What is it like working in Jail? The idea of working in a Jail and/or Prison can be a little disconcerting, especially when there is little known about this work environment. The same is felt for friends, family and loved ones who are concerned for your safety who are accustomed to the portrayals in mainstream media. As a nursing student, an individual will go through a variety of clinical settings from Medical-Surgical to Psychiatric rotations but will rarely step foot into a Jail/Prison setting. But fear not, I hope to ease everyone's mind and let you all know that the Correctional setting is one of the most safe and controlled environments for a variety of reasons. The details in the following are specific to my own workplace and might not be applicable to all workplaces, but different variations of safety measures will exist. The Correctional setting varies from many other settings because Safety is a top priority. From entrance to exit, most facilities are built with safety in mind. The workflow of both Custody teams and medical staff mesh and intertwine and steps are taken to mitigate the risk for everyone. At the most basic level, Custody encompasses a variety of roles while maintaining the safety of all inmates including their own staff and any adjacent staff (ie. Medical staff, Forensic Mental health, program staff). As medical staff you will be providing a variety services for the inmates which will require a set of safety measures which we will review next. THE FACILITY Like I had mentioned, buildings are built with safety in mind. Many of the processes will attempt to control the flow of incoming and outgoing personnel while accounting for each and every person and/or inmate in the building. Looking at most Correctional buildings you will notice that there are a variety of entrances that require a certain set of clearance levels. Certain doors are open to the public or civilians such as the lobby or visiting areas. Then there are doors only for staff such as you and custody. And lastly, there are doors only accessed by Custody staff. Many modern jails/prisons will have centralized rooms that oversee everyone coming in and out. It is not uncommon to be walking around the facility (inside or outside) only to be met by a surveillance camera looking at your or the path you're taking. They attempt to cover each nook and cranny of the building being able to follow an individual's movement from start to finish from hallways to elevators, excluding the inside of bathrooms. The ability to account for everyone going in and out, including their movements are key to increasing safety. In regards to movements, Correctional facilities have control over the large steel doors separating corridors electronically and manually with keys. These separations are put in place to control the movements of certain staff, especially those transporting inmates to and from court / medical floor / other areas of the building. They can keep inmates in the right areas and open only when appropriately supervised by staff. If a nurse is attempting to enter a housing pod for medical care, the centralized control room will open the door when deemed safe after reviewing any risks on the other side. At my facility, in addition to a central control surveillance, radio confirmations of clearance are required before entering a housing unit. Be aware that they have their own policies regarding safety. The mixture of surveillance and confirmation helps reduce any mistakes on their end. Housing units As a nurse, you will most likely be located on a medical floor, a designated area that may mimic a clinic or hospital setting (Infirmary for prisons). This will be separated and secured by the same set of doors and will be controlled by a central surveillance or through badge/fingerprint access. Any planned movements will be accounted for by Custody ahead of time and live movements are often relayed to the central control to confirm the safety of proceeding to the next area. As for the rest of the Correctional facility, layouts may differ but generally housing units will be separated by the severity of charges or even gang affiliation. There is usually a centralized area for Custody/ Deputy/ Correctional Officer Staff that oversee the housing unit or "pod". Again this is another safety feature as they must have eyes on all things that are happening on the pod. There is usually quick access onto the pod as Officers have to be able to act quickly in case of any emergency. For example, the facility I am at has a centralized Officer desk that sits directly in the middle of the pod. All pods reflect the same layout throughout all floors so that safety measures can be consistently repeated regardless of the housing unit. Some facilities have this Officer area in the corner of a pod with every cell facing outward, but this varies from facility to facility. Your Personal Bodyguard In my opinion, the best safety measure that is common practice at most facilities is the Staff escort in and out of housing pods and for the duration of your stay on the pod. Knowing that you will have your own personal guard with you at all times ,while interacting with any inmate, gave myself a little bit of comfort when I first started. This type of escort is quite common within many correctional settings. Any staff that is not Custody or badged staff generally require an escort during the entirety of their activity or task. For example, when entering a pod our facility requires Custody escort when interacting with inmates. They will notify you if the inmate is not clear for a face to face