Editor’s note: This following excerpt is from “Straight to Jail: A Nurse’s Guide to Correctional Nursing” by Veronica Dailey, RN, CCHP, founder of The Prison Nurse. The book is rooted in her personal experiences as a correctional nurse and was written to highlight the realities, challenges and incredible resilience of nurses working behind bars. Order your copy here.
Chapter 9: Adapting clinical skills to the correctional setting — Practicing medicine in a prison
Correctional nursing isn’t just about maintaining order. It’s about practicing solid, high-level nursing with a twist of resourcefulness. You won’t have every tool you’re used to. You won’t have a respiratory therapist or rapid response team waiting at the push of a button. But guess what? You do have your brain, your training, and some of the sharpest clinical instincts you’ll ever develop. Let’s get into what practicing medicine behind the wall really looks like.
Top conditions and chronic illnesses
Correctional facilities are like their own mini-hospitals, and your patients come with complex, often neglected health histories. Chronic conditions dominate here. Expect to see a lot of:
- Hypertension
- Diabetes (Type 1 and Type 2)
- COPD and Asthma
- Hepatitis C
- HIV/AIDS
- Mental health disorders (schizophrenia, bipolar disorder, depression, PTSD)
- Substance use disorders and withdrawal management
- Wound care: everything from pressure injuries to drug related wounds
The twist? Many of these patients haven’t seen consistent medical care in years, if ever. That means you’re not just managing chronic illness. You’re often identifying it for the first time. You’ll also see conditions you wouldn’t expect in the general population, including advanced complications of untreated diseases and some very creative methods of self-harm.
Treat every patient as someone with complex, layered needs and learn fast where your facility’s limits are in terms of treatment, referrals, and escalation.
Care realities for common conditions:
- Hypertension: Patients may have been on and off medications for years. You’ll often be re-establishing care from square one. Teach them why it matters, even if you’re only talking through a cell door.
- Diabetes: Watch out for wide swings in blood glucose. Many patients don’t understand insulin use, and some may even try to manipulate insulin dosing for secondary gain. Be vigilant.
- HIV/Hep C: Adherence can be hit-or-miss. You may be part of initiating life-saving antivirals, or advocating for specialty referrals. Either way, you’re often their most consistent link to care.
- Mental health disorders: These are often undertreated or misdiagnosed. Work closely with psych services, and don’t be surprised when a medical complaint turns into a mental health crisis.
- Withdrawal management: You’ll see everything from opioid withdrawal to benzodiazepine detox. You must know the protocols, watch for signs of decompensation, and advocate for safety, because as we all know, detox can be deadly.
Sick call and triage
In corrections, sick call isn’t just about complaints. It’s about clinical judgment. Inmates submit request slips or electronic forms daily, sometimes dozens at a time. Some are legitimate, others are attempts to manipulate. It’s your job to sort through the noise.
Key points:
- Triage fast: Learn to spot red flags quickly. Chest pain? Trouble breathing? That’s top priority. Dry skin or a request for extra lotion? Not so much.
- Assessment on the fly: You might assess patients through a food port or standing in a hallway. Make every minute count.
- Documentation matters: If you didn’t document your reasoning, it didn’t happen. Be concise but complete.
I once had a sick call slip that read: “My stomach is eating itself and I can’t keep anything down.” As dramatic as it sounded, the patient was showing warning signs of cholecystitis. This particular patient ended up needing an emergency cholecystectomy. You learn to read between the lines.
Medication pass
Ah, med pass. The cornerstone of your shift and sometimes the entire shift.
In the free world, med pass is a quick stop at the Pyxis. In corrections, it’s a production. You’ll push a med cart (which might be a glorified rolling tool box), unlock it with a key you’re absolutely responsible for, and administer medications through cell doors, on tiers, or in designated med lines depending on the facility.
A few things to remember:
- You are responsible for each med given. Double-check everything.
- Watch for cheeking, trading, or “accidental” spills
- Maintain strict procedures with controlled substances. This is non-negotiable.
- Always have custody staff present during med pass. If they aren’t there, you don’t start.
And remember: safety over speed. Med pass might take longer here, but that’s the nature of the beast.
