Prison nursing: why its complexity makes it a rich learning environment for students

The wide spectrum of healthcare need in prison, along with its multidisciplinary working, makes criminal justice a highly rewarding setting for clinical placements

When I tell people I work in a prison, they often assume I face threats, violence and intimidation on a daily basis. But I have worked as a prison nurse for four years now, and none of these are part of my day-to-day life.

In fact, it is quite the opposite; my days are often filled with laughter and gratitude, and I take great pride in delivering quality health care to vulnerable people who are often at the lowest point in their lives.

My career came to a turning point and now it’s flourishing

Working in a prison had always appealed to me, but I wasn’t sure whether I could do it, and after gaining my adult nursing degree in 2014, my first staff nurse post was on an acute surgical and gynaecology ward.

When the ward became an elective unit three years later, I knew I would miss the fast pace of working in an acute setting, so used this as an opportunity to move my career in another direction.

I decided to take the plunge and applied for a job with Practice Plus Group in the primary care department at HMP Wakefield, a high-security male prison that also has an in-patient unit. I was successful in securing the post, and within 18 months I had been promoted to my first band 6 position.

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My career has flourished in the prison environment and I have been able to explore the learning opportunities this setting has to offer. I have gained my non-medical prescribing qualification, and in August last year, I transferred to women’s prison HMP New Hall in West Yorkshire as the band 7 primary care clinical team lead.

Working in a prison combines elements of general practice and emergency nursing

Prison nursing is complex; I often describe it as a combination between practice nursing and being an emergency department nurse. It is thought-provoking and pushes you to use your clinical judgement in a huge variety of ways, yet it is an area of nursing seldom spoken about in the nursing community.

My day often begins with clinics, where I see patients requiring services including phlebotomy, wound care and sexual health. But I can be called on to see a patient in acute crisis at any moment, ranging from an asthma attack, drug misuse or myocardial infarction to mental health crisis or even attempted suicide.

‘Many prisoners are victims of trauma, and forming therapeutic relationships with them and making a difference to their lives is incredibly rewarding’

At HMP New Hall, we have nursing teams specialising in long-term conditions, substance misuse and sexual health, as well as a team of advanced nurse practitioners. We also have a specialist midwife for our mother and baby unit, a fantastic mental health team and a learning disability nurse.

Patients in criminal justice settings present with a broad spectrum of health needs

This allows our team at HMP New Hall to offer a range of learning opportunities to students, and provide placements for those studying adult, mental health and learning disability nursing, as well as midwifery.

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No two days are the same when you work in a prison, nor are the patients we treat. The appeal for me has always been – ‘what will today bring’. In just a 20-minute appointment, for example, I can teach someone how to care for their own wounds and provide education about medication use and drug safety. I can have a positive impact on their health that can even save the person’s life.

Working in a prison enables me to broaden my nursing skills and continually develop myself and my team to meet the demands of the patients we treat. Within the space of a day, my nursing skills are drawn to every corner of the clinical sphere, and it’s a humbling environment.

Opportunity to develop communication skills as part of the multidisciplinary team

During a placement in a prison, you will meet people from a variety of backgrounds and circumstances. Working in the confinements of the prison walls is a great opportunity to improve your communication skills, which will benefit you throughout your nursing career, whatever path you choose.

Multidisciplinary team working is essential in a prison and is an integral part of any decision-making process. As well as the nursing teams, a typical multidisciplinary team in a prison includes a GP, pharmacist, dentist, healthcare support workers, recovery workers and physiotherapists.

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Not only will you have the opportunity to become a vital part of a vast health in justice team, you will be supported to take the lead in decision-making processes and use the knowledge of those around you to create evidence-based, effective care plans for the patients you meet.

Therapeutic relationships with individuals who have experienced chaos and trauma

Before coming into prison, many of my patients had highly dysfunctional lives that lacked structure. Appointments were often missed and medications misused, with their healthcare needs quickly spiralling out of control.

Entering prison gives them the structure they need to allow them to help themselves, with our support. Many prisoners are victims of trauma, and forming therapeutic relationships with them and making a difference to their lives is incredibly rewarding.

‘A placement in a prison will increase your confidence, and help you develop coping mechanisms for dealing with almost any situation you may face in your nursing career’

There is an element of risk in prison nursing, which is higher than in most other workplaces. But we have prison officers in place to protect us, along with robust policies and procedures we have to follow.

I often think I am more at risk just walking around a supermarket, where you have no idea who is in your vicinity. In a prison, you do, and you follow the guidelines to keep yourself and your colleagues safe.

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It is also important to remember that prisoners are people just like us; I once tripped over on a landing where the cells are and felt someone grab my arms to help me up, asking if I was okay. When I looked up to thank them, it was a prisoner, not a colleague.

Being thrust into the prison environment has given many of my patients the time to focus on bettering themselves and managing their healthcare needs. Overcoming addiction, managing long-term conditions and sexual health treatments are just a few examples of healthcare concerns that are high on their priority list.

A nursing career that’s not for the faint-hearted

Prison nursing can be challenging at times. It is not for the faint-hearted, and can sometimes make you question your role or purpose in the situations you are plunged into behind the prison walls.

But it is incredibly rewarding, and as a nursing student, you will gain many valuable skills that you can take forward in your nursing career. A placement in a prison will also help increase your confidence, and you will develop coping mechanisms that will help you deal with almost any situation you may face during your nursing career.

Prison nursing is unique. If you are interested in a placement in a prison, why not give it a try? You won’t regret it. If you have any questions or just want advice, please feel free to contact me on Twitter at @nurseinjustice.

Emma Firth is the primary care clinical team lead at HMP New Hall in West Yorkshire