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Jump to Key Points Correctional nurses use the same clinical knowledge and skills whether they are distributing medication, treating wounds, managing chronic health conditions, or responding to emergencies. But working in a jail means that the environment and the patients present unique challenges.
“Safety in correctional facilities is a heightened priority,” said Twanna Hopkins, MHA/INF, RN, NC-BC, CCHP, chief nursing officer at a NaphCare jail, a private healthcare company that provides medical, mental, and dental health services to jails and prisons. “Nurses work with custody staff to provide healthcare in a safe environment.”
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Correctional nurses have a unique role in healthcare, caring for incarcerated individuals who tend to have more acute and chronic health challenges, including infectious diseases, substance abuse disorders, and mental health comorbidities, than the general public.
Although the US has one of the highest incarceration rates in the world, there are fewer than 28,000 nurses working in correctional facilities, and security is likely to be a greater concern than healthcare administration.
- Correctional nursing = specialty; requires independent triage, assessment, emergency response.
- Incarcerated patients have ↑ infectious disease, SUD, and mental health comorbidity burden.
- Security/custody coordination essential; patient advocacy may require escalation for access delays.
- Vacancy rates up to 40%+; shortages linked to heavier workloads, burnout, and potential errors.
- Safety measures include escorts, alarms, cameras, alert devices, and situational-awareness training.
“This is the only nursing profession [correctional nurses] that works in a facility or in an environment whose mission is not healthcare,” explained Lori E. Roscoe, DNP, PhD, APRN, ANP-C, CCHP-N, president-elect of the American Correctional Nurses Association. “Safety and security are the primary mission, and we still have to do what we need to do to take care of our patients.”
Care on the Inside
In hospitals, registered nurses (RNs) monitor patients during rounds, respond to call lights, and check vital signs. But correctional nurses often depend on custody staff to notice when an incarcerated person starts skipping meals, seems confused, or appears injured. Those observations can begin a clinical assessment.
Correctional nurses work in facilities to provide healthcare; their role requires working alongside custody staff and within the facility’s security structure without surrendering their clinical judgment. However, sometimes, those systems collide.
“You are working there to take care of patients…and if it means you have to go to a supervisor because you need to see a patient and the officer in the unit is saying he can’t send him because he’s short-staffed…you either go to the nursing supervisor or the sergeant or lieutenant on duty,” Roscoe said. “Patient advocacy is huge in correctional facilities.”
Nurses working in correctional facilities also recognize the toll that the prison environment takes on mental health.
“We care for individuals during some of the most challenging moments of their lives,” said Tara Taylor, RN, chief nursing officer for NaphCare who provides care in a state prison. “Nurses ask questions or observe behavioral changes to make mental health referrals [and] receive suicide prevention and detox training to screen patients.”
The level of specialization led the American Nurses Association to recognize correctional nursing as a specialty with its own scope and standards of practice.
“One common misconception is that correctional nursing is not a specialty,” Taylor added. “In reality, it is a specialized nursing environment that requires nurses to combine clinical knowledge, keen assessment skills, compassion, safety awareness, and the ability to work independently…Correctional nurses must have very strong assessment skills and must be able to think critically and respond appropriately in triage and emergency situations.”
Workforce Crisis
Correctional institutions are not immune to nursing shortages. Prisons, jails, and juvenile detention centers compete with hospitals and clinics for the same nurses, but there are additional recruitment challenges: Many RNs have never considered working in corrections, and there is often a perception that correctional nurses are less skilled than nurses in other specialties, Roscoe explained.
“In certain places it’s much more difficult to attract people even to come in and interview,” she added.
The challenges have led to high demand and significant shortages. Correctional nurse vacancy rates in the US are as high as 40%. In North Carolina, the prison system reported a nurse vacancy rate of 48%, while the vacancy rate for RNs tops 40% in South Dakota.
Nursing shortages can have consequences beyond an unfilled position. Correctional nurses might need to distribute medications to 100 incarcerated patients up to four times/d, while balancing other clinical responsibilities. Some data found that one correctional nurse could care for up to 800 incarcerated patients, and high nurse-patient ratios have been linked to impaired decision-making and greater risk for clinical errors.
“Staffing shortages impact correctional nurses the same way they would impact hospital nurses,” Hopkins said. “They may have to work longer shifts and experience heavier workloads, which can lead to increased stress and potential for burnout.”
Correctional nursing shortages have forced facilities to turn to contract nurses. While short-term nursing contracts can keep facilities operating, it comes at a cost. Travel RNs working in corrections earn $135,000-$250,000 plus tax-free stipends compared with $65,000-$150,000 for staff nurses working in county jails and state and federal prisons.
Creating a Safer Environment Inside
Workplace violence is a concern for nurses regardless of the environment. More than one third of RNs reported an increase in workplace violence, including verbal threats, harassment, or physical violence. The same threats exist for correctional nurses but Hopkins pointed to the heightened security measures in correctional facilities that help keep nurses safe.
“Compared with a hospital, a correctional nurse is safer because the community cannot enter or exit the facility without security clearance,” Hopkins told Medscape Medical News. “A custody team member escorts correctional nurses when entering housing units, works in the medical clinic, and assists with medication administration.”
Nurses may be escorted by correctional officers; medical areas have emergency alarms, cameras, and communication systems; and some facilities provide personal alert devices. Staff is also trained in situational awareness and emergency procedures, and medical personnel must also account for sharps and other tools, Hopkins added.
Working in corrections requires clinical confidence, independence, adaptability, and an ability to function in an environment where healthcare and security must coexist. For RNs with experience in emergency care, behavioral health, substance use, or chronic disease, the chance to educate, advocate, and care for underserved populations is a major draw.
“Many of our patients have not received consistent healthcare until they are incarcerated,” Taylor said. “As correctional nurses, we have the opportunity to help them improve their health and educate them on their diseases and how to manage them, so they can return to their families healthier.”
The experts cited in this article had no relevant disclosures.
Jodi Helmer is a freelance journalist who writes about health and wellness for Fortune, AARP, WebMD, Fitbit, and GE HealthCare.
