definitely was not afraid to ask the “dumb” questions.  At that time, I had not worked in the emergency department for 5 years, and suddenly was faced with new innovations in equipment and technology that I had never seen before, let alone was proficient at their use.  Everyone knows how they learn best – for me, it was watching once and then hands-on practice.  I cannot emphasize enough how important it is for you to practice with the equipment before being in a situation where your patient’s life may depend on using the equipment correctly and expeditiously. 

Correctional nurses are very aware that their practice is a wonderful combination of acute care, emergency, community health, psychiatric, women’s health, school, and palliative care nursing. We must know a lot about a lot!!  In addition, we often practice in low-resourced settings where we must be able to fulfil a number of roles that are likely delegated to others in a traditional hospital or primary care setting. For example, many correctional nurses must be able to draw labs, obtain an EKG, and give a respiratory treatment. All of those functions are most often performed by ancillary staff in an acute care/tertiary setting. So, if you are new to corrections, you may need to review some of the skills learned (or not learned!) in nursing school that you have not had to use in past positions. It is vitally important that before you use any skill, you are trained appropriately and are comfortable performing the skill. Thankfully there are many internet resources for learning. 

Here is the first list of Top Ten Skills for Correctional Nurses. Part II is upcoming. These are not in order of importance, but rather they are listed alphabetically.

Dental Assessment

I knew very little about tooth disorders until I became a correctional nurse, but now I am well-versed in oral disorders, especially dental caries, infection and thrush.  Many  sick call requests are tooth-related, and most facilities include an oral inspection and patient education about oral hygiene in either the Receiving Screening or Initial Health Assessment encounter. Become friends with the site dentist and ask for help and mentoring in dental assessment skills. Get a jump start on understanding dental infections with this short video.

Ear Assessment

How proficient are you with an otoscope? There are plenty of ear infections to evaluate in the correctional patient population. Are you ready? Here’s a short video, but you will need to practice and have a nurse practitioner or other experienced staff mentor you.

Electrocardiogram (EKG)

Is that sudden onset chest pain described by an otherwise healthy 38 year old patient a cardiac, gastrointestinal, or musculoskeletal condition? A 12-lead EKG will help with diagnosis if the leads are placed correctly. How about reading the output? Does your facility have instant access to outside EKG reading services or must you fax/scan/email a copy to the on-call provider? In any case, fundamental understanding of 12-lead EKG operation and interpretation is needed in most correctional settings. Here is a short video on lead placement and an article about Acute Myocardial Infarction that provides a basic overview. 

Labor, Delivery, and Fetal Heart Tones

Pregnant women in jails and prisons are likely to be at high risk for premature deliveries or complications. Many times correctional nurses must evaluate symptoms of labor onset and fetal health. It is vitally important that fetal heart tones are documented as part of the vital signs at every encounter with a pregnant patient, if the pregnancy is far enough along that they can be auscultated.  Occasionally we have to manage a precipitous delivery! Here is a short video from the March of Dimes that describes Pre-term labor.

Phlebotomy

Starting an IV is one thing, drawing tubes of blood is something else. When you consider that our patient may be an IV drug user and may have scarred vessels, then things may become very difficult very quickly. In addition, determining which tubes to use for which test requires an understanding of the different tubes available, and the requirements of the lab with whom you are working.   On top of that, you must know when to spin the specimen, when to refrigerate and even when to freeze the specimen.   So, you can see in this case, it is vitally important to have a manual, a poster or some other guide in the lab area so that you can check before even drawing the patient’s blood to ensure you are doing everything properly so that the test is valid. Here is a short video on drawing blood using a tube holder (i.e. vacutainer^Ò) device. 

There are many more nursing skills needed by correctional nurses, but this is a priority list of potentially less-familiar skills needed in the correctional setting to start. We will discuss five more in our next post, Top Ten Skills for Correctional Nurses, Part II.

So, what surprising skill did you have to develop when you started in correctional nursing? Share your experience in the comments section of this post.

You may like the following classes available at The Correctional Nurse Educator:

• A Cardiac Primer for the Correctional Nurse: Heart Sounds and Murmurs
• A Cardiac Primer for the Correctional Nurse:  Arrhythmias and the ECG
• Dental Concepts for the Correctional Nurse
• Women’s Health for the Correctional Nurse