Drawing from her own experience, Nurse Consultant, Laura, examines what kind of person can be a Prison Nurse, and how. Understanding and viewing the prison population with empathy is key.
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How To Become A Prison Nurse
Working in a prison provides unique challenges for any nurse.
The environment, the prison system, resources and the population of patients can make nursing within prison settings difficult at times, yet the challenges also provide significant rewards.
I worked as a Band 7 Mental Health Nurse and later a Matron within a male prison and it was one of the most interesting and enjoyable times of my career.
I had always had a fascination with prisons, driving past the aboding walls and windows dressed in iron bars, I had often wondered what it was like the “other side”.
I didn’t plan a career working in forensic mental health but ten years after qualifying I found myself managing a prison health care service.
In this article I will talk about the routes to becoming a prison nurse and the courses and training you may want to do to support your journey to working in a prison.
Learn About ‘Prison Health’
When considering a career in prison nursing it is useful to have an understanding of some of the political, social, legal and economic aspects which influence the delivery of health care in this setting.
I guarantee it will come up in any interview for a prison nursing job!
The right to health is a fundamental human right and is protected within the European Convention on Human Rights, under Article 2 (Right to life) and Article 3 (freedom from torture and inhuman or degrading treatment).
Those incarcerated in our prisons are protected by the Human Rights Act and their access to health care should be equal to that of people outside of prison.
The actual act of incarceration is the punishment for a crime.
Once in prison, people are under the care of the state and shouldn’t receive any further punishment or unfair treatment.
The health care offered to the prison population has received significant political interest over the last two decades.
A vast array of national and international policies and guidance have been developed to support the principle of “equivalence”.
Have a read of the Bradley Report published in 2009 or the recent National Institute for Clinical Excellence (NICE) guidelines for the physical health of prisoner to get a better understanding of some of the needs of prisoners.
Perhaps the biggest change in prison health care was the contracting of all health care to the NHS in 2006.
With the NHS having responsibility via local primary care and mental health trusts, health care within prisons saw improvements in quality, access to treatments and governance structures.
This change also supported nurses working in prisons to complete training, supervision and maintain professional development links.
Throughout my career I have remained passionate about fighting injustice and ensuring some of the most vulnerable people in society receive appropriate health care.
To be a prison nurse you may be required to reflect on your own moral and ethical belief systems.
Men and women are incarcerated as they have committed a crime and there are times when their crimes may upset you or effect you emotionally.
I would always recommend engaging in clinical supervision to support your own wellbeing as a nurse.
Unless I needed to know a prisoner’s crime because of a risk issue, I chose not to ask about their crimes, instead viewing each prisoner as a new patient and working with them as I would in any other clinical environment.
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Understand The Prison Population
What makes nursing in this environment interesting and rewarding is the significant health needs of the prison population.
There are currently over 83,000 people incarcerated in prisons across the UK, approximately 79,000 males and 4000 women.
It is widely accepted that prisoners present with higher rates of both physical and mental illness.
There are often significant complexities with substance misuse problems, self-neglect, chronic conditions and serious mental health problems.
During my time working in prison I don’t think I ever met a prisoner with just a single issue, there were always multiple needs to address.
It made nursing interesting, dynamic and rewarding!
I would be asked to see a prisoner who had chest pains.
I would complete my physical health assessment and then when talking with them I would learn they were seriously depressed, had not eaten for days, had grief issues, had been abusing alcohol before arriving at prison and had significant underlying health concerns like diabetes or heart disease.
Be Proactive With Training
As most healthcare in prisons is run by the NHS or private health providers, the journey to becoming a prison nurse follows that of other nursing specialisms.
All nursing courses are now degree level with entry to university courses via UCAS applications.
As a vocation, many universities will look for relevant experience to support applications.
It is a good idea to try and gain experience working in clinical settings, for example, nursing assistants in hospitals, care homes, day centres.
In 2019 the Nurse Associate role was developed.
TNA’s are registered with the Nursing and Midwifery Council and undergo training in a range of clinical skills.
It is now commonplace for NHS trusts to fund staff to undertake this course with support to complete academic training and a range of clinical placements.
