Things You Should Know Before Becoming A Prison Nurse

"It was a steep learning curve both professionally and personally and I would honestly recommend any nurse spend some of their career working in a prison."

To succeed as a Prison Nurse, it’s important to get out of the hospital mindset. Former Prison Nurse, Laura Woods, lays out several points to consider for anyone looking to work in this sector.

Topics covered in this article

Introduction

Getting Used To The Environment

A Sensory Overload

Understanding Prisoner Health

A Working Relationship

Learning And Maintaining Boundaries

Looking After Your Personal Well-Being

Introduction

I didn’t set out to work in prisons.

I don’t think many people do.

But after working as an RMN for 9 years in Psychiatric Intensive Care I moved to manage an Inpatient Unit inside a male remand prison.

The prison had over 800 men incarcerated inside, ranging from 18-year olds to 93-year olds.

I had worked with men who had criminal histories in mental health wards and was used to managing disturbed and challenging behaviour.

However, working in a prison is a totally unique experience and one which I will never forget.

It was a steep learning curve both professionally and personally and I would honestly recommend any nurse spend some of their career working in a prison.

Any previous clinical skills and experience can help prepare nurses working in prisons but there are aspects of the role and environment which are impossible to prepare for.

I’ll highlight in this article some of the aspects of prison nursing I wish I’d known before I started!

Getting Used To The Environment

The environment is a shock.

Many United Kingdom prisons were built in the 19th century.

They are imposing, oppressive, old and can feel like a maze to navigate.

Many of the healthcare units have not been purpose built which makes clinical care challenging at times.

I used to undertake full physical and mental health assessments when new prisoners arrived and had to work in a room with no sink, poor sound proofing making confidentiality tricky and often had to remind prison officers to knock before barging in!

Another aspect of the environment is the security and management of keys.

To move around the prison independently you need to have been key trained.

I thought it would take me ages to get used to what keys were for certain doors but surprisingly it took no time at all.

I got used to which route to take to get to certain wings and you become quickly inducted into the prison “etiquette”.

“Coming through” is a phrase you will hear multiple times in a day, as you get to a gate or door and there are other staff coming towards you, a signal to not lock it and allow others through.

You will also quickly learn how to use a radio.

In prisons there is a central communication room or “comms” where communication is managed via a radio network.

Often radio signs correspond to departments based on the phonetic alphabet.

Healthcare is Hotel, so you will sign on the net as “Hotel 1, or Hotel 2” for example.

This is also the commonly used radio sign for emergency calls.

If you are allocated to carry Hotel 2 you will be the nurse responding to emergencies.

A Sensory Overload

I had spent most of my career before working in a prison on a Psychiatric Intensive Care Unit (PICU).

Anyone who has worked in mental health units will know they can be noisy, busy and nurses are alert to the ever-changing energy of the ward.

My first day as a nurse in the prison I remember hearing the emergency alarm go off, I jumped up ready to run to the incident.

A colleague smiled and simply said “you’ll get used to that”.

I think I believed before I started that the prison was effectively an 800 bedded hospital and I was hyper alert to every alarm, raised voice and incident.

Over the first week I quickly got used to the sights, sounds and smells of the prison.

Rather than see it as a giant hospital, I grew to understand the prison as a community and that as a nurse, healthcare was a team working in that community.

We were a cog in the bigger machine and provided a service to those living there.

I didn’t need to respond to alarms, that was the prisons job.

Prisons are noisy.

It will take time to adjust to the shouting, banging, alarms, slamming of metal gates and constant radio communication.

Your nervous system will become desensitised and you will know what to react to and when.

Your nose will also become accustomed!

Wings housing 150 men can be filled with smoke, body odour, mugs of weak tea, instant noodles made in kettles and cleaning fluids.

The atmosphere in a prison can be heavy, the culture raw and alive, the sounds and smells symbolic of some of the struggles.

As a nurse I enjoyed the energy and challenge, the pace and the reward.

Understanding Prisoner Health

One of the first things I became aware of in the prison is the high rates of poor health within the population.

Many of the men I worked with had not seen a GP for years.

Their health needs were complex.

