Jailhouse Medicine
Nurses work in many different locations - prisons are no exceptions
By Doug Childers

The injury was fairly straightforward, if painful. During a softball game, the man slid awkwardly into second base and separated his fibula and tibia from his ankle. The fact that he was an inmate in a correctional institution made the situation complicated.

The man was transported from the Greensville Correctional Center — the largest one for men in the state — to Virginia Commonwealth University Medical Center, where he underwent surgery 90 minutes after the accident.

“He came back to us in the infirmary and was in a cast for nine months,” said Dolores Wagstaff, LPN, a correctional nurse technician with the Virginia Department of Corrections. “He walked out on his own two feet.”

Because inmates exercise outside, the inmate’s injury wasn’t unusual.

“We have a lot of sports injuries,” said Teri Chrisley, RN, chief nurse of institutions for the Virginia Department of Corrections.

In fact, the 325 nurses who work for the Department of Corrections in Virginia’s correctional institutions provide the same sort of primary care that nurses offer in a community setting.

“Anything that you see in the general public, we’ll probably have, too,” said Tanya Gary, RN, clinical coordinator for the Virginia Department of Corrections.

“Nurses are among the most-respected figures in correctional institutions.” Teri Chrisley, RN

That includes “anything from basic nursing care like you’d receive in a doctor’s office to post-op care after a visit to the hospital,” Wagstaff said.

Among the most common services correctional nurses provide to the nearly 31,000 inmates in Virginia’s state institutions are treatment for chronic issues like seizures, diabetes, hypertension and pulmonary problems. The Department of Corrections also administers flu shots to its inmates. This year, it ordered approximately 6,500 flu shots, and correctional nurses encouraged chronic offenders to get them.

There are limits to the services rendered onsite, though. While correctional nurses routinely offer dialysis, IV antibiotics and significant wound care, inmates who require major surgery are sent to local hospitals. And the institutions’ medical staffs try to avoid labor and delivery behind bars. Inmates’ babies are delivered in hospitals, and Social Services typically arranges for a family member to take custody of the child.

“But we have primary surgery set up on some days of the week, plus oral surgery,” Gary said.

Most of the state’s correctional institutions also practice telemedicine in partnership with Virginia Commonwealth University and the University of Virginia, which allows inmates to receive services ranging from orthopedics to psychological evaluations onsite. During the telemedicine session, the patient is with a nurse.

“We try to do everything within the institution,” Chrisley said. “If we send an inmate out, it’s for a reason: we can’t provide that service.”

Inmate Health

While inmates may not necessarily be less healthy than the general population, Gary said they present “some diseases earlier than you would see in the general public — in their 40s or 50s versus 60s — because they haven’t seen consistent health care.”

The fact that inmates often don’t receive consistent health care while they aren’t incarcerated poses a special problem for correctional nurses. Nurses may get an inmate’s high blood pressure under control while he’s incarcerated, for example, only to see it go back up once he’s released.

“When they’re released, they don’t have health care, so they go to free clinics, and they may have to wait for care,” Gary said. “It’s a lapse in coverage. A lot of them come back to us with minimal health care.”

Pregnant inmates may also suffer from inconsistent health care. Many enter correctional institutions without having received any prenatal care.

“They’ve not gotten anything, and they’re five, six or seven months along when they come into the system,” Wagstaff said.

Likewise, the aging prison population poses another set of special problems.

“We have dementia, Alzheimer’s and fall risks,” Gary said. “They present a big challenge because our facilities weren’t designed to accommodate these guys, and you have to make adjustments.”

“Every day, we’re looking for new ways to attract people to the field.” FROM LEFT TO RIGHT: Tanya Gary RN, Teri Chrisley RN and Dolores Wagstaff RN from the Virginia Department of Corrections

Nurses’ Roles

Prenatal care, dialysis, treatment for hypertension . . . in many ways, correctional nursing is similar to the care provided by nurses in the general public. They aren’t exactly alike, though. Correctional officers don’t monitor doctors’ offices, and the patients there rarely plot escapes.

“We’re aware of our surroundings at all times,” Chrisley said. “When we’re changing a dressing, we don’t lay the scissors down.”

To prepare for a career in correctional health care, nurses hired by the Department of Corrections begin with a week of security in-service.

“This training includes management/staff issues, customer service skills, mental health, emergency plans and blood-borne pathogens,” said Larry Traylor, spokesman for the Department of Corrections. “We review report writing, go over policies and procedures, mediation counseling techniques, defensive tactics and a few other rules and regulations.”

The department also runs a weeklong basic skill program that “includes things like substance abuse, HIV, games inmates play, infectious disease, mental health, documentation and legal issues,” Traylor said.

