When first thinking of prison services, healthcare provision may not be the first thing that springs to mind in terms of priorities for safety. However, prisoners require healthcare and medical intervention as much as the wider population, but may also require greater attention in areas such as mental health and substance misuse disorders. There are just over 92,000 inmates currently situated in British prisons across the country, posing a substantial requirement on the provision of healthcare across 127 prisons. Since 2002, the NHS have taken over employment of healthcare staff to work within prison services – before this time it was direct employment as healthcare workers through Her Majesty’s Prison Service. Throughout most prisons, there will generally be RGNs and RMNs, with certain services employing more specific nurse appointments depending on the specifics, demographics and care needs of the patients. In this article, we hope to outline the challenges and prospects of working as prison nurse, often providing care to those who need it most in a dynamic and unfamiliar environment. In a discussion with Nursing Times, nurse Stephanie Smith said of the sector, “you don’t need to be brave or stupid to work in a prison – you just need to be non-judgemental”, highlighting the misunderstanding around the real value of working in this setting.
Many prison nurses mention their surprise that although a prison setting may initially seem intimidating, life inside the prison as a healthcare professional can be similar to treating patients in other care centres. The everyday tasks of providing medication, ensuring safe access to controlled medication, querying and chasing up care reports for vulnerable patients and supervising clinics are still found within the prison setting. Furthermore, typical sanitation routines are employed as outside of prison, including safe waste and needle disposal following blood tests and small medical procedures within the prison. There may also be different clinics that are run at different times of the week and month to allow specific demographics of patients to be treated effectively and efficiently – for example, patients with diabetic and metabolic disorders may be seen in a combined clinic. There will also be clinics for patients with specific healthcare needs like those who have viruses like HIV or hepatitis and require more intensive monitoring and long term planning. For those patients subject to assault or health crises, some prisons may have a medical ward whereby close watch can be kept on patients and their health monitored on site, rather than transport to a hospital.
For RMN’s, the role involves providing care and working under senior clinicians to carry out care plans, with a possibility of large amounts of autonomy in helping prisoners and patients alike. Having a non-judgemental attitude in this patient facing context is important to ensure high levels of care and consistency in practice. RMN’s may work with patients who have complex mental health needs, giving services such as triage to counselling and therapy, dealing with medication requests and support, and talking with patients and prisoners to optimise their care as best possible. A large part of the RMN role within prisons and secure services is keeping the mental health of the prisoners as a priority whilst they serve their sentence, and to keep their human rights and dignity intact. Prisons can be an unforgiving, dark environment, particularly for those serving long sentences, and co-morbidities of pre-existing mental health conditions can cause a deterioration in some prisoners. Thus, it is the role of RMN’s, care staff and prison staff to ensure the quality of life of patients is kept to a good standard during their time in care. Some prisons may also run specific clinics for certain offences which may require psychological therapy or counselling to address to prevent reoffence such as assault and sexual offences. A vital role of an RMN is to provide crisis support to those found self-harming or attempting suicide, which can be an eventuality in prison care, particularly for those patients subject to long sentences or violence during their stay.
Regardless of the healthcare role, prison staff and healthcare providers such as nurses have a responsibility to ensure prisoners receive care services akin to those within the community. Nurses also have an important role to empower prisoners to be vocal about their health, triage their health issues to other secondary and tertiary care teams, and to ensure the mental wellbeing and human rights of the prisoners is being kept to good levels. Although the sector may seem intimidating, unsafe and frightening, the standards of care within prisons are often of utmost importance in keeping the morale and health of prisoners as high as possible. Prisons offer a different aspect of healthcare to those used to working in the community, as this job allows nurses to empower members of society who are so often seen as not deserving of basic healthcare provision. Through non-judgement of prisoners, compassion can be bred and high levels of healthcare can be provided to continue the equality of healthcare excellence needed across the societal spectrum.