Correctional forensic nurses provide healthcare to those incarcerated in the criminal justice system in a variety of settings such as jails, prisons, and juvenile detention centers. Jails are managed by cities and counties; detaining individuals arrested but not yet tried for an offense (pre-sentence) or serving out a sentence of less than 2 years. Prisons house individuals convicted of a crime and can be managed by the state or federal government depending on the nature of the offense. Juvenile detention centers varied and can hold both pre-trial and sentences youth. In addition, youth sentenced for serious offenses may be placed in adult facilities.
The role of a correctional forensic nurse
Correctional nurses are often the first health care professional to see an inmate about a medical condition. A thorough assessment allows the nurse to determine care requirements. This could mean delivering nursing care directly or arranging for the patient to see a physician or advanced practitioner. Correctional nurses must often work closely with corrections officers in situations such as emergencies in the housing units or monitoring inmates for medical attention. These nurses are challenged to provide maximum health care in a setting with a mission and design for other purposes – security and public safety. Therefore, resources can be limited and creativity is needed.
Nursing care in jails and prisons differ based on the length of time in contact with the patients and the context of care. Jails have more frequent turn-over of inmates and these individuals have recently been removed from their normal living environment. This means potential for drug and alcohol withdrawal is high; communicable diseases is concerning; and attention is given to urgent and emergent conditions. Prison nursing involves a longer contact with the patient population leading to management of chronic conditions and a more stable health care environment. Although infectious diseases continue to be of concern in a closed community, prison heath care has reduced concern for withdrawal and an increased focus on chronic disease management.
Several nursing processes unique to the setting help in managing nursing care in jails, prisons, and juvenile detention settings:
Intake Screening: Correctional forensic nurses screen inmates entering the facility for a variety of immediate medical and mental health needs such as alcohol or drug withdrawal, suicide potential, trauma, infectious diseases, and chronic medications. This screening assists custody with housing placement, initiates scheduling for ongoing health visits, and determines if the inmate must first be seen in an acute care setting for injury treatment.
Chronic Care Clinic: Inmates are scheduled for regular appointments in the medical unit to manage chronic conditions such as hypertension, asthma and arthritis. In addition, chronic care clinic visits might be scheduled to attend to infectious processes or pregnancy management. Although a chronic care visit involves contact with a physician or advanced practitioner, correctional forensic nurses provide key elements of chronic care management including patient education and medication compliance review.
Medication Administration: Because many medications, even over-the-counter preparations, can be misused in the correctional environment, these medications must be administered individually through a medication pass or pill line process. Several times daily the inmate population requiring medication doses report to a nurse for administration. This may be centralized in the medical unit or decentralized with nursing staff administering medication in the housing unit.
Nursing Sick Call: Nurses provide episodic health care services to correctional patients through a request system called Sick Call. Inmates request treatment, usually in writing, and are seen by a nurse. Standardized protocols allow administration of over-the-counter medications for simple conditions like athlete’s foot, constipation, or the common cold. If the nursing assessment indicates an acute condition, a follow-up appointment with a physician or advanced practitioner is arranged.
Although graduate nurses have been successful in assimilating into the role of correctional forensic nurse, the autonomous nature of the role and need for excellent assessment skills warrants experience in general nursing practice before entry into the specialty. In particular, a background in emergency and/or mental health nursing is helpful. Currently, certification is not required to enter a position as a correctional forensic nurse, however, certification is available through the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA). Information links for these certifications are included in the resources section.
Written by IAFN Corrections Task Force Member, Lorry Schoenly, PhD, RN, CCHP-RN. Dr Schoenly is Visiting Professor, Graduate Nursing Program, Chamberlain College of Nursing and a Correctional Health Care Risk Consultant.