encounter (ie. behavioral reasons such as being disruptive or being uncooperative). If deemed safe to interact, the officer will allow several options for interaction. You may be able to speak through the cell door as they normally have small vents so that both sides can be heard. Additionally, many traditional cell doors have a small food port that can be opened and closed with a lock. This can be used for things such as a blood glucose check, oxygen + pulse check and even a blood pressure. If you need the inmate to be out of the cell, they also have the ability to open the door and supervise your interaction. There is rarely a time where inmates are left alone with non-badged staff, there is always an Officer on standby if not directly next to you. Part of their role is to keep you safe while they are on duty. They take responsibility of everything that happens in their pod so they will let you know if it safe to proceed or possibly even ask you to return at a later time if too many liabilities exist at that time. The Population First thought of a Jail or Prison and you might be thinking that you will be going face to face with some of the worst individuals hardened by the Institutionalized system. How could you possibly try to help anyone in this setting if you'd be fearing for the worst? At least that's what I thought initially. I came to find out that the people needing help managing their medical conditions are still just ordinary human beings. Some inmates have downright horrible charges and some menial, but I did not choose to work here just to look up each and everyone's case before helping them (although you may come across the occasional National news headliner!). Aside from being in a system that strips them of several freedoms, having medical and mental health needs puts them in a vulnerable position. Many of them respect medical staff especially when they need help and will rarely seek to lash out at medical staff. There are those who are just downright disrespectful and malicious toward Medical and custody staff, but you can easily find the equivalent at a local county hospital. Luckily we have Custody staff to prevent any escalation, whereas the hospital will resort to using nursing staff initially. Similarly, psychiatric units within a hospital are normally ran by the nurses and it is up to them as a team effort to subdue someone who is on a danger to others psychotic break. Rude and disrespectful individuals are not limited to just the Correctional setting, but I am glad a steel door and badged staff exist between me and those types of characters. One of the Safest settings Although you will be working in a facility filled with alleged/convicted criminals or those with violent backgrounds, the facility and workflow were designed for a variety of safety measures to keep every individual safe. This includes Custody staff, Medical staff and the inmates. Policies will vary from jail to jail but the goal is the same, keep everyone safe at the end of the day. To reiterate:
As you can tell, this type of environment is well controlled in many ways from the structural components of the building to the workflow of custody and their integration of medical staff. It does good job of mitigating risk but it does not completely negate the risks involved in this setting. Don't get me wrong, the system doesn't provide a risk free environment but it is definitely reduced especially when you as a nurse take extra precautions to keep yourself safe. There are plenty of precautions that a nurse can take to help keep themselves safer in this type of environment (and is also applicable to other settings as well!) and will be discussed in the next segment. If you're still interested in working in this facility or got an interview be sure to check out The Ultimate Guide to Corrections Nursing Interview
0 Comments
Getting the job
Congratulations! You did it, you finally applied for a Correctional Nursing position at your local county jail or maybe one of many State Correctional Facilities but there is only one problem, you have no clue what the hell they do and what they might ask you in this interview. It can definitely be stressful to think of all the 'what if' scenarios' but if your only reference might be "Orange is the New Black" from Netflix, it can be a little difficult. Being prepared is key so I'll go over some of the most common topics that come up in a correctional setting. Whether you are a brand new nurse or even a seasoned veteran in the field, I hope you will find this information useful. Many correctional facilities are State and County operated but there are also plenty of privately run facilities as well. Expect a panel interview, common with government jobs, possibly with Charge Nurses, regular staff and maybe some administrators. My own interview had two charge nurses, our clinical nurse manager and one regular staff nurse. The thought of having several pairs of eyes patiently watching you as you formulate an answer on the spot can be a little daunting, but I soon realized they only read predetermined questions off a list. Correctional Interviews can be broken down into one of two types of questions
REMEMBER THIS: They do not expect you to know the specifics about Jail and Prison! They don't expect you to have read a policy and procedures manual but it certainly does help if you at least have a basic understanding of the population and common themes found in this environment. A little preparation will show you put a little extra effort into the interview process, which speaks volumes about you as a Nurse and individual.