Emergencies and codes
There’s no code button to press. No team bursting through the door with a crash cart. You can call for backup, another nurse or an on-site provider, but until they get there, it’s just you. You’re the response. Here’s how it works:
- You respond, assess, and initiate treatment with what you have on you or in your emergency bag.
- Custody decides when the scene is safe or assists with transport (if needed).
- You radio for medical backup, or you are the backup.
- BLS/ALS is called if it’s beyond what the facility can manage in-house.
The key is this: Don’t panic. Preparation is everything. Know where your emergency bag is, what’s in it, how to call for help, and who’s going to show up when you do. Always train like it’s real because one day, it will be.
In my first week at the facility, we had multiple codes. One of them involved a multi-patient overdose. At first, we honestly thought it was a drill because it was that intense. It wasn’t a drill. Every nurse dropped what they were doing and responded. The onsite doctors were escorted straight to the scene the moment they arrived. That day ended up including my first (and only) fatality on the job. Be prepared for anything. I remember it vividly, especially the state of my brand-new New Balance shoes by the end of it. They were soaked and stained with everything on that tier: vomit, blood, Narcan spray, and water (still not sure where the water came from). It was chaotic, messy, and deeply real. But it taught me quickly: this is correctional nursing.
Practicing with autonomy
In a correctional setting, there may be long stretches where no provider is physically present. You’ll be making initial assessments, decisions about triage, and even calls about sending someone out to the ER. This kind of autonomy is empowering but it can also feel heavy. Lean on your clinical knowledge, trust your instincts, and don’t be afraid to say, “I’m not comfortable with this, he needs to go out.” Correctional nurses are often the frontline decision-makers for higher levels of care. Your voice matters.
Special populations
Correctional nursing includes care for unique populations with distinct needs:
- Geriatric Inmates: Falls, incontinence, dementia, and chronic illness are all common. Many elderly inmates require adaptive care plans. And yes, we do have hospital beds, Hoyer lifts, Foley bags, trach care, and more.
- Pregnant Patients: Care coordination is key. You may have limited access to OB services, and you need to monitor for complications like preeclampsia or preterm labor. Know where your emergency delivery kit is, what’s in it, and how to use the items inside.
- LGBTQ+ and Transgender Inmates: These patients may be on hormone therapy, and they may also face higher rates of mental health issues or abuse. Respect, privacy, and medication continuity are essential.
- Mental Health Patients: Many facilities have a significant psych population. Know how to recognize escalating behavior, suicide risk, and when to involve psych services immediately.
Documentation dos and don’ts
Documentation inside is critical. Not just for care continuity, but also for legal protection. Your notes could end up in court. So yes, write like a lawyer is reading over your shoulder.
DO:
- Chart objectively: “Patient states…" / “Noted 3x3 cm abrasion to left forearm…"
- Document refusal of treatment clearly and with a witness if possible.
- Include time, location, and who was present for significant events.
- Use facility-approved abbreviations and follow documentation policies.
DON’T:
- Use sarcasm, opinions, or assumptions (e.g., “faking,” “manipulative,” “seeking attention”).
- Document things that weren’t done. (Seriously. Just don’t.)
- Leave blanks or chart for someone else. If it’s not your work, don’t touch it.
You’ll chart in an EMR, paper MARs, or some hybrid depending on where you work. Either way, chart like it matters. Because it does.
Correctional nursing demands a rare mix of clinical skill, resourcefulness, and mental toughness. You’re not just giving meds or checking vitals. You’re practicing full-scope nursing in one of the most unpredictable environments imaginable. Whether you’re triaging a sick call, managing chronic illness, or responding solo to a code, you’re doing it with limited tools and high stakes. But with every shift, you sharpen your instincts, grow your confidence, and redefine what capable looks like. You won’t have everything you had on the outside, but you have enough. And most importantly, you have what matters most: solid clinical judgment, unwavering presence, and the ability to deliver excellent care behind the wall.
Pro pod tip
Keep your emergency response gear stocked, your stethoscope within reach, and your cool intact. You’re not just the nurse, you’re often the whole medical team.
Reflection question
What’s one clinical skill you feel confident in and one you’d like to strengthen to feel more prepared for emergencies in a correctional setting?
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