Inside Correctional Nursing

Mel White, RN, begins a morning work shift like most nurses. In the dispensary, he begins preparing insulin and other medications his patients with diabetes and other chronic diseases will need to take with their breakfast. He’ll check in with any patients who may not be feeling well, answer questions about results of lab work they’ve had done, and update health records.

 

Unlike most nurses, however, White isn’t seeing his patients in a hospital. For the past 30 years he has been a nurse with the State of Rhode Department of Corrections. Of the nearly 1,050 inmates of the John J. Moran Medium Security Facility in Cranston, about one-third of them need medication, and during that morning rush, White and fellow nurses need to ensure everyone is cared for within an hour.

White says people would probably be surprised how similar nursing behind bars is to nursing in the community.

“A lot of people form their idea of prison from TV, and a lot of what they see is dramatized and not reality,” White said. “This a group of patients who need medical care, and we’re here to help them.”

Autonomous Nursing

White is one of about 50 nurses who care for more than 3,200 inmates in six of the state DOC facilities, which includes the Anthony P. Travisono Intake Service Center. In this center, which serves as Rhode Island’s jail, about 1,333 people are processed monthly.

During intake, nurses screen for various medical and mental health needs. Here nurses ask what medications they’re on; whether they have an infectious disease; are they withdrawing from drugs or alcohol; and any other concerns they have. It is generally the nurses’ call to decide what the next course of action should be.

It’s this autonomy that drew Gordon Bouchard, BSN, RN, CCHP, to correctional nursing.

Bouchard, who oversees the department as the director of nursing services, was a medic in the U.S. Army then worked his way up the healthcare ladder as a civilian, first as an LPN and eventually earning his Bachelor of Science in Nursing from the Rhode Island College. He worked in med/surg and emergency department nursing. When he joined the DOC 21 years ago, he found an environment other settings didn’t offer.

“Nurses here tend to work independently most of the time,” he said. “Correctional nurses have to have exceptional assessment skills. We’re the ones who make a call as to whether a patient should see a physician or a specialist.”

 
More Complex Patients

Inmates are typically more complex patients than nurses will see in the community. Drug and alcohol abuse are more common. People behind bars are at high risk for sexually transmitted and infectious diseases like hepatitis C and HIV.

In Rhode Island, testing for HIV behind bars is an effective tool for treatment. According to Science magazine, the CDC in 2006 recommended an “opt-out” option for HIV testing for inmates. Rhode Island, however, has been mandating testing for those who have been convicted of a crime since 1989 (people who have been charged but not convicted may opt-out). One-third of all HIV diagnoses in the state in 1990s were made at the DOC, Brown University researcher Josiah Rich, MD, MPH, discovered in a study.

“Most of the patients had no healthcare prior to coming here,” Bouchard said. “We’ve had to inform patients that they have diabetes, are HIV positive or have some of other health concern that they otherwise would not have known.”

For instance, the lab work of one patient revealed his blood glucose level at 1200 mg/dL.

“We have to teach the patients that insulin is not a cure and to make smart choices when they’re able to buy snacks,” Bouchard said. “We had one inmate recently who tore his quadriceps, so we have to educate about exercising properly. There is also something new that we’ll have to teach to the patients and staff.”

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