Physical and mental health were closely linked with disproportionate rates of chronic physical illness such as diabetes, asthma and coronary disease alongside serious mental illness such as schizophrenia, depression and personality disorders.

There are also very high rates of drug and alcohol issues which can complicate any other condition.

For nurses working in prisons it is important to be aware of how common substance misuse is and how it can impact basic nursing care.

Those addicted to substances can seek medical care in prison as a way to get medications, hospital appointments and access to doctors so it is important to undertake thorough assessments.

One of the key things to know before working in a prison is never to take any clinical contact at face value.

Take time to ask questions, build rapport with prisoners, think outside of the normal parameters.

It may be a brief contact to provide wound care or give a vaccine but make each contact count.

You may be seen by some as in a position of authority so trust from prisoners in the nurse patient relationship will take time.

A Working Relationship

Before I started working in a prison, it would have been good to have a full understanding of the relationships between the prison system and the NHS.

Having worked in the NHS I was used to the management structures, governance processes and support systems, however when in a prison you have to be aware of both the NHS structures and the prisons and how the two work together.

There were times when I knew what my patient needed, what the best practice was and what nursing intervention was required but I then had to navigate the prison and its various rules and practices.

The underlying ethos of the two systems can feel opposing.

As nurses we are motivated by care, compassion and promoting wellbeing and health for our patients.

At times it may feel that the prison culture is the opposite, motivated by containment and security at best and even punishment at its worse.

I will always remember a case where a young man had swallowed a large quantity of an illicit drug.

I was called to assess him after he began complaining of stomach pain.

On review he was physically deteriorating, tachycardic, raised temperature and a distended abdomen.

I informed the officers that he needed to go out to the local hospital.

The prison staff told me they could not escort him out as they were carrying out searches on the wings, the prison was in lockdown and they were concerned he was a security risk.

The two priorities conflicted.

I continued to advocate for the patient, escalated my request through their management structure and ended up directing the governing Governor.

It can feel difficult navigating the prison structures in order to provide effective nursing care but stick with it.

Where there are challenges there are also rewards!

I think the greatest lesson I learnt during my time in the prison was how important my professional relationships were.

It is easy to align yourself with your patients “against” the prison.

Although advocating for our patients is a must, a balance must be found.

For healthcare staff the people we provide care for are patients first prisoners second, for prison staff the opposite is true.

The best outcomes were always achieved when I was able to work in collaboration with officers.

Learning And Maintaining Boundaries

As nurses we are taught about boundaries, the need to maintain integrity and ensure we act in a professional manner at all times.

Within a prison setting it is so important to be robust with our boundaries.

As a woman working in a male prison I learnt quickly how to communicate in a confident manner, be approachable and professional but also be assertive when needed.

Saying no or challenging unacceptable behaviour can feel scary at first but you will gain respect from both prisoners and staff.

Before starting work as a nurse in a prison it is useful to understand some basic theories of institutions, culture and themes of the population.

A lot of the men and women you will come across in the prison population have spent years being incarcerated and their behaviour has had to adapt to “surviving”.

This can present as challenging, demanding, anti-social and difficult to manage at times.

As a nurse you can be perceived as a friendly face in an oppressive environment or even weak.

Be aware of prisoners using this to their advantage.

Strong boundaries and self-awareness are a must!

Looking After Your Personal Well-Being

Lastly but perhaps most importantly is your own well-being.

Before working in a prison take time to reflect on the personal and professional support structures you have in your life.

I knew prison nursing would be tough, I knew I needed a level of resilience but I was not prepared for the psychological and emotional impact of working full time in a prison setting.

Once inside the prison gates, it is easy to become detached from the outside world.

Days can feel long, isolating and tiring.

No one is immune from absorbing the culture which surrounds you.

Oppression, routine, distress, anger, fear and survival run through the prison population and a level of personal insight is needed to monitor your own stress levels and emotional health.

Take breaks away from the environment, engage with clinical supervision and plan your annual leave to get consistent holidays.

Use personal support from friends and family to maintain an objective perspective.

I would take 5 minutes in the car before arriving home to “de-prison” myself and return to be a mother to my young son.

I would advise any nurse to try working in a prison.

Your clinical expertise will improve, your critical thinking sharpens and the rewards endless.

It is frontline, energetic and never dull!

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