“Safety is the number-one priority” in correctional nursing, Wagstaff said.

But the relationship between the inmates and nurses is professional, not adversarial, and the interactions between them are not necessarily tense.

“Inmates are very polite to nurses,” Chrisley said. “Nurses are among the most-respected” figures in correctional institutions. One key reason for some inmates’ respect is the fact that nurses are among the few people to care about their health.

Building trust and good will is important, Chrisley said, because many inmates seeking medical attention lack the verbal skills to describe their conditions precisely. “Inmates aren’t sure of their condition. They just know they feel bad. So everybody has to be triaged.” In general, she said, “the more you talk to an inmate, the better you listen. We’re good listeners.”

Strong assessment skills are critical in correctional nursing because correctional nurses play a key role in diagnosing and treating medical conditions.

“At a doctor’s office, the nurse takes the blood pressure, and then the doctor takes care of the situation,” Wagstaff said.

In correctional institutions, “our nurses are usually our primary contact,” Gary said. “Our guys are assessed by the nurse to determine whether they need to see the doctor there or at a hospital.”

Given the number of chronic conditions they see, correctional nurses emphasize preventative medicine and education.

“We designate cases like high blood pressure, and they get routine care,” Wagstaff said.

Chrisley added, “We call them up even if they have no complaints.”

Career Opportunities

The shortage of nurses in a variety of fields is a national problem, and correctional nursing is no exception.

“We’re impacted as much as the community itself,” Wagstaff said.

To attract nurses to the field, Chrisley said, “we offer nurses reasons to work for the Department of Corrections. Benefits with the state are always a plus. We have nurse positions open. Every day, we’re looking for new ways to attract people to the field.”

Salaries for correctional nurses employed by the Department of Corrections have gone up, making them more comparable to salaries paid to nurses in the private sector.

“It’s difficult to be competitive when you have VCU and private companies that pay nurses well,” Chrisley said. “But our benefits add up to what the salaries don’t. It depends on what your needs are: salary or benefits. Some private sector jobs have high salaries but no benefits.”

The job opportunities in correctional nursing are numerous. Every state institution has at least one full-time nurse onsite five days a week, and the larger ones have multiple nurses assigned with 24/7 coverage. All institutions have a nurse or doctor on call 24/7.

“We have a medical department in each institution,” Chrisley said. “How big the department is depends. It could be a small office or a 40-bed facility infirmary setting.”

In addition to the nearly 50 institutions that have Department of Corrections nurses, three private companies provide nursing staff at nine state institutions. Armor Correctional Health Services provides medical staff to three institutions, and the Geo Group Inc. operates Lawrenceville Correctional Center, the state’s only institution run by a private company.

Prison Health Services provides nursing staff to five institutions, in addition to operating the infirmaries at three institutions — the Fluvanna Correctional Center for Women, the Greensville Correctional Center and the Powhatan Correctional Center — that serve as hubs for smaller state institutions in the area. Whenever possible, inmates needing more extensive care are sent to them rather than to an area hospital.

Nationally, Prison Health Services employs 4,700 health care professionals. In Virginia, it has approximately 280 full-time employees, 60 to 70 percent of whom are nurses. All five institutions have registered nurses onsite 24/7.

All of Prison Health Services’ nurses at Virginia institutions receive 40 hours of training with the Department of Corrections as an orientation to the corrections environment.

The five institutions for which Prison Health Services provides medical services are among the largest in the state. They all have full dental suites, optometry, infirmary care and onsite x-rays. The company also offers inpatient mental health at the Greensville Correctional Center and the Fluvanna Correctional Center, as well as an 80-bed mental health unit and a 40-bed infirmary at Greensville. In addition, the medical staff has performed surgery at the Powhatan facility, and the Greensville facility will serve as a surgery hub in the near future.

“Our goal in 2007 is to provide chemotherapy onsite rather than transporting inmates to a hospital,” said Lori Ellis, RN, BSN, regional manager for Prison Health Services. “We ask ourselves, ‘What offsite events are on the rise?’ Chemotherapy is one.”

Ellis said that the nursing shortage has an impact on her company because “we’re all competing for the same pool of nurses.” But offering salaries that are comparable to, if not better than, what is offered to nurses working in the general community helps attract applicants.

“Because of the environment, how do we attract nurses? We have to be a cut above what the community is providing,” Ellis said.

In the final analysis, though, salary and benefits are only two components of the decision to pursue a career in correctional nursing, Wagstaff said. “Nursing is a compassionate profession, and a lot of nurses aren’t in it for the money. Some of our inmate population is among the neediest.”

For more information, visit
www.vadoc.virginia.gov,
www.armorcorrectional.com,
www.thegeogroupinc.com and
www.prisonhealth.com.