Patty Daugherty, RN, is on the inside looking out across the grounds of the Edna Mahan Correctional Facility for Women in Clinton, N.J. She sees herself in graduate school, possibly in the fall, working to become a nurse practitioner specializing in adult care. Then, she'll return to the prison or another correctional facility.

As health services administrator at Edna Mahan, the only women's prison in New Jersey, Daugherty runs its hospital and eight-bed infirmary and oversees mental health care for about 1,100 inmates. The campuslike facility of minimum- and maximum-security buildings, many of them dating to the 1800s, is a mile off the beaten path-a mile called Freedom Road.

Inmates range from parole violators to lifers, from 19-year-olds to one woman in her 70s. "Some of these women come for life. They're going to die in prison," Daugherty said.

In the meantime, it's up to her and her employer, Correctional Medical Services, which has a contract with the state, to see to it that prisoners' lives are long and healthy from the moment they are transformed from citizen to inmate. Daugherty's round-the-clock staff includes a physician medical director, a part-time physician, a full-time nurse practitioner who runs a chronic disease clinic, RNs and LPNs.

Corrections nurses use all their skills, Daugherty said, beginning with assessments before an intake physical that includes a chest X-ray, Pap test and mental health exam. "You see everything from smashed fingers to little emergencies," she said. "We do the chronic care things. We do acute care. We have cancer patients. We have women who are having babies. We have the infectious things."

For her first nine months at Edna Mahan, Daugherty, 48, was the infection control nurse, dealing with conditions that aren't rare in the general population, but are particularly high among the incarcerated: HIV and AIDS, hepatitis C and sexually transmitted diseases. "Lots of chlamydia, some syphilis and a few cases of gonorrhea," Daughtery said. "With some of the women, it almost seems as if they don't take care of themselves at all and they come to prison to get the medical care they need."

Daugherty said she saw a newspaper ad for a county corrections nurse and went for an interview just to see what it was like inside a prison. "I thought this was the only opportunity I was going to have," she said, which is a good thing when you consider that the other way to see it is as an inmate. "It looked pretty fascinating and kind of scary and that appealed to me," she said.

It wasn't long before Daugherty was working as a corrections nurse in Northampton County, near her home in Nazareth, Pa. That was 1998, and she's been in and out of the penal system since, en route to Edna Mahan. What she's learned along the way is that she feels safest and happiest on the inside.
Daugherty's children-two sons and a daughter-were apprehensive when she settled on a