- 06 March 2019
- 12 min read
What to expect from your job as a prison nurse
Ever wondered what it's like to work as a prison nurse? Is it dangerous? Does it vary from working in a hospital? Prison nurse, Laura Woods, tells us about her job.
The prison population in the United Kingdom is at an all time high.
There are approximately 92,500 people incarcerated in 127 prison estates, with the number of prisoners expected to rise to over 94,000 by 2020.
Of the 127 prison estates in the UK, 14 are managed by private companies. The remaining estates are managed by Her Majesty’s Prison Service (HMPS) which is an executive agency of the government.
Health care services within prisons have been run by the NHS since 2002.
Prior to that all health care staff were employed directly by the HMP Service.
This posed significant issues to the quality of care delivered to prisoners with a distinct lack of governance and quality measures inherent in the NHS.
Each prison in the country has NHS health care services with local NHS trusts to the prison usually commissioned to deliver a range of practices.
Prisons up and down the country vary in which health care services are available inside the prison but all NHS services within prison employ both Registered General Nurses (RGNs) and Registered Mental Health Nurses (RMNs).
The principle of health care delivered within prisons is one of equivalence.
This means that prisoners should have equal access to healthcare as if they were in the community.
This in reality is challenging as prisoners present with higher rates of both poor physical and mental health.
For nurses working in the prison however, the population provides a diverse, complex and challenging patient group to work with.
Nurses will work within teams which mirror those found in hospitals, community teams and GP practices outside of the prison.
Primary care services offering nurse led clinics, minor injury units and chronic disease management can all be found in most prison estates. Nurses will also provide emergency response to physical health crisis.
Some prisons have NHS run drug and alcohol treatment services although many of these services are delivered by private or charity run organisations.
In most prisons there are specialist mental health services which provide the assessment, treatment and management for prisoners with mental health problems.
Some prisons have inpatient units or “health care wings” which provide a hospital setting for both mental health and physical health patients.
A day in the life of a prison nurse
The appeal of nursing within prisons is the daily diversity.
Each day will be different with its own unique set of clinical tasks.
As you walk through the prison gates your first task may be receiving a list of prisoners requiring immediate nursing assistance.
Prison staff may have booked people into see you, have wounds assessed and treated, you may triage referrals and decide who requires medical referral to the GP or you may be dispensing medication across the prison and engaging with prisoners around their physical health needs.
Nurses will run clinics which manage prisoners with long term conditions. Clinics include diabetes, respiratory health, cardiovascular disease, musculoskeletal disorders, sexual health and blood born viruses.
Throughout the day nurses will be allocated to respond to emergencies.
Prisons have an alarm system and staff communicate via radios.
When the alarm sounds nurses may be required to respond to potential medical emergencies.
This can include suspected cardiac arrest, respiratory arrests, life threatening injuries as a result of accidents or assaults, drug overdoses or suicide and self-harm incidents.
Nurses often work in teams and have allocated roles to manage the changing clinical demands of the prison.
For nurses allocated to working on health care wings or inpatient units the day represents that of any ward-based service.
Medication rounds, multidisciplinary ward rounds, meeting with patients to assess ongoing needs, developing and maintaining care plans and documenting care.
Mental Health Nurses working in the prison will often carry a case load of patients and deliver both primary mental health care and secondary services.
Some prisons offer psychological group programs and mental health programs which deal with certain types of offending such as sexual or violent offences.
RMNs will offer crisis support and safety planning for prisoners who express thoughts of suicide and develop risk assessments in conjunction with prison staff.
Up to 80% of the current prison population has a diagnosable mental health condition, however only a small proportion of these will require transfer to an outside hospital for treatment.
This means RMNs within prison are dealing daily with a range of serious mental health conditions, including psychosis, mood disorders and personality disorders.
As the law courts in the surrounding area close, prisons can expect anywhere between 10 and 50 new arrivals each day.
Every prison in the country has nurses working in “reception”, the area of the prison where new prisoners are processed.
A considerable role for both RGNs and RMNs is the first night assessments. Nurses are required to screen all new prisoners, covering all aspects of physical and mental health.
Physical observations are carried out, (Blood Pressure, respiratory rate, pulse, oxygen saturation) and full interviews assess current and historical physical health issues, immediate concerns, current medications and any risks which can determine where a person will be located in the prison.
It will then be the nurse’s responsibility to refer to clinics, document assessments and liaise with other professionals across the prison.
Not all prisons have nurses across the 24-hour day, with many NHS services working during the day only.
