Correctional Nursing

Written by: Evelyn Wilson, RN, BSc.N,(C)COHN, Shirley Kennedy RN, BHScN, Ian Clarke RN, BSc.N, Subaida Hanifa RN, BSc.N, CPMHN(C) on behalf of the Ontario Correctional Nurses Interest Group

A day in the life

Tim is a correctional nurse who has worked at a provincial maximum security detention centre as a registered nurse (RN) for 10 years. On a typical day, he begins his shift by passing through three security grills before he stops at the sergeants’ office where he gets a report of issues that occurred overnight. The report states that John, a new admission, was sent to the ER with chest pain and returned five hours later with a prescription. When Tim gets to the health-care unit (HCU), he confirms with the correctional officers that John has not experienced any further difficulties. Tim lists John to see the physician for follow up during today’s medical clinic.

Tim ensures that medications for inmates going to court are prepared and available to them before they leave the building with the court bailiffs. Twenty-five of the 40 inmates on the court list require medications and/or assessments. The correctional officer contacts Tim before the court transport vehicle leaves the building, and Tim sees the inmates in the admitting and discharge area. Before leaving the HCU, Tim ensures that he has completed the security check for his medication cart; this is a safety measure to ensure that items do not go missing. Tim understands that everyday medical equipment can quickly become a weapon in the wrong hands. Tim gives out prescribed medication to 18 of the inmates going to court. Five inmates ask for Tylenol; going to court is stressful and headaches are not uncommon. Tim completes an assessment on James, including Clinical Institute Withdrawal Assessment (CIWA) scoring. James was drinking heavily before his incarceration and is on a protocol to minimize the risk of alcohol withdrawal. Tim administers and interprets TB skin tests, reassures an inmate that is feeling anxious, and then lets the correctional officer know that Bob will need to be seen in the HCU for a dressing change before he goes to court. Tim returns to the HCU and a correctional officer escorts Bob in. Tim feels confident about his safety, as the security protocols are well established. Bob’s wound is an abscess with cellulitis caused by IV drug use. Tim uses the dressing change as an opportunity to engage with Bob and lay the foundation for a therapeutic nurse-client relationship. Tim does health teaching about the wound while explaining how to access health-care services and institutional resources that might support Bob in substance abuse recovery.

Once the inmates who are remanded to court have left the building, Tim takes a short coffee break. Until now Tim has been the only nurse on shift but others are starting to arrive. Four RNs will provide medication and respond to inmates’ health-care requests. The clinic nurse will work with the physician to triage and treat inmates. The admit nurse will assess and initiate a care plan for the 15 new admissions that are expected today. The mental health nurse will work with inmates with significant mental health disorders. There are 485 inmates in the facility and eight nurses on duty.

Tim spends the remainder of the morning assessing inmates to determine if they have the physical and mental fitness to work in the institution, and assisting his colleagues as needed. After lunch, Tim prepares for the Methadone Maintenance Program (MMP). The MMP is part of the detention centre’s harm reduction strategy for clients with opioid addictions. Thirteen per cent of the inmate population is in the program. The next 90 minutes are spent assessing inmates, administering Methadone, providing supportive counseling and documenting.

Just as Tim gets back to the HCU, he hears “Code White” broadcast throughout the building. Code White is a request for all available health-care staff to respond to an emergency. Tim picks up the emergency kit and AED and rushes to the area where he finds two other nurses already at the scene. The inmate has been involved in an altercation and the nurses in attendance advise Tim that the injuries are minor and his assistance is not required. Tim returns to the HCU, tidies up and completes a final security check of his medication cart to complete his shift.

On his way home, Tim reflects on his day. He loves the autonomy and variety of correctional nursing and he feels good about the connection that he has made with each inmate he cared for.

Background

In Ontario, approximately 700 nurses work in more than 42 federal and provincial correctional facilities, caring for about 21,000 individuals who are incarcerated. The Correctional Service of Canada (CSC) introduced RNs at Collins Bay Institution in 1974. In Ontario’s provincial system, RNs working in correctional facilities pre-dates the province taking control of county jails in the early 1970s. Nurses represent the largest group of health-care professionals working in the correctional system.

Specialty Education

A baccalaureate degree or nursing diploma, current CPR certification and good standing with the College of Nurses of Ontario (CNO) as an RN are required for employment in correctional nursing. No specialized post-graduate education is needed. Nurses with experience in emergency nursing, mental health nursing, or those with several years of general nursing experience thrive in this environment. There is a growing demand for formal education in the field and OCNIG is currently exploring options for certification in correctional nursing. Courses in forensic nursing and criminal justice are helpful to nurses and are offered in some Ontario community colleges. Structured orientation is provided to newly employed correctional nurses by all correctional employers in Ontario.

Scope of Practice Application

Men, women and youth who are incarcerated are the focus of the correctional nursing practice. Correctional nurses promote health, assess and provide treatment of health conditions through supportive, preventive, therapeutic, palliative and rehabilitative means in order to assist people who are incarcerated attain and maintain optimal health. Correctional nurses require competency in general clinical practice, health teaching and interviewing. They need strong physical and mental health assessment skills, the ability to triage and respond to emergency situations and an exceptional ability to build therapeutic nurse-client relations. Correctional nurses enjoy working to their full scope of practice with autonomy and attend to the health-care needs of inmates from the time they enter the system until their release back to the community.

Practice Environment

Correctional and detention centres throughout Ontario are under the jurisdiction of either the federal government (i.e. Correctional Service Canada), or the provincial government (i.e. Ministry of Community Safety and Correctional Services and the Ministry of Youth Justice Services). Facility capacity varies from 10 to 2000 beds. Regardless of the setting, the standard of care must be comparable to care available in the community. The period of detention is determined by the criminal justice system and can vary from less than 24 hours to life imprisonment. RNs work as part of an interdisciplinary team, which may include physicians, psychiatrists, psychologists, registered practical nurses (RPN), social workers, chaplains and correctional officers. Security considerations impact the provision of nursing care in this practice environment.

Clinical Laddering

Correctional nursing offers professional growth in the areas of forensics, mental health, emergency, public health, palliative care and more. Nurses with correctional nursing experience can pursue careers in education, research, nursing leadership, management, policy development and consultation.

Liability Protection

Correctional nurses that are members of RNAO are automatically eligible for professional liability protection through the Canadian Nurses Protective Society (CNPS). This coverage satisfies the CNO’s professional liability protection requirement.

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