1. Safety and Security When Caring for Ill or Injured Offenders in Prison

2.   Welcome to Washington State Department of Corrections Health Services.  This presentation is offered to give you an overview of information you need to know before you begin working in a prison environment. Washington Department of Corrections

3.   Don’t bring anything personal into the prison,  No purses, wallets, cell phones or other electronic devices, no cameras.  No personal photos or identification except your work badge Keeping the Environment Safe

4. Staff Considerations  Nothing around your neck  Stethoscope  Name tag lanyards (use breakaway type)  Keys  Long hair or dangling jewelry

5. What to Wear  Professional attire includes scrubs, lab coats when appropriate.  Fanny packs should stay zipped  Don’t wear all gray or orange scrubs, or red shirts

6.   DO NOT GIVE ANY PERSONAL INFORMATION!!!!!!  Marriage status, children, residence, work schedule  Be cordial but not personal Sharing Information

7.   There are multiple housing units, some with individual cells and others that may have dormitory housing.  Usually housing units are separated.  Offenders are separated from each other due to levels of security, gang affiliations, sometimes race issues etc.  That separation includes coming to health services. Prison Environment

8.  Living Areas

9.   Stay in the “Yellow Zone” – always being aware of what’s around you. Who’s around you. Your position in the room etc.  Keeping an escape route available to you  Making sure someone knows where you are  Signing in and out of units Increased Personal Awareness

10.   There are multiple levels of security that determine how much freedom an offender has.  Max Custody is the most secure and the offender is always accompanied by two or more officers.  Close Custody offenders will also be accompanied by officers.  Medium Custody has less restrictions and may come to health services independently.  Minimum Security has even less restrictions and may even be working in health services. Levels of Security

11.   In Patient Infirmary – an area in the prison where offenders are housed who need 24 hour nursing care, either for acute illness/injury, or chronic conditions.  An Out Patient Unit – an area where offenders come for sick call or chronic care appointment with a provider. They may also come for urgent or emergent issues.  Special Population Living Units: Mental health units, special needs units, higher security level units, etc. Areas You May Work

12.   Routine care for in-patients  Assist practitioners in Out Patient Units  Sick call –triage, wound management, chronic care  Mental Health Residential Units  Pill lines and insulin line – either from Health Services or in the living units. May be at the cell front.  Respond to emergencies  Infection Control  Blood drawing and specimen preparation  Wellness checks for those in segregation or Intensive Management Units.  Participate in New Offender Orientation or education classes. What Will You Do?

13. “Sick Call” Nurses triage patients coming to sick call to determine if they require immediate intervention. All medically necessary care is provided.

14.   When they arrive at health services they may be restrained by custody.  If restraints limit your ability to assess you can ask for them to be removed but it is up to the custody officer to determine if that is possible. The Incarcerated Patient

15.   Keys must be secured at all times.  Med room, IV pump, K-pad etc Keep supplies and ‘stuff’ to a minimum.  Keep cupboards locked or secured. Offenders are never allowed in controlled supply rooms or medication rooms.  All “sharps” must be accounted for by checking them out and back in if not used. Environmental Considerations

16.   Make sure all ‘sharps’ are secured, never left unattended  IV/lab trays, instrument trays, syringes and needles, maintenance carts, etc.  Limit what you take into the room.  Make sure you take out what you brought in. “Take it in, take it out” Environmental Considerations

17.   Never leave meds at the bedside or unattended  Use name and DOC number for identification  When administering make sure they swallow them, an officer will often stand by to do a mouth check to make sure they don’t “cheek” the meds  Meds may be ordered to be crushed and dissolved Medication Administration

18.   Times or dates for specific procedures, discharge, appointments  Give generalities but not specifics  Should give clear directives, leave no room for confusion. Make sure the instructions you give are possible  Never bring anything in for an offender or offer candy etc. What NOT to tell the patient

19.   Any off unit trips needed  Procedures that may involve security hazards  Calls about the patient  Plans for admission to or discharge from an inpatient unit or transfer to an outside healthcare facility. What to share with custody

20.   Working in the prison healthcare environment can be a rewarding experience  It’s recognized by the American Nurses Association as a nursing specialty  Great opportunity to work with patients who really do appreciate the care you give  Very diverse population, ethnically and socially  Great opportunity to learn new things Correctional Nursing