Nov 02, 2020
By Britney Saik
A correctional facility nurse describes what it’s like to work on the ‘inside’
Tuesday, June 4, 2019, started off like any other day. Typical routine: work starts at a dawn-breaking 06:45 hours. So, as usual, I stumble out of bed, hair dishevelled, feeling befuddled after four wake-up alarms perturbed my otherwise deep, restful sleep and quiet, yet vivid dreams.
I assemble myself, and arrive at my workplace — a correctional facility — heroically, on time.
On this particular Tuesday, I receive an email congratulating me on five years of nursing service. Half a decade of being a registered nurse — extensively in corrections and casually in the field of oncology. It was a real milestone.
What I learned
Working as a nurse in a correctional facility has given me diversity in experience, expanded my assessment skills, and enhanced my autonomy for critical decision-making.
Correctional nurses wear many hats: we connect and listen to the stories of patients with a history of psychological and physical trauma. We heal the sick through wound care, administer IV antibiotics or fluids, as well as monitor and treat patients for opioid and alcohol withdrawal.
Correctional nurses also care for patients experiencing various health conditions, such as acute or chronic illnesses, suicidal ideation, hunger strikes, or even care for patients pre- and postoperatively.
We dutifully safeguard our radios as we listen overhead for various codes announced. Code 99s signal medical distress, when correctional health-care team members, including physicians, nurse practitioners, nursing staff, and paramedics intervene and expediently treat patients — perhaps for an opioid overdose, or a seizure, or physical trauma from assault. We also listen for codes to alert staff to inmate violence toward other inmates, or codes of inmate aggression toward staff members.
Correctional nurses wear many hats: we connect and listen to the stories of patients with a history of psychological and physical trauma.
A challenging environment
Correctional nurses acknowledge the potential violence and volatility of the environment in which we work, while carrying out our tasks of routine nursing care.
Yet jail can also be reframed as an opportunity for patient rehabilitation, to achieve wellness. (I’ve witnessed three patients in the last five years who personally chose to delay their bail because of the exceptional health care they received while “inside”!)
Nurses assist and empower patients to face their innermost challenges, during their most vulnerable and distressing life moments, through collaboration with multidisciplinary team members as well as correctional officers (COs).
COs are critical to ensuring staff safety, and are eager to aid the health-care team. They provide assistance to health-care staff during incidents of inmates’ medical distress. They also alert nurses to inmates’ psychological decline or aggression. In my experience, collaboration between health-care staff and COs is fostered through mutual respect, professional accountability, role recognition, and collegial support.
Burnout and bliss
I’m fortunate in that I haven’t succumbed to physical fatigue or mental exhaustion, unlike so many of my nursing colleagues. Many times, I’ve assumed the role of counsellor or advisor to a colleague, creating a safe haven for them during times of frustration, sadness, and burnout.
I fell in love with the helping and healing aspect of nursing. However, I think it’s natural that at some point in every nurse’s career, one may be faced with some kind of dichotomy — a disharmony between two things in opposition to each other. It occurs when a nurse intrinsically feels a certain way yet must act in opposition to their feelings, because of duty. Avoiding this inner dissonance can fray the fabric of one’s confidence, unweaving the fabric of one’s professional identity. This results in a lack of fulfilment and connection to the nursing profession — in other words, burnout.
I admit that on some days, I too have felt utterly shattered, yet was made whole again through the support of co-workers, friends, and family, who are often the bright light and personal superheroes for so many of us health-care providers. Those who support us are often under-recognized and inadvertently take the brunt of our hard days, impossible schedules, and drained reserves of self upon our returning home, even when we try our best to articulate and express the gratitude they deserve.
Other days, working in jail can be pure bliss: I saved someone today. Actually saved his life. I replenished his spirit. Refilled his goblet of hope. Glimpsed lucidity in that one’s eyes, if only for a moment, and they understood me. These are personal accomplishments. Then, the most precious compliment, more valuable than a treasure trove of lost rubies or diamonds:
- “You’re a good nurse.” Or,
- “Thank you.” Or,
- “You’re the first person who has been nice to me in a long while. Keep it up. So many of us need it.”
That third compliment was, in fact, the first kind words I heard in a place so often filled with inmate violence, rage, and misunderstandings. So I smiled, gathered my first ruby, placed it in my small, mental satchel, sealed it tightly, and continued along my way.
Correctional nursing has challenged my expectations of both myself and my nursing role in an environment susceptible to violence.
Introspection and reflection
I should have constructed a larger mental satchel to hold the kind words and compliments. But as a nurse, the constant, unending introspection — “Could I have done more? Should I have reacted that way?” — manifests as a feeling of humility, compassion, and empathy.
Yet, the flip side of humility is considerably darker: the feeling that one is undeserving of the good and needs to work relentlessly harder. This makes us vulnerable to succumbing to a mental prison of our own making: an abundance of guilt and ceaseless worrying.
On reflection, I feel that luck led me through the prison gates, through each heavy, leaden door, past the grey cement blocks, in search of myself. Jail has allowed me, early in my career, to discover my professional identity as a nurse, as well as explore and broaden my capacity for empathy and compassion. The correctional environment has also fostered my eagerness and enthusiasm to do good, form trusting nurse–patient relationships, and make a difference in the lives of vulnerable and marginalized people.
As a nurse, I took a pledge to care for the sick and the injured, which includes the victims and perpetrators of crimes. At times, these groups are starkly distinct. Other times, a translucency occurs, in which the difference between the two groups is obscured. In a correctional facility, the individual seeking medical attention before me is distinctly clothed in correctional coveralls. I am keenly aware of the individual’s circumstances, whereas in the community setting, I may be acutely unaware.
Correctional nursing has challenged my expectations of both myself and my nursing role in an environment susceptible to violence. I interact and provide care for individuals who have been charged with various crimes, and they are my patients. I have been deemed a steward of their care, and handed the responsibility to empathetically guide their experience within the health-care system during their stay in a correctional facility.
Kindness jostles the mind, awakens the senses, and permeates one’s entire being. I’ve met a few incarcerated patients who revealed they never had the blessing to experience an amiable friendship, a loving relationship, or a safe home. Nurses possess the faculty and capability to gift others, especially our patients, with daily kindness. We play a critical role in assisting our patients to cultivate their capacity for personal growth, instil hope, and foster a patient’s ability to adapt and transition to change in a dignified, humane way.
Life is about meaningful connections, and helping others to become the best versions of themselves. I hope that my kindness will inspire kindness in others. I hope that I was able to help some inmates reframe their jail experience, thus empowering and motivating them to enact some type of positive change into their lives. I hope that in the past five years, I was able to make a difference, however big or small, in the hundreds of lives I’ve encountered in jail. Kindness is a universal language that is easily accessible to everyone and inexpensive. It gives nurses the power to reach and touch lives, within and far beyond the prison walls.
Here are some genuine survival tips for working in a correctional facility:
- When working in jail, never wear scrubs the same colour as inmates’ coveralls.
- Never go home with work scissors in your pocket, unless you purposefully meant to cause an institutional lockdown to vex your co-workers. (Missing sharp objects in jail is a BIG deal!)
- Never underestimate the number of things that can be hidden in the alcoves of the human mind and orifices of a person’s body.
- A healthy sense of humour and a friendly smile can be an adjunct to healing and give hope to the broken.