Correctional Nursing: Interview with Marites Benito-Mateo, RN, BSN
Caring for inmate patients in a guarded care environment
Marites Benito-Mateo, RN, BSN
Mercy Hospital, Bakersfield (Truxton)
Charge Nurse on 5 West, Guarded Unit
Tell us about your nursing career.
I graduated in 1988 from nursing school in the Philippines. I worked in med-surg when I first came to the United States. I went into correctional nursing 15 years ago.
What brought you to correctional nursing?
The unit was part of my rotation where I was working at the time.
How does your unit function since it's not located within a prison?
We operate a guarded unit inside our acute care hospital. Access to the unit is restricted. Guarded care patients stay within the unit unless they require treatment or a procedure that can’t be done on the unit, and they are restrained. When a guarded care patient must leave the unit, correctional officers accompany them and stay with them until they return to the unit. Officers also accompany the hospital staff every time they enter a patient room.
What do you treat on your unit?
We treat everything on our unit: cancer, orthopedics, med-surg, cardiac, diabetes. We do it all.
What was it like the first time you stepped onto the unit?
I was really scared. Once I got to know them in the context of my role as a nurse, I realized that caring for guarded care patients is the same as caring for patients on any other hospital unit. I am just extra careful.
Do you know each patient's criminal history?
We don’t know their criminal history. We only have access to their medical history.
What are some of the challenges of your work?
You have to be careful not to share any personal information like you might with a patient on another unit. And patients on other units can have more information about their plan of care than guarded care patients can. For example, they can’t know when they are being sent for a test or procedure, or when they’ll be discharged.
Does this go against what you were taught in nursing school?
It’s for everyone’s safety, including theirs.
What are some other challenges you’d like to share?
It can be frustrating when someone refuses care, for whatever reason.
Can their families visit them on the unit?
Only under certain circumstances and it has to be ordered by the physician.
What happens with patients who are dying?
We have chaplains that round every day to offer pastoral counseling. If the doctor orders it, we try to find a facility with a hospice bed available, but it isn’t easy. I often pray with patients to offer them some comfort.
What are the boundaries like in this environment?
You don’t give anything away, just your first name. And you wear a poker face. Sometimes a patient will try to test you or manipulate you to get something more from you.
What do you tell nurses that come to the unit for the first time?
I remind them to be respectful, to have firm boundaries, and to ask for help if they’re unsure about how to handle themselves.
Do you see yourself doing this for a long time?
I’ll probably stay until they kick me out!
Do you have other goals in your nursing career?
I’m looking into a certification in correctional nursing.
What characteristics do you need to work in correctional nursing?
You need to have compassion like any other nurse, but you also have to have firm boundaries.
Did You Know? Correctional Nursing
Correctional nursing is a specialty that few nurses or members of the public know anything about, or frankly, think about. While most nurses have an idea what it’s like to be a hospice nurse, a school nurse or a PACU nurse, it’s rare for nurses to have insight into the lives of their fellow nurses who work with inmates (who also happen to be patients).
Correctional nurses can work in private prisons, state prisons, county and state jails, in the federal prison system, as well as within military prison facilities. Some correctional nurses — like this article’s interviewee — provide patient care to inmates in locked units located within the walls of regular hospitals.
A 2009 article cited by the National Commission on Correctional Health Care (www.ncchc.org) estimated that there were approximately 18,000 registered nurses employed as correctional nurses nationwide at that time.
Prior to the 1970s, standards for correctional healthcare were sorely lacking. At that time, much inmate treatment was provided by prison guards and some physicians who occasionally visited for perfunctory care. Inmates sometimes provided medical and nursing care to one another.
According to a 1975 article by Rena Murtha, a well-known nursing director within a large correctional system at the time, nurses were often “a tool of the warden, a slave of the physician, and an unknown to the patient.” In 1976, a ruling in a Supreme Court case (Estelle v. Gamble) stated clearly that lack of access to proper inmate healthcare is a violation of an individual’s civil rights. This landmark case was a watershed moment for correctional healthcare. Soon after, the American Medical Association adopted specialized standards of care, and since the 1970s inmate medical care has improved dramatically.
Although not all correctional healthcare facilities are accredited, hundreds have sought and received accreditation from the National Commission on Correctional Health Care.
Treating Inmate Patients
As you will learn from our interview, correctional nursing is a specialty all its own. Although the patient care is the same as anywhere else, nurses in corrections need to give a great deal more thought to their own physical and psychological safety than those nurses working with non-incarcerated patients. Strong personal boundaries and a certain level of emotional protectiveness are inherent in the practice of correctional nursing. Nurses must guard against manipulative behavior and the potential for inmates to act out, verbally or physically.
Working with inmates often exposes nurses to individuals with dangerous histories who have engaged in socially aberrant behavior. Not all nurses would be interested in this type of nursing or in the environments where such nursing takes place. However, some nurses find personal and professional satisfaction in this very singular specialty.
Many inmates can suffer from diseases — or combinations of diseases — that are not regularly seen in the general public, mostly due to high-risk behaviors in which inmates are inclined to engage. This can be clinically challenging and interesting.
Correctional nurses assess and treat patients who suffer from terminal illnesses, a variety of mental illnesses, and many chronic illnesses. Inmates also present with injuries from assaults, unsuccessful or interrupted suicide attempts, as well as drug addiction and symptoms of detoxification. As inmates age, end-of-life and geriatric issues also need special consideration. Faked illnesses are also a common cause for concern.
According to some sources, correctional nurses have a great deal more independence and autonomy within the correctional medical system than they might have elsewhere. Since physicians are not always on duty for patient care, correctional nurses must exercise autonomy and critical decision-making on a regular basis.
Online sources identify average salaries for correctional nurses ranging from $41,000 to $85,000. Salaries vary based on geographic region, position, as well as whether the facility in question is under the jurisdiction of a state, county, city, federal corrections authority, or private corrections contractor. Most anecdotal evidence found online reveals that benefits packages are often quite competitive and attractive, but also vary widely based on the same factors that impact differences in salary.
Correctional Nurse: www.Correctionalnurse.net
Correctional Nursing on Allnurses.com: www.allnurses.com/correctional-nursing
National Commission on Correctional Health Care: www.ncchc.org
Journal of Correctional Health Care: www.ncchc.org/pubs/journal.html
Academy of Correctional Health Professionals: www.correctionalhealth.org
The American Correctional Association (www.aca.org) offers certification for correctional nurses and managers:
Certified Corrections Nurse/Manager (CCN/M): www.aca.org/certification/ccn.asp
Certified Corrections Nurse (CCN): www.aca.org/certification/ccnm.asp
Keith Carlson, RN, BSN, is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing.
This article is from workingnurse.com.