Where prisons have nurses working at night, they will be based on healthcare wings.
The prison day is influenced by the prison regime and night time is “patrol” state which means all prisoners are in their cells. Nurses are present on site to respond to emergencies only during this time.
What soft skills does a prison nurse need, and how will they use them?
Working in a prison requires nurses to be adaptable, flexible, personable and possess advanced communication skills.
The prison environment can feel oppressive and at times claustrophobic, yet nurses have to deliver healthcare equivalent to services outside of the walls.
This requires resilience and a commitment to the nursing profession.
A sense of humour is a must and an ability to challenge situations or people when advocating for your patients.
The journey to becoming a prison nurse
In order to register with the Nursing and Midwifery Council (NMC) and become a registered general or mental health nurse you have to complete an undergraduate degree.
Applications for university are via UCAS and you will need A levels or equivalent such as an access course in health studies.
Many universities will expect you to have some experience in your chosen field such as working in a hospital as a nursing assistant or evidence or working with people.
Whilst undertaking your degree you will have the opportunity to do practice placements in a range of clinical areas.
If the NHS trust local to your place of study delivers health care in a prison, then enquire about doing a student placement there.
Most prisons will allow students to visit and spend a day with nurses. Don’t be afraid to ask!
Why prison nursing?
Working as a nurse in a prison is fascinating.
Some prisons in the UK house over a 1000 men or women with ages spanning from 16 in Young Offenders Prisons to 90-year olds in adult prisons.
As a population, prisoners have complex physical and mental health needs and, in every interaction, there will be a multitude of factors which need assessing.
Prisoners often arrive in poor physical health and for some, you will provide them with their first access to health care for many years.
Unique to the prison is the opportunity for screening and health promotion.
Prisoners are a captive audience, with some incarcerated for many years.
For example, some disease management will require regular monitoring.
In the community this relies on people attending appointments, engaging with their treatment. In prison, patients are available, present and accessible.
For nurses it is also an opportunity to work easily alongside other professionals in order to offer multidisciplinary care.
All under the same roof, sexual health nurses, GP’s, Psychiatrists, Podiatrists, mental health nurses, psychologists, pharmacists, social workers and substance misuse practitioners can collaborate to assess, treat and manage the complexities prisoners present with.
I'm qualified - what does my career path look like?
Once you qualify as a nurse you will be able to apply for a substantive post.
Prison health care will employ newly qualified nurses as well as more senior roles like Charge Nurses, Sisters or Matrons.
There are many post-qualifying courses which you can complete once working in a prison.
As a registered nurse you will have to complete courses which contribute to your continuing professional development.
For prison nurses this may be include specialising in an area of physical health such as cardiovascular disease or respiratory medicine or you may decide to develop an interest in offender health by completing a course in criminology or forensic nursing.
Working in a prison provides a range of career pathways for Registered Nurses. It will equip any nurse, no matter what the speciality with skills above and beyond their scope of practice.
You may decide to run a nurse led clinic and train in your chosen field as a Clinical Nurse Specialist.
Working as an RMN in prison - mental and physical work
Nursing inside a prison will require joint working between nursing disciplines.
RGNs will work with prisoners who have complex mental health conditions and RMNs will work with mental health patients who may have acute or chronic physical health issues.
So, yes, in many teams within the prison General Nurses and Mental Health Nurses will work in collaboration.
A collective approach to working with prisoners is needed and the relationships between general and mental health nurses are vital.
When responding to emergency situations it may be common for pairs of nurses to respond in order to offer both an RMN and RGN approach to care.
Rewards and challenges
Working within prison estates was one of the most rewarding times in my career.
Each day I was faced with new challenges and no two days were the same.
Often I was the first person a prisoner would meet as they arrived.
For those arriving for their first time in prison they were frightened, hopeless and completely overwhelmed.
I was able to provide reassurances and support at a highly difficult time.
Nursing in the prison motivated me to improve all of my clinical skills.
The challenges created opportunities for clinical and professional development.
As an RMN I learnt advanced physical health assessment skills above and beyond the usual scope of practice in Mental Health.
The greatest challenge was the environment itself and the interface between the NHS and the prison service.
As a nurse I had to work at not only delivering the best nursing care but also overcoming the prison system in order to do this.
Being inside the prison walls makes you vulnerable to feeling isolated along with the people incarcerated there.
As a nurse I had to commit to staying connected to practice within the community in order to stay connected to the rest of the NHS.
Working in a prison is not for everyone but for those who chose to work there it will provide you with challenges and rewards that will have a lasting positive impact on your nursing career.