How did you get into nursing, institutional nursing?

I started out in pre-law, got married and had children. Then my marriage broke up and I needed employment while raising my family. Nursing let me do all that and go to school. One of my first jobs was as a clerk and jail matron in Fullerton City Jail. Here I was, this young, naive idiot, green as a gourd, searching prostitutes, emptying their purses and not knowing anything about what I'd find. A fellow worker, who looked really young with long, blond hair, worked as a decoy for the police to catch perverts in the city parks. I found all that strangely interesting and was drawn to law enforcement. I went on to county jails, juvenile halls and the Chino Women's Prison, working at different times as a nurse psychologist or nurse practitioner.

What brought you to work with juveniles?

I wanted to obtain some success without complications at home, so I put off working with adolescents until my own children were grown.

There are two different departments where I work: the sheriff's department (jail) and probation (juvenile hall and placement). Probation tends to be more focused on giving the kids a new start, placing them in a better environment and getting them away from gangs, etc. You may see an adult appearing in juvenile court because of charges incurred as a juvenile, which were never resolved. Jail is for those 18 and older who are awaiting court appearances or just "doing time."

What do you do as an institutional nurse?

Riverside County detention facilities house inmates/juveniles in "pods" and a nurse may visit all the pods several times during the course of a shift, passing pills, completing procedures and seeing inmates for sick call. We see a good amount of psychosomatic complaints, mental health cases, as well as bona fide medical problems. We evaluate to determine whether there are truly medical concerns or if the inmate is just malingering. We also respond to "man down" or emergent situations.

Inmates get very good medical and dental care while incarcerated. We see many with active disease processes that went unchecked on the outside and who, once incarcerated, catch up on medical, dental and specialty appointments.

Any special anecdotes you remember?

I've found myself with notorious criminals that, to me, were just other patients. There was the hired killer from the Mexican Mafia, so handsome and polite it was hard to believe his past, once I knew his history. There was a murderess working as my "trustee" and I've talked with members of the infamous Manson family. There was a child in juvenile hall who was there for setting his house on fire while his mom slept on the couch.

I've heard some truly horrific stories of everything from sexual perversion to murder, but also have seen some truly amazing transformations.

Families can be incredibly supportive in spite of the severity of the charges, while others abandon their loved ones altogether.

What are the special challenges of working with those incarcerated?

The first and foremost priority is the safety and security of the institution and staff. Nurses are used to "calling the shots" in many settings, but this is not the case when dealing with our population. Say an inmate is having a seizure, the nurse's instinct is to jump in and help or protect as needed. Here, security must first check everything to make sure it's not a diversionary tactic.

Regardless, institutional nurses are always advocates for the inmate/patient. Each of us makes a concentrated effort to remain nonjudgmental, objective and neutral when dealing with detainees. It is not for us to decide. Seeing them as "criminals" colors our attitude. Most of the time the nurse doesn't know or doesn't want to know the charges. We bridge the gap between the sheriff's department and probation. It's a fine line.

Anything else to add?

Institutional nurses receive tremendous support and respect from the sheriff, probation staff and the detainees as well. I have always felt more secure in this environment than in a hospital setting because I learned early on how to survive and to recognize my enemy.

There is so much more to institutional nursing than we learned in nursing school. It is a wide-open field, never dull. It's exciting and interesting and is the best-kept secret in nursing. I have worked in all facets of nursing and I can honestly say that the people I work with and the job I do is the best of the best.