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WORKING NURSE: Please tell us about your nursing title and specialty.

 

JENNIFER CLEMENSHAW, RN: I am the Director of Nursing in a private prison run by the GEO Group Inc., employed by Physicians Network Association. I have been in this position now for two years. The facility holds approximately 750 Arizona Department of Corrections male inmates; mostly DUI offenders and parole violators. I had previously worked part-time at the facility, and when I found that they had an opening for a nursing director, I became a full-time employee.

What first led you into this specialty?

I got into this specialty somewhat by accident. In 1988 my husband and I had just relocated from Miami to Las Vegas. In Miami I had been working for a large law firm as a paralegal, doing medical research. I did not want to work in a hospital, and the paralegal field in Las Vegas was not well developed at that time. An acquaintance suggested I check into correctional health. I did, liked it, and have been working in it ever since!

Is there any such thing as a typical day as a prison nurse?

A typical day here is similar to running a busy doctor’s office for my staff. We are staffed 24 hours a day, seven days a week. The nurses run a pill line, administer medications and insulin. They assist the physician and psychiatrist when they are present. They run sick call lines, deal with patient complaints, and provide treatment following protocols or refer the patient to the provider as needed. They deal with any emergencies that may arise—such as bites and stings, burns, respiratory and cardiac emergencies, triaging and sending patients to the emergency room or hospital as needed.

Working hand-in-hand with the Health Services Administrator I monitor staff performance, schedule staff and oversee all aspects of their daily duties. I also maintain a number of databases to monitor needed testing—such as annual mantoux testing. And where would we be without gathering those ubiquitous statistics on all aspects of our operation and forwarding them to various interested parties! I answer inmate complaints and concerns, and counsel inmates with Hepatitis C, Latent TB, STDs, scheduling them for needed lab work and meeting with the provider as necessary.

I order pharmaceuticals and medical supplies and work with the security staff to ensure that the security and medical staff work together as a team to provide the needed medical care without either compromising that care or violating security rules and regulations.

I draw blood on a weekly lab line, and monitor the results—working with the provider to provide care based on those results. I monitor the staff licenses and certifications needed to ensure that we are in compliance with the Arizona State Board of Nursing. I work with the local and state Health Departments in reporting the care provided for patients with reportable diseases. When necessary, I provide hands-on nursing care with the nursing staff. I hold monthly staff meetings which give us the opportunity to discuss any concerns or problems that have arisen, and I give in-service training on various topics at that time.

We also host nursing students from Arizona State University for a rotation and an introduction to correctional nursing. I monitor their performance and ensure that they have the opportunity to perform tasks that they may not be exposed to in a hospital setting, such as drawing blood and assisting the provider with minor surgery.

Your days sound very full and varied! What do you like best about this specialty?

I find new learning opportunities every day as new inmates arrive, and with the many varied disease processes present in our population. The opportunity in prison nursing of being able to follow a patient long-term—rather than just seeing the patient one time for a short period during an illness—can be quite rewarding. I also enjoy the opportunity to be involved in infection control. I have the opportunity to meet with patients on a one-on-one basis to educate them on infectious diseases such as Hepatitis C and STDs.

Teaching is another rewarding and major part of our operation. Many inmates are ignorant of basic health precautions such as hand washing after toileting, safe sex practices, or tattooing.

Are there any particular challenges you face with this specialty?

One of the challenges of dealing with inmates is differentiating between the subjective and objective findings of their complaints. Unfortunately many inmates have alcohol and drug abuse issues, and some attempt to obtain prescriptions to foster their habits while incarcerated.

I would imagine there are particular concerns you would want to emphasize to nurses considering prison nursing. What advice do you have for this interesting specialty?

I personally would advise any nurse entering this field to have had some prior nursing experience. The idea of dealing with felons such as sex offenders should not be a concern for you if you want to excel at this type of nursing. The reason why someone is incarcerated should be irrelevant to your ability to offer excellent health care. Safety concerns should also not inhibit a nurse’s ability to perform the job well. Solid assessment skills and confidence in nursing judgment—along with good old-fashioned common sense—is an essential part of this career.

FURTHER REFERENCE

Organizations:

The National Commission on Correctional Health Care, www.ccchc.org
The U.S. Department of Justice, National Institute of Corrections, www.nicic.org
American Correctional Association, www.aca.org

Publications:

The Journal of Correctional Health Care, published by Sage Publishing
Standards for Health Services in Jails; Standards for Health Services in Prisons; Standards for Health Services in Juvenile Detention and Confinement Facilities, published by NCCHC
Correct Care (newspaper)