Correctional Nursing: How Inmate Incidents Closed Our Hospital Ward

In the mid-80s, our community hospital began receiving complaints about the high visibility of inmates with officers posted outside their rooms. The hospital did not have a specific correctional nursing unit so the prisoners were scattered throughout. As the inmate census increased, so did people's fear and complaints until our hospital decided it was time to open a ward just for prisoners and jail inmates. I suddenly became a correctional nurse.

The hospital's prison ward eventually consisted of 30 beds, mostly semi-private rooms with 2 four-bed wards, and 4 private rooms. The ward was separated from the elevator by a large, locked, metal gate. Initially officerswere posted outside each room, escorting nurses into the room for patient care.

One major problem with correctional nursing, as I have learned, is when prison officers and guards fail to realize the importance of an inmate's right to proper health care and want to dictate when a nurse should be called to assist. Some officers stopped going all the way to the bedside with the nurse; a couple were reported for sleeping on duty. At times, the officers displayed animosity towards certain nurses.

Reports of inmate incidents and misconduct began. The officers discovered postings of department store ads depicting children in underwear on the bathroom wall of a child molester. Then there was the case of the missing flashlight. A "shakedown" revealed that an inmate removed the metal strip from the flashlight and attempted to fashion it into a knife. His plan was to take a correctional nurse hostage. They also discovered possession of razor blades by another prisoner.

These incidents shocked us because apparently, the officers were not as cognizant to what was happening nor did they work diligently for our safety as correctional nurses. In addition, nurses and officers became more careless. Our hospital did not provide formal training in safety and caring for prisoners.

An inmate was receiving a narcotic for pain and Insulin injections for his diabetes. We discovered that he removed syringes from the needle box in his room and injected the narcotic into his IV. Nurses failed to note his daily need for an IV site change due to clogging by the poorly dissolved drug. A prison inmate on isolation received his linen at the door by nurses who failed to remove the old linen. He hid linen in the ceiling tiles and used them in an escape attempt (from the seventh floor!). Fortunately, he was a dumb criminal who was observed from outside, escaping during the officer's shift change. The second escape prisoner was more successful; he was found hiding under a nearby house later in the same day.

When correctional nurses filed complaints, resigned, and/or transferred to other wards, the hospital viewed and changed its policy. They stationed officers inside the rooms making them available at the patient's bedside at all times. This did not stop the antics of conniving inmates, who are always challenging a person's awareness of their surroundings.

Once, I walked into a room to find the officer asleep with his mace on the bedside table! He was reported and appropriately reprimanded for this transgression. The hospital and its correctional unit was about to undergo the final test of endurance.

The prisoner was a young, skinny, 5' 6'', 90-pound black male, admitted with a complaint of shortness of breath; he became gradually disoriented throughout the day. Apparently, he made concerning statements to the officer that should have been relayed to the nurse. The patient spoke of being doomed, cursed by his ex-girlfriend who put "roots" (voodoo) on him; he was convinced that he was dying. He wanted us to call his pastor immediately for blessings. According to the officer, when not sleeping, the patient had been pacing frantically inside the four-bed ward until he apparently grabbed the officer's gun. The officer was short in stature; he weighed about 150 pounds.

I heard yelling and ran into the room; I will never forget what I saw. The skinny inmate, with superman strength, was in a violent struggle with the officer over the gun, which they waved in the air. As they fell on the bed, I ran out to alert other officers, our security, and my supervisor. Suddenly, four other prison officers entered the room; they slammed the door, not allowing our staff to enter. After much commotion, the inmate was subdued; within an hour, they transferred him back to prison for his "misbehavior". The discharge was improper, although examined by the doctor; the nurses did not perform a final assessment and discharge teaching. I attempted to call report to the prison's correctional nurse but I only had the original health information and the incident report. It did not matter because the patient never made it back to the correctional institution.

Apparently, there was another incident between our hospital and the prison. It resulted in a severely beaten inmate with his jaw broken, and lungs collapsed. The officers claimed he attempted to attack them again (all five of them). When I returned to work the next day, I saw a semi-conscious prisoner, handcuffed to the bed, with two chest tubes and his broken jaw wired shut. It took almost a month but he recovered without further complications.

The prisoner did not remember the incident, the beatings, or anything after he passed the officer going to the bathroom. It was later said that the officer possibly dozed asleep sitting next to the bathroom; this allowed the patient to grab his gun. The doctors believe that, prior to the incident, the inmate suffered from a clot embolism (to his lung) that led to low oxygen levels with increasing confusion and disorientation. If the officer communicated to the nurse, oxygen application probably would have helped prevent the entire incident.

Of course, that was the last straw for our administration; the correctional hospital ward was disbanded, the inmates again scattered throughout the hospital but more discreetly. That was my first taste of correctional nursing; I always like a challenge so seven years later, I started working for the county jail. That was an entirely new ballgame, and article!