Nursing Behind Bars

I worked in a Maximum Security Prison for 3 years. The Maine State Prison holds 1,000 inmates. All which are adult males ages range from 18-100. Typically men are sentenced to the Prison if they are serving more than 5 years. There are different areas in the Prison that a Nurse will work. The Clinic, Infirmary, Special Management Unit and IMHU.

The Clinic:

This is the central zone for all nursing staff. The Clinic consisted of 3 exam rooms, a room for physical therapy and dental suite staffed with a Dentist and a dental hygienist. There is a small room for eye exams, which the ophthalmologist would work once a month. The MD works in the clinic as well.

The Clinic holds the pharmacy. Med deliveries would arrive here and get sorted out. There’s 1,000 inmates at the Maine State Prison so we went through a lot of meds!

Normal Day of a Clinic Nurse

6-6:30- count and report

6:45-7:30am- Diabetic Line (the nurse has to document all needles and lancets used and count must be correct)

8-11:30- Sick Call, Wound Care, Vitals

Lunch and meet with the providers for orders from your sick calls

1-4pm- Schedule EKGs are done at this time. Medical equipment is given out (briefs, ostomy supplies, water for CPAPs ect.). Contact any inmates you need to follow up with (there is always follow up), put in any new orders ect.

4-5pm Diabetic Line

5-6 – Finish Documenting on your day

*AT ANY TIME AN ICS (code) COULD BE CALLED

*ICS can be for security or medical or both!

Sick Call. Sick call is a form and is used by inmates to communicate a medical problem. These sick calls are picked up by medical staff and triaged by nurses. They’re time protocols from when a sick call is picked up to when triaged to when they are seen by a nurse. If a nurse determines that a provider needs to see the inmate then they triage it and place it on the provider’s list. Two nurses are typically staffed in the clinic for sick call and they see around 15-20 sick calls per day.

The Infirmary:

This unit holds 7 hospital beds and a variety of medical conditions can be treated here.

Inmates just like any other human have surgery so this is where they would come to recover post-op. ANY Inmate that requires an IV had to be placed in the infirmary (this include central lines as well). If you’re asking yourself why? Well Prison has a lot of drugs and we don’t want to give them easy access.
All inmates are considered FULL CODES if they had a medical condition and were placed on hospice they would become DNRs and have to stay/live in the infirmary.
A nurse is not allowed in any room unless he/she is with a Correctional Officer. All medications that are given must be followed by a mouth check from the officer.
As a prison nurse you’re not only responsible for counting narcotics but also all syringes, needles, diabetic lancets, tools (forceps, scissors ect), blank scripts.
Admissions into the infirmary are only through the Medical Director

SMU “Special Management Unit” “Segregation”

SMU is the unit where we place inmates that need to be separated from General Population. The Department of Corrections (DOC) is responsible of determining who is housed in this unit.

Example of people in SMU

Inmates that are too dangerous to live with others, this inmate would receive therapy from mental health, they also have to complete certain courses through the DOC.
PC “Protective Custody” Inmates. This is an inmate who is at danger if they are in General Population. Example could be an inmate who murdered another inmate’s family member. Any sort of conflict of interest that could be determined dangerous.
Inmates who have recently assaulted another inmate/officer can end up in SMU for a certain amount of time.

Normal Day of a SMU Nurse

6-6:30- Report and Count

6:30-7:30 Med pass. The nurse and her med cart goes cell to cell with a Correctional Officer and administer medications. PRNs are only given at med pass times. Sick calls are picked up during med pass.

8-11:30- Sick Call, Wound Care, Vitals

11:30- 12:30- Med Pass

12:30-1. Lunch

1-4 Sick Call, Wound Care, Vitals, EKGs. Stock med cart order meds ect.

4-4:30 Diabetics

5-6- Document

SMU is housed to inmates who are acutely dangerous. All SMU inmates are escorted to medical with 4 point restraints and two DOC officers. The SMU nurse can only see one person at a time so sick call goes slower. Whereas in the Clinic Inmates wait in the waiting room and are called on as needed. SMU can house anywhere from 1-30+ inmates and can see just as many ICS’s as General Population.

Typical ICS’s in the SMU

SIB (self injurious behavior)

Inmates get a hold of small pieces of razor blade and will cut themselves. This is usually in rebellion because an officer made them mad.
Head banging. Inmates will bang their head off the wall
Choking
Suicide attempts
“Cover up”
an inmate will cover his cell window. This is considered an ICS because the officers do not know if the inmate is hurting himself or not. If the inmate does not respond then DOC will do an “Extraction”.
Extraction
DOC will forcibly go into the cell and restrain the inmate. This usually involves chemical exposure (mace). An inmate may be placed in a restraint chair. It is the nurses job to assess the inmate after an extraction.
Chest Pain
Many inmates will call chest pains even if they are not having chest pain. EKG must be done.

Intensive Mental Health Unit (IMHU)

This unit houses psychiatric patients. These inmates receive intensive therapy daily. They are follow by a psychiatrist, psychologist and many social workers. The nurses are responsible for administration of medication and assessing and reporting any changes to the team.

People in IMHU

Inmates that have been determined by the court to be guilty and not criminally insane…. Although they’re a handful of inmates who should have gotten criminally insane.
Jails will send IMHU people who have not been charged but are not able to be held safely in a jail setting.

IMHU can administer medication against will with a courts order to stabilize the patient.
If they are determined not criminally responsible they will be released from the IMHU and go to a psychiatric facility.
An inmate from General Population who is no longer stable can be admitted to the IMHU once on proper medication and deemed stable he can return to GP.