In this post, we continue our discussion about the Top Ten Skills that Correctional Nurses should have as they care for their patients. We have begun the discussion in our previous post, Top Ten Skills for Correctional Nurses, Part I.  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.  Remember, too, that most state nursing scope of practice decision trees require that you have the training, and competency is documented for the skill.

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. 

In this post, we continue with Part 2 of the Top Ten Skills for Correctional Nurses. Remember that these are not in order of importance, but rather they are listed alphabetically.

Respiratory Treatments and Oxygen Tanks

Before corrections, my clinical nursing experience was in the emergency department. In that specialty, oxygen comes out of the wall. Unless you work in a hospital associated with a corrections department, or have the good fortune to work in a newer Infirmary, more likely than not you are using oxygen from tanks. I remember being slightly intimidated by the tanks, both because they required a special tool to open, and if the regulator was not on just right, there could be problems with actually getting the oxygen to the patient. In addition, stories of the care required in handling the oxygen tanks (“they can explode if you are not careful….”) made me hope that I never had a patient that needed it! (I have since learned they are not as delicate as I was told, and there is more chance of someone tripping over the tank if you leave it on the ground than there is of it exploding from being dropped on the ground). If you are unfamiliar with oxygen tank usage, check out this video.

Although basic nebulizer treatments are not difficult to administer, if you haven’t done them before you should review so you will be able to effectively set up the treatment and also instruct your patient in its administration. The brand of equipment you have at your facility may be different, but the main principles are the same; this video by the Veteran’s Administration clearly articulates how to use a nebulizer. Be mindful of the strength/dose of the solution ordered to ensure that you are using the correct one.

Skin Issues: Inflammation, Infections, Infestations

Correctional nurses are called upon to evaluate many skin conditions and need to be able to effectively describe what is seen as well as determine if the condition needs provider attention. Whether viewing MRSA, scabies, or a suspicious mole, skin issues are big in our specialty! Start now developing skill in identifying what you see as well as using the “language of skin” to document it.

Infestations with lice, bed bugs, or scabies are also encountered with some frequency in the incarcerated patient population, and early identification and treatment are important to the health in your facility and the greater community.

Splints, Slings, Casts

Having an emergency nursing background can be very helpful when dealing with orthopedic patient injuries common in correctional facilities. Splints, slings, and even casting may be part of correctional nursing activities. A basic first aid course can be a valuable addition to your training. Here is a splinting video that shows many of the basic skills you will need.

TB Skin Testing: Placement and Reading

Proper placement and correctly reading the Mantoux tuberculin skin tests (TST) is a specialized skill given only brief instruction (if at all) in most nursing school programs and typically is not used by most nurses in traditional health care roles. Yet, correctional nurses are often required to place and read a TST on every incoming person, or at least the Federal Marshall Service detainees. The Centers for Disease Control and Prevention has an excellent training program and additional materials that you can obtain about Tuberculosis and its care and treatment to include a DVD, facilitator’s guide, testing rulers and wall chart that is excellent (this is available for download only).

Visual Acuity Testing

Right up there with teeth, ears, and skin is the need to evaluate vision and eye complaints in correctional nursing practice. Visual acuity evaluation may be needed after eye trauma or at the Initial Health Assessment. Although you probably experienced the standard Snellen eye chart as a patient, do you know the particulars of administering a visual acuity exam? Does the distance from the chart really need to be that precise, or is it fine to say the patient can stand “anywhere on that floor tile?” How should the results be documented? Here is a short video from a family practitioner that will get you going quickly.

There are many more nursing skills needed by correctional nurses but this is a priority list of less-familiar skills to use to start. 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 also find the following classes available at The Correctional Nurse Educator helpful:

• Asthma I and II for the Correctional Nurse
• A Tuberculosis Primer for the Correctional Nurse 
• Ectoparasites in the Correctional Environmental 
• Red Eye for the Correctional Nurse
• Skin Assessment I and II for the Correctional Nurse
• Sprains and Strains for the Correctional Nurse