The TNA role is an excellent way to progress becoming a qualified nurse.
If funding a degree is too difficult for you the Open University are now doing nursing as a degree with many NHS trusts funding the part time course whilst you work.
Whichever route you take into nursing, if prisons are an environment you are interested in then the placements you do as a student can support your career once qualified.
Be proactive when you are studying, contact local prison health care services and ask to visit.
Your university should have practice links with the staff inside of the prison to share with you.
A top tip is contact early!
In order for any staff to work in a prison you have to go through substantial security checks, this can be a lengthy process.
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What To Do After Qualifying
Once you are registered with the NMC as a qualified nurse you can apply for nursing jobs in prisons.
Each prison will have different structures and services and will employ a range of nurses.
Adult, general nurses (RGNs) may be employed to run clinics for diabetes, respiratory disease, coronary disease amongst others.
Most prisons have a response service, so nurses will respond to physical emergencies.
This can appeal to nurses who enjoy fast pace clinical work and often nurses with A&E experience apply for these roles.
For Mental Health Nurses (RMNs), prisons offer a range of services including inpatient units, crisis teams, drug and alcohol teams and integrated mental health teams which run like community mental health services.
If you want to work within prisons, there are specific training courses or academic qualifications which can support you.
Some nurses will already have a degree in criminology or psychology and there are universities which offer forensic specific masters level courses.
I gained a MSc in Clinical Forensic Psychiatry from Kings College and it advanced my career significantly.
It focused entirely on working with patients within the criminal justice system and improved my knowledge base and clinical skills.
Do some research into the range of courses offered.
It may be that you want to do a shorter course in substance misuse, mental health problems or more clinical courses such as wound care or assessment skills.
There is also a wealth of literature relating to offender health.
If you have an interview for a prison nurse job it is vital you do some background reading.
Look up news articles, academic papers and national guidance.
The specific needs of prisoners are often in the media and there are academic journals devoted entirely to offender health.
Any registered nurse, from any clinical background or interest can find a role within the prison establishment but the important thing is to recognise the significant cultural and environmental challenges the prison can present.
Challenges Faced By A Prison Nurse
Prisons by their very nature can be in direct conflict with “health”.
The act of incarceration can be detrimental to anyone’s physical and mental health and as a nurse working in a prison it can often feel that you are working with poor health caused, effectively, by the prison.
It takes resilience and an ability to look after your own health to work inside prison.
They can at times feel oppressive and you may feel “locked” away from the outside along with your patients.
I would always diary in some time to link with outside clinical services to maintain connections to the NHS.
A further challenge is working across two systems, the prison and the NHS.
Both organisations have different management structures, differing polices and ultimately different priorities.
I often found it frustrating having to navigate both systems when trying to deliver effective nursing care.
The key to overcoming this is building good relationships with prison staff.
There will be prison staff who are assigned to healthcare and having working relationships with these officers helped me and my patients greatly!
The day to day running of the prison is called the “regime” and it can often present challenges to nursing.
There are certain times of the day when prisoners are not allowed out of their cells and whenever they are, they will need to be escorted by an officer.
This can sometimes impact clinic running times, access to unwell prisoners and delivering certain treatments.
As a nurse I found I embraced these challenges.
It required me to be creative and determined and made each day interesting!
The journey to becoming a prison nurse can follow many different paths.
It was unusual to meet nurses who had set out to work in prison from the beginning of their career.
Many had worked for an agency and covered some shifts only to find they loved it!
There are perhaps many myths about working in prisons.
Will it be scary?
Will I experience violence?
Will I become de-skilled or detached from other NHS colleagues?
The only way to really find out if you enjoy working in a prison setting is go and visit, work a shift and get to know the unique environment.
I was often the first person a prisoner met on arrival as all prisoners have a full health screen on their first day.
I worked with prisoners as old as 93 and as young as 18.
It was never a dull day!
I loved my time working in prison and still undertake assessments in prisons across the country.
Working with the prison population is interesting, diverse, varied and incredibly rewarding.
Browse our available Prison Nurse jobs here.
Let me know in the comments your thoughts on becoming a Prison Nurse and what I've said about my journey - let's chat there!
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