Kevin Connor, RN, a certified correctional health professional, was working in 1980 as an ICU nurse when he was recruited for a job in correctional nursing. He wasn't remotely interested-at first.

Then he discovered he would earn $2.50 more per hour, which would fast-track his plans to buy a home. Connor took a job at Glen Helen Rehabilitation Center in San Bernardino, Calif. He never expected to get hooked on correctional nursing.

Not all jurisdictions pay correctional nurses more than hospital nurses to compensate for the risks involved in working with offenders; several nurses said they earn less than they would at a hospital.

But although his original motives were financial, Connor discovered that he enjoyed treating inmates who often had never been to a physician and were particularly grateful for medical help.

He also thrived on the challenge of working in an environment where nurses made the majority of decisions-not physicians.

Several other correctional nurses tell remarkably similar stories. They stumbled into jail or prison nursing by accident and were surprised when they found they liked the field. These days, the field attracts more nurses in general. Thirty years ago, prison nurses lived with the stigma that correctional jobs were reserved for those who couldn't land regular hospital positions.

That reputation began to shift in 1976 after a landmark U.S. Supreme Court case. A Texas prisoner sued an officer who would not allow him to go to the medical ward. The court ruled that lack of access to medical services is a violation of an individual's civil rights.

The ruling led the U.S. Department of Justice to ask that the American Medical Association create standards for correctional health care.

Image makeover
These standards have vastly improved the quality of care in prisons and have made the field more attractive to nurses, said Rebecca Craig, MPA, RN, past president of the American Correctional Health Services Association.

Facilities that meet the standards become accredited, although accreditation is not required unless mandated by a court or contract.

Now, nearly 600 correctional institutions are accredited, said Edward Harris, president of the National Commission on Correctional Health Care.

"Correctional nursing is no longer the ugly stepchild," said Kathy Hebert-Laginess, MBA, RN, president of SecureCare Inc., a company based in Ann Arbor, Mich., that provides health care for correctional facilities. "People no longer think you must be a bad nurse or doctor if you are in correctional health care."

Unusual challenges
Now that the field's image has improved, more nurses are discovering the perks of treating inmates.

Correctional RNs usually have the chance to work with diseases that rarely crop up in the general population, said Kleanthe Caruso, director of nursing at the Texas Department of Criminal Justice Hospital at the University of Texas Medical Branch at Galveston.

Offenders are more likely to have rare diseases because many have pursued high-risk lifestyles that included drugs and alcohol, poor living conditions and lack of medical care, she said.

Because Caruso's hospital treats only the inmate population, her staff nurses face interesting ethical issues, she said. They may have patients who are sentenced for execution who attempt to commit suicide, but the hospital staff still is required to resuscitate them.

For Margaret Collatt, RN, certified correctional health professional, the autonomy is one of the highlights of the field.

As a nurse for the Oregon Department of Corrections, Collatt attends to sick inmates in the prisons. She has learned to handle everything from athlete's foot to an emergency situation, and she's allowed to administer a prescription medication when the inmate meets symptom criteria preapproved by a doctor.

Collatt started her career more than 20 years ago in a traditional hospital, only to face frustration when she had to ask physicians for permission to give patients medicine they could have bought over the counter.

"I thought, 'Why am I wasting my skills here?' " she said.

She struggled to no avail to juggle the irregular shifts at the hospital with single parenting. After five months, Collatt took a job at a mental health facility where the schedule was more regular.

Three years later, though, the facility downsized and she was laid off. When Collatt heard about an opening in corrections, she took the job.

"At first it was a little unnerving to hear the gates slam behind me," she said.

She also had to adjust to seeing patients who sometimes threaten her. Collatt usually responds by telling them the consequences for the action. When one inmate threatened to hurt her family, she explained that she'd have to call the police if he acted on this idea.

Correctional officers usually stand outside examining rooms unless an inmate is particularly dangerous. When an inmate is too ill to walk to the examination room, an officer will accompany the nurse to the cell.

"You must come across as confident and not show any weakness," Collatt said. "If you do, they will take advantage of that and try to get favors." This can include sexual favors or asking a nurse to mail something.

Hard lessons
Collatt gained some of this wisdom the hard way. One time, a prisoner was scheduled for surgery and was taken from the prison to the hospital. When he arrived, though, he told nurses he was sick with the flu. The surgery was rescheduled and he went back to the prison.

When the date for the second surgery arrived, he tried to escape by pulling out a gun that had been hidden in the operating room. He tried to shoot the nearby correctional officer three times, but missed.

Collatt said that this taught her to carefully question inmates' requests. The prisoner had faked the flu in order to check out the room so someone could plant the gun for the second surgery appointment.

Although incidents such as this can taint the correctional health care field, inmates also can be some of the best patients, said Connor, who now works at West Valley Detention Center in Rancho Cucamonga, Calif.

He usually sees an average of 50 patients a day when on sick call, and many of these inmates have avoided health care for years because they lacked insurance or wanted to avoid capture by police.

One time, Connor took a phone call from an inmate's father who was angry that his son was not receiving adequate medical treatment.

Connor agreed that the inmate needed attention and sent the son to the hospital. It turned out that his son had a heart arrhythmia and pancreatitis. When Connor called the family to report the situation, they were extremely appreciative, Connor said.

"They are more teachable and grateful because often they don't get any other help," Connor said. "It gives me a lot of job satisfaction."