Outside to Inside – reflections of a prison nurse

I started my career in Offender Healthcare long before even contemplating nurse training. For 17 years, I was a Healthcare Assistant in a multitude of settings which included general medical, surgical, psychiatric and, eventually, offender health. I joined the workforce at HMP Wadsworth in 2006 as the prison’s first ever Substance Misuse Healthcare Support Worker and remained in this post until I was extremely fortunate to have been seconded by St George’s Healthcare NHS Trust to undertake my Nurse training in 2012. I was all the more fortunate be accepted to study at King’s College London.

My time at King’s enabled me to reaffirm and build upon existing knowledge and skills, while also learning and developing those skills required for practising once qualified. Training was definitely an eye opener and helped me to fully appreciate and understand exactly what it takes to become a registered nurse. Upon reflection, although I always had great respect for the profession, I did not have a full appreciation of how far nursing has advanced; what it takes now to achieve a degree in nursing and also what is required to maintain that registration and develop it once qualified. The modules that were incorporated into the programme took into account the requirements of being a registered nurse of today and that care is evidence based and delivered at a holistic level.

Although not an expectation of St George’s, it was always my intention to return to HMP Wandsworth as a qualified nurse. I enjoyed the challenges and unpredictability that came with working in such a setting where no two days were ever the same. I felt privileged to have the opportunity to work with one of society’s most underrepresented and often stigmatised patient groups.

I was aware that returning as a qualified nurse was likely to bring fresh challenges in a professional role in which I was now fully accountable and working alongside colleagues who once remembered me as a Healthcare Support Worker. I was often reminded of a common belief that prison nursing can deskill you as a practitioner. In some ways this could well be true as some of the skills you would apply in a ward setting, for example, would not necessarily be used in the prison setting. However, to nurse within the prison setting requires essential skills and qualities that frequently require fine tuning and adaptation.

These include:

  • Methodical and rapid assessment in both clinical and emergency settings recognition of who may be considered vulnerable
  • Excellent communication skills that are adaptable to the individual and environment
  • Empathy and a non judgemental approach to all whom are under your care
  • Excellent time management skills
  • Flexibility and adaptability.

The list is non exhaustive, but it would be fair to say that these are all skills and qualities that are also applied within the general setting outside of prison. However the challenges that come with working within the strict constraints of prison, due to security needs, require nursing staff to constantly adapt to the environment at any given time and reevaluate priorities to ensure care is still delivered.

The working day of a prison nurse is rarely predictable and the roles and tasks I would undertake could range from running nurse triage clinics to assisting the emergency nurse in the event of incidents that are relatively commonplace in prison such as cardiac arrest, deliberate self-harm or the adverse effects of psychoactive substances such as the legal high commonly known as ‘Spice’.

In addition, a key part of prison nursing is the health screening of new prisoners who come into our first night ‘Reception’ centre. They are then seen again in the ‘Second Day Screening’ clinic the following morning. These clinics are specific to the identification of any prisoners who are at risk or currently suffering from chronic physical or mental health problems. Such clinics are also crucial in identifying vulnerable groups such as those with substance misuse issues, learning difficulties, former veterans and younger prisoners or first timers. The needs of each of these groups are individual and therefore effective communication through appropriate referral to relevant departments and agencies ensures that the safety of the individual is maintained. The importance of getting it right over the first two days cannot be underestimated and time is of the essence. There are tight time limitations on these clinics, particularly in Reception where prisoners need to be processed swiftly to ensure they are located on the wings without delay. Constant communication with the discipline staff is essential to ensure that no prisoner gets missed and, subsequently, lost in the prison system with potential health problems that may require attention.

The prison also has a six-bedded hospital unit known as the Jones Unit. This houses those who may be too sick to remain on prison wing locations, or who have returned from an outside hospital and require a period of observation and stabilisation before returning to the wing. During shifts spent on the unit I have managed a full patient caseload supported by one healthcare assistant. I have been responsible for ensuring individual care needs are met, as identified in their care plans. During my last shift on Jones I had to send two patients out to hospital due to reported deteriorations in their Early Warning Scores (EWS) and general health state. This meant liaising with the duty GP and duty prison Governors to ensure that they were transferred out to hospital without delay. In the interim, their health was maintained through regular observations and, for one, administering supplementary oxygen after a rapid drop in his saturation levels.

This is just a brief overview of what tasks and duties can be typically expected of a prison nurse over any working day. It is variable and rarely dull as, wherever you are based in the prison on any given day, there is always something to do or learn. A thick skin and strong stomach are essentials for such a post, as is life experience and being an excellent multi-tasker. If this is you, I would strongly recommend this as a career choice. The job as a prison nurse can be extremely challenging and, at times, frustrating but the small achievements made along the way make it a rewarding vocation.

Christine is an alumna of King’s College London

For more information on Adult Nursing, click here.

Chrissy

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