The Population
Understanding the population of the Correctional system can allow a nurse to identify potential medical issues specific to that group that may need to be addressed immediately or monitored through close observation. There is a wide spectrum of people within the Correctional system. Many Prisons/Jails are able to house the following:
Common Medical Problems
Majority of the inmates found in jail suffer from the same common illnesses as their hospital counterparts. As a result, many institutions implement standardized procedures to address these health issues. You, as a prospective nurse, do not know any of these standard procedures. What you do know is how to effectively assess an individual based on the medical history and presentation. The following are some of the most common medical problems found in correctional settings:
These are no different than the medical conditions you have studied and encountered throughout numerous nursing textbooks. Employers want to know that you know the fundamentals and can readily identify signs and symptoms of a worsening condition before it becomes unmanageable. And more importantly, aside from being able to assess for possible complications they also want to know that you can implement nursing interventions to manage the condition.
Substance Abuse
One of the most common charges of people I see booked in the county jail is possession of illegal substances ie. drugs and public intoxication. This can mean a few things for us nurses. Assessments can be misleading if the individual is currently under the influence of illegal substances. Signs and symptoms can drastically be altered as a result. You do not have to be an expert at drug use but you do need to know the potential complications as a result of habitual use and immediate cessation while in Jail. Many individuals may be reluctant to verbally admit they are under the influence because they think they will be given extra charges. Despite this fact, you must do your best to develop your nursing plan around the signs and symptoms you observe. Common illicit substances and things to look for
Mental Health Disorders
Mental Health illnesses have grown in prevalence among this population. A 2017 study by the U.S. Bureau of Justice Statistics indicates that roughly 44% of inmates had a history of mental health disorders. The biggest concerns regarding mental health illnesses include harming oneself or harming others as it puts individuals in immediate danger. Proper identification of those with mental health problems can assist in getting treatment or medication sooner rather than later. The following are some of the most common mental health disorders found in the Jail/Prison setting:
It is important that you can assess the signs and symptoms of a worsening condition as well as the associated risks. It is not your job to diagnose an individual but instead help identify the needs of a person in a potential crisis.
Questions about you as an individual
These particular type of questions help the interviewers gauge how well you will work within this type of setting alongside the other team members. For the most part it is important that they get a sense of a great work ethic and that they are hiring a team player. Additionally these are common questions asked in a variety of job interviews. I wouldn't call them generic but you can definitely draw from past experiences to help answer these questions. Why do you want to work here? This is definitely more open ended, but we all know what is not the correct answer: the money. Some things that can help set you apart is the desire to work in a new setting that you might find challenging because there is a new learning curve. For example you could discuss how you would like to work with the underserved population. Name a time you had a disagreement with another employee and how you resolved it? This is a common occurrence in the work place environment. Disagreements can happen often but what employers are looking for is that everyone can work as a team to find a solution or compromise. It is not always easy to confront someone regarding a disagreement but the ability to acknowledge their perspective on a subject then finding a compromise is invaluable. Tell us about yourself? This is not your chance to talk about recent episodes of the latest netflix series you are binge watching at this time, but it is your chance to discuss some of the distinguishing qualities of yourself as a person that translates over into your work ethic as a nurse. There are certain traits and characteristics that make employers more confident in hiring you. Key take aways:
Feeling a little more confident armed with the above information? Take the next step with the downloadable study guide that you can take with you anywhere found on the link below
Included in the Study Guide: - Common Questions and answers to them - Specific concerns for Alcohol, Opiates and illicit drugs including explanations of withdrawal symptoms - Additional tips and information of the interview process to help you ace the interview - Includes specific examples of different types of questions and common scenarios Additionally one on one emails are included to help guide you through the process in case you have additional questions! The All You Need to Know: Correctional Health Nurse Interview Guide If you happen to have any questions or comments please send me a message and good luck to you on your journey to becoming a Corrections Nurse. |