Correctional nursing moves to the head of the class.

Providing inmates with health care is a critical part of the operation of every correctional system in the U.S. For the medical staff working in jails and prisons nationwide, the correctional setting poses unique challenges. Many inmates have a history of high-risk behaviors, compounded by a lack of medical care or treatment. Therefore, they are more likely to have chronic illnesses and infectious diseases than people who live in the community. The U.S. Bureau of Justice Statistics reported in 2006 that more than half the nation's inmates in jails and prisons had a mental health problem. Inmates who had a mental health problem also had a high rate of substance dependence or abuse, according to BJS.

[ILLUSTRATION OMITTED]

Security concerns are also an issue for medical staff providing care in a correctional environment. Inmates may act inappropriately and their behavior may be unpredictable. Some inmates may become violent. Others may try to manipulate medical staff for their own benefit. Despite these concerns, medical staff know that security staff are always present to provide backup or assistance in case of an emergency.

With all the challenges medical staff face, "outsiders" may wonder why anyone would want to work in a correctional setting--especially nurses who must work directly with inmates on a daily basis. The American Nursing Association (ANA) believes the answer for nurses lies in the unique role that they play in providing a variety of medical services. In the book Corrections Nursing: Scope and Standards of Practice, ANA notes that registered nurses are the "primary health care providers in correctional settings." ANA points out that because health care is provided in community corrections and institutional settings for adults and juveniles, registered nurses must be prepared to "address a wide spectrum of needs," including women's health, pediatric through geriatric services and end-of-life care. Working with inmates requires a "sound background" in public health; psychiatric, emergency, chronic and critical care; disease management; and medical-surgical services.

Personal Satisfaction

DeeAnn Marsh, RN, CCN/M, who began working as a correctional nurse, is now the medical director of the Dakota Women's Correctional and Rehabilitation Center in New England, N.D. When asked what a typical day was like for her as a nurse manager, she replied: "Well there is no typical day at this place. I think that is what makes my job so much fun. I look forward to coming to work every day because every day there is a challenge of some type. Our team is always busy--24 hours a day, seven days a week. We do nursing assessments on inmates who complain about health issues. We do all our own blood draws. We do doctor calls, minor surgical procedures, psychiatric doctor calls and dental doctor calls. We treat injuries such as cuts or broken bones. And then there are the true medical emergencies that we have to deal with: anaphylactic shock, heart attack and stroke. This is just a little bit of everything we do every day."

According to Colby Braun, Marsh's supervisor and the operations manager of the center, nurses are the "driving force" behind the medical program. This belief is shared throughout corrections. The work of the nurses benefits offenders and staff as well as the facility, Braun said. In addition to providing medical care, correctional nursing involves promoting healthy behaviors. Indeed, providing health education is a key part of correctional nursing and an important task for the nurses at Dakota. Nurses at the center are able to "educate inmates on ways to change the things that are affecting their lives," Braun said. The goal is to persuade inmates to take responsibility for their health.

Braun points out that nurses have a positive influence on the climate of the facility. "It is the first time in a lot of inmates' lives that they have been able to focus on themselves, and medical issues are very high on the list. By dealing with inmates appropriately, the nurses are able to calm them. Inmates believe that their medical needs are being taken care of." A calm climate is a benefit for the line staff as well. "If the inmates are feeling good about what is happening around them and they feel confident, then it makes it easier for the line staff in the housing unit," Braun said.

Nurses in Demand

It comes as no surprise, therefore, that correctional nurses are in great demand, like their counterparts in hospitals and other health-related organizations. One of the keys to recruiting nurses is undoubtedly the rewards associated with a career in correctional nursing. While Marsh characterized the work as "fun," Braun explained that many nurses "have come to the facility from a hospital or nursing home" and "really love what they do." Carol Braun, who previously worked in a hospital dialysis unit and is now a nurse working with the Florida Department of Corrections, was quoted in the department's recruitment brochure for health care professionals. Like many other correctional nurses, she explained why a career in corrections is so satisfying. "Correctional nursing is very challenging and rewarding. It's a place where I provide care using every skill I learned in the classroom. I find satisfaction in the fact that inmates are grateful for the care and compassion provided to them. ... Correctional nursing has enabled me to grow personally and professionally as no other nursing experience has. There is no comparison."

The department's job description for registered nurses illustrates the range of responsibilities they have: "This is work in assessing patient health problems and needs, developing and implementing nursing care plans, and maintaining medical records. This employee administers nursing care to ill, injured, convalescent or disabled patients. The incumbent may advise patients on health maintenance and disease prevention or provide case management. This work may also include inspecting facilities and/or evaluating or providing consultation on health care programs, services or policies."

A U.S. Federal Bureau of Prisons job summary for a registered nurse not only illustrates the varied duties of correctional nurses but also the continuous need for RNs in its institutions across the country.

Unfortunately, a career in corrections is often not the first choice for many nurses. Reasons for this may have to do with salary, the specialty being less known than other nursing specialties, and nurses having a negative view of working in a correctional environment because of misperceptions. Corrections often receives a bad rap in the media; riots and escapes garner negative headlines while the positive, hard work of correctional staff goes unreported.

[ILLUSTRATION OMITTED]

The Benefits of Certification

The good news is that the efforts of correctional agencies and the American Correctional Association have highlighted the many opportunities available to correctional nurses, including job satisfaction and professional growth. Today, some nursing schools offer students a chance to study correctional nursing, and positive articles about the specialty can be found in magazines and on nursing-related Web sites. ACA has taken a significant step toward enhancing the image of correctional nursing by developing a certification program for nurses and managers. Becoming certified demonstrates that a nurse has mastered the body of knowledge required for his or her specialty; a certified correctional nurse denotes a specialization, like cardiac care, flight/transport, and labor and delivery. Many other organizations promote nursing certification in general. For example, The American Nurses Credentialing Center said that certification "shows that you have made continuing professional development a priority and an integral part of maintaining your ongoing competence to practice--providing evidence to the public and the profession of the strength of your nursing abilities." The Massachusetts General Hospital said it "serves as a testimonial to your dedication to nursing, bringing a greater accountability to the profession," and it distinguishes "you as a resource and leader to your colleagues in your specialty." The August 2007 Journal of Neuroscience Nursing, agreed, "Certification in a specialized area of nursing supports one's knowledge base and reflects competence [and] professional commitment to lifelong learning through required continuing education and re-certification and documented experience in a given specialty."

Even scientific research has shown positive results for certification. The American Board of Nursing Specialties (ABNS) reported that "numerous studies have demonstrated the positive benefits of nursing certification." ABNS conducted its own study to "validate nurses' perceptions, values and behaviors related to certification." The 2006 study of more than 11,000 nurse respondents from 20 specialty nursing certification organizations representing 36 different certification credentials documented the perceived value of certification among certified nurses. "It is perceived to enhance feelings of personal accomplishment, provide personal satisfaction and a professional challenge, enhance professional credibility, and provide evidence of professional commitment."

Perhaps the best testimonial of the benefits for becoming a certified correctional nurse is from a recent graduate. Marsh first became a certified nurse and continued with her professional development by becoming a certified nurse manager when she became medical director of Dakota. She shared her experience about the program: "Initially, I just wanted to test my knowledge of correctional nursing, but as soon as I found out that I had passed the exam and became certified, I immediately knew that 1 wanted to take it as far as I could. I became a certified corrections nurse manager in January 2008. I wanted to gain as much knowledge about this challenging and diverse specialty as I could."

Marsh said she has received many benefits from her certification, both personal and professional. "I have gained recognition and respect from my peers and my supervisors. Also, the knowledge I attained really gave me added confidence in the decisions that I have to make at the women's prison on a daily basis." She encouraged other nurses to become certified, explaining, "As far as the nursing profession, I think it is going to help to increase the awareness of the challenges and rewards in the field of correctional nursing. I believe that most people really don't have any idea of the level of expertise that is required to be a correctional nurse. Only the best nurses make good correctional nurses."

Colby Braun, commended Marsh's efforts and said that he has seen her grow professionally. He noted that the agency's medical director is "excited about Marsh's accomplishment." Braun also said that Marsh's certification "is a great thing for the facility. It brings credibility and integrity to the department."

Correctional nurses who are ready to join their certified colleagues can learn about the program and download an application at www.aca.org/certification or contact Peg O'Brien, ACA's certification specialist, at [e-mail] to discuss the program.

RELATED ARTICLE: Certification for Correctional Nurses

ACA launched its certification program for nurses in January 2007. Since that time, correctional nurses and nurse managers throughout the country have taken the step to become certified. The easy-to-follow process begins with enrollment in the program. You simply complete the application and send it, along with the required documentation, to Peg O'Brien, certification specialist. You can then begin studying for the comprehensive exam with (optional) study materials that can be purchased through ACA customer service. The next step is to sign up for a testing site and take the exam. Tests are proctored at ACA conferences, affiliate conferences and on an as-needed basis throughout the country. The schedule for the testing sites is on the ACA Web site. After you pass the exam, you will receive a certification certificate and a packet of information that explains the re-certification process. Most important, you will become part of a select group of certified correctional nurses.

Diane German is the educational and training products manager for ACA. Peg 0 'Brien is ACA's certification specialist.