Job description: Prison Nurse

I was a prison nurse for about 5 years as a registry nurse in the early 2000s. I thought it would be scary, but it really wasn't...well, maybe only the first day. This prison was in Hawaii and housed a general population of male inmates and also had a maximum security wing. I experienced working in both areas.

At the time, I was a pretty new nurse and I was trying to obtain any new experiences I could. I have a background of an Associates Degree in Administration of Justice because I once wanted to be a criminal investigator and did have the experience visiting a prison several times prior to becoming a nurse.

As I drove into the secluded area with fencing all around and checked in at the guard shack, I felt a tinge of apprehension and a little bit excited at the same time. I entered and identified myself, I was searched, my belongings were searched, and then I passed through a metal detector. I was escorted to the clinic where I got the quick tour of the clinic with its various rooms and the attached infirmary. There was one inmate that had the job of cleaning and emptying trash bins.

The clinic area had an intake area/desk, eye clinic, foot clinic, patient rooms, ortho room, dentist's room, med room, nurse's station, Nurse Supervisor's office, and more. The infirmary was a small inpatient setting, much like a hospital, with private rooms and a nurse's office. There was also a psychiatric ward with private rooms and a suicide watch room.

Things to remember. Always treat people with respect. Always treat everyone equally, no favoritism. Always remember where you are. Nurses are not privy to the information of what crime(s) were committed by an inmate. As a patient, that is not pertinent information...but staff talk.

In the clinic, inmates were seen by appointment which had to be requested ahead of time. If an inmate felt sick or wanted to be seen for a health concern, they would submit a "chit" to be seen and then were assigned an appointment date and time. They were escorted in by an adult correctional officer (ACO). Most of the staff in the clinic were permanent staff, so I did not work there. I was surprised to hear that inmates were allowed to request for elective surgery. Specialty physicians came on certain days of the week or once a month, depending on the specialty to see inmates. On different days, I might be assigned to work in the infirmary, psych ward, or in the modules as a med nurse.

The infirmary was much like working in the hospital. However, no equipment (such as stethoscopes, BP machines, thermometers, etc. for obvious reasons) was ever to be left in any room. I was new, I was pretty young. One patient gave me a hard time on my first day. Some of the patients stayed a short time for recovery, others were there long-term for a chronic condition or because they needed total nursing care. I met an inmate, Ronald, who I heard was a notorious hitman once. He had a chronic condition that needed monitoring and regular nursing care, or maybe he was provided the privilege of a private room out of respect - I was never sure. But I heard he spoke to the man who gave me a hard time after I left. That man apologized to me the next day and never bothered me again. Another patient, Richard, was bedridden, a quadriplegic who could speak and only move his head. I heard that he had been found guilty of child molestation which is not looked upon kindly in prison. It's hard to imagine that he could have done anything physical to anyone in his current condition, so I have to assume, he became that way after his crime(s), maybe in prison. He seemed friendly, but after a few minutes he started asking me if I had tattoos and wanted to see my skin - creeped me out.

Just like in the hospital, there were nursing tasks such as taking vital signs, nursing assessment, medications to be given, and charting. Overall, very straight forward, minimal charting, and very little heavy lifting. If patients required more than basic nursing care, they were transferred to a hospital under constant supervision.

In the Psych Ward, the patients were locked in their rooms. They were allowed outside in a separate outdoor area for 1 hour a day. I passed medications to them through an opening in their door and observed, no touching. A psych physician visited with them once a day to monitor their condition. One man was so eloquent in his speech when he saw me, but once I was unable to be seen by him, he persistently talked to himself about things that did not seem to make sense. Any person admitted to the suicide watch room was stripped of shoelaces and the regular inmate clothes. He was given a plain T-shirt, pants, and rubber slippers/flip-flops. His room had a mattress with no coverings, a toilet, a camera monitor, and a small window through which he could be seen.

Sometimes, I was assigned the role of med nurse. When I was the med nurse, I had to first prepare all the meds which were packaged in 30-day bubble cards according to the MAR and verify new orders. It was important to get this right before I left the medical area because I had to walk to the modules where the general inmate population were housed and it was a bit far.

When taking the paved outdoor walkway between modules, there was the occasional inmate walking also. There was a watchtower on both ends of the walkway with armed guards who could potentially neutralize a threat to staff. Inmates knew to cross to the opposite side if they were close to crossing paths with staff. If they did not do so in a timely manner, the tower announced to them to do so.

Could this prison be co-ed? I saw what I thought were women interspersed with the men playing basketball in the courtyard on the other side of the fence. I later found that if someone had been taking female hormones prior to incarceration, they were allowed to continue their medication regimen.

An ACO is supposed to stay at the door to watch the line, but many times this did not happen. They watch the floor from an elevated office with large glass windows. An ACO would walk me in, open the nurse's office door, and then go up to their office and watch from there. At each module, I was escorted into the nurse's room where I entered and then locked myself in. Once the door was locked, I arranged my meds in a box so I could dispense quickly. The med cards stood up in the box so I could flip through them easily. I wrote the name of patient on each card and dated the blister to be given so I could keep track. When I was ready, I called the ACO office to let them know that the inmates could line up for their meds.

There was a small opening in the door, like a mail slot, through which I gave medications to the inmates. As each inmate came to the window, they were to put their hand in all the way so I could pop the meds from the blister packs into their upturned hand.

Remember: allow them to put their hand through the slot all the way and you pop the meds into the palm of their hand. You never reach out to them. Sometimes they would not put their hand all the way through and you had to remind them to put their hand through, at least to the wrist. This is for your safety. If you allow yourself to reach to them, they could grab your hand and pull you through the opening and injure you.

Many of the inmates were being given prophylactic medications for tuberculosis. Many were on sedatives and anti-anxiety meds. Not all inmates received medications. The blister cards always had 30 tabs. Some medications, such as antibiotics, were only for a set number of days. If the course was completed and there were meds leftover, the card was placed in a big bin for (what I assumed) disposal. Afterwards, I documented meds given in the MAR.

When entering the Maximum Security wing to give medications, one door opens and the next one does not open until the last door is closed. There are more ACOs for less inmates. The inmates are all in private cells with solid doors. As the medication nurse, I go cell to cell, they do not come to me. I was told not to linger at the small opening in their cell door because they can throw urine or feces at you. I directed them to put their hand out through the opening and I pop their meds into their hand. Most of the inmates were respectful, but I had one inmate ask me if I knew who he was and what he was in prison for. When I told him I didn't, he seemed very angry and started to yell. It was a bit intimidating to be in there, but I felt safe because I was always accompanied by an ACO.

I worked in the prison as a registry nurse for about 5 years. It was less pay than my hospital job, but it was easy work and I enjoyed the people I worked with. I didn't use my clinical skills much, so it was not very challenging. I left because I wanted to continue to learn more and work in a more acute setting.

I was a new nurse when I worked at the prison. Looking back, I should have insisted that an ACO stay at my nurse's office door in the medium security modules when passing meds, in case something should have happened. Inmates prepared the food in the staff dining room. It always looked fresh and smelled wonderful, but I never did eat there out of caution.

Overall, I enjoyed working in a prison. I know people who work in prisons and they find it rewarding and because prisons are generally run by federal or state, they have very good benefits.