“I don’t think about why the prisoners are here. I just focus on the patient in front of me.”
Debra’s worked as a nursing support worker in an adult male sex offenders’ prison for the last 10 years. She loves her role and was inspired to work in a secure environment by her dad, who was a prison officer for 35 years.
She says: “I was never frightened or worried at the prospect of working behind locked doors. I felt nothing but excitement on my first day and remembered my dad going to work. I can picture him now in his prison cap, with the key chains hanging from his belt.”
Growing up in the 70s she remembers living in a prison house. “In those days, prisoners would come to decorate rooms in our house. Me and my four brothers would ask them: ‘What are you in for?’,” she recollects.
“I chose to work in this environment because I enjoy looking after all people, but I recognise it’s not for everyone.”
Routine and emergencies
Now it’s Debra who’s entering the prison four days a week to carry out a role integral to the nursing team there. She’s the only HCA in the team, working alongside three registered nurses. She says everyone brings something essential to the team and they have a close working relationship.
“It’s a long walk from and to the car park but we all meet there and walk in together at the start of the day and end our shift by walking out together too. We look out for each other throughout the day. I always offer to help if someone in my team looks snowed under, and the offer is always reciprocated.”
Debra sees around 20 people a day in her clinics, which she runs independently each morning and afternoon. These cover a range of essential checks such as bloods, small dressings and weight management. And while these are fairly routine for a nursing support worker with more than 20 years of nursing experience, Debra also has to be constantly alert to potential emergencies which she could be called to at any time.
“If I get a code through the radio at any point, I stop everything and attend the emergency,” she explains. “One time I got an urgent call from an officer who told me a prisoner was in a terrible state. They had no idea what to do and needed my help quickly. I rushed to him and could see it was serious straight away. I got him cleaned up and sent to hospital urgently.
“It turned out to be sepsis and by acting fast and as a team we got him the help he needed. In our individual roles we have different priorities, but the governor acknowledged what I did that day. I felt appreciated; my work didn’t go unnoticed.”
Debra’s working day
When Debra started working in the prison, she already had plenty of health care experience behind her, having worked in home care for 12 years, then Bristol Royal Infirmary for five years, where she worked with older people and in A&E.
Now her shifts in the prison start at 7.30am and finish at 6pm. At the beginning of the day there’s a handover where the whole nursing team catch up with what’s happened on the previous day. By 8.30am Debra’s running her first clinic of the day, which is always the bloods clinic. After this, she takes time to send off samples before getting on with her afternoon clinics.
I enjoy looking after all people, but I recognise it’s not for everyone
“My role could be likened to that of an HCA in a GP surgery, but with more security codes to consider,” she says. “I love what I do because I get a chance to build a rapport with my clients. Some of them come to see me every week for me to check their weight, their INR (international normalised ratio) or other blood sampling I need to do. Some have been here for years, and you get to know them. They say ‘hello Miss’ as I walk around the wings.”
She says that seeing her patients make changes motivates her. “They may come to me overweight, and I encourage them to make a change. ‘You can do this’ and ‘I’ll be with you,’ I remind them.”
Debra’s days were quite different during the COVID lockdowns when there were fewer in-person clinics. Adjustments had to be made, for example, only urgent bloods were taken, and telephone appointments became the norm. She explains: “We could phone prisoners in their cells. We’d establish their identification and talk as any other health care professional would.
“At no time are prisoners able to phone health care staff directly. To request an appointment, they use an electronic kiosk located on the residential wing to send a message to the nursing team who then phone them, to get them booked in and provide a movement slip to show the prison officer they have a health care appointment.”
Protecting staff
Debra continues to develop new skills and knowledge and does the same training as any other HCA to keep herself clinically up to date. But she also needs specific training to work in a prison environment. “I must be able to use the keys appropriately,” she explains. “After I take them out of the cabinet, no one can else see them throughout the day. They can’t be taken off my chain, which used to belong to my dad, and they must be kept in my key pouch. The keys must be returned at the end of the day and as you walk out you hold your chain up to show it’s empty.”
This is actually my dream job
Radios are used for communications and so people know where an individual is at all times, so training on their use is also compulsory.
“These are useful safety devices, which help me feel more secure,” says Debra. “When you change positions, you describe where you are. I could also call a registered nurse if I need them quickly. I just press the red button for an officer. I know about 20 would appear very quickly if I needed help.”
There’s also an emergency button in the room where Debra conducts her clinics. “You need to consider where you put your desk so you can get to the button in an emergency. I always sit nearest the door so I can get out if I need to,” she adds.
Understanding the role
Debra acknowledges that her family background gave her an insight into prison life that most people wouldn’t have and understands that for some people her role may seem daunting, even unpalatable.
“I like looking after all people and love my role so this is actually my dream job,” she says. “I never wanted to be a registered nurse, but I’ve always wanted to be as good an HCA as I can be, and I feel I can do this in my job. I feel supported by the whole nursing team who acknowledge and thank me for my help and are always telling me that they couldn’t manage without me in the team.”
She adds: “If you have any questions about nursing work in a prison, I’d suggest giving one a call or taking a look around. It’s the best way to get a true picture of what we do.”
RCN professional lead for justice and forensics Liz Walsh agrees: “The nursing workforce in prison is often hidden from view and the wider nursing community, therefore, I would urge anyone with an interest in this field to get in touch with their local prison health care service to find out more.”
She says nursing support workers are an essential part of the multidisciplinary workforce in prisons: “Caring for prisoners provides an opportunity to make a real difference to some of the most vulnerable and disadvantaged people in society.”
Read more
- Learn more about the RCN Nursing in Justice and Forensic Health Care Forum and how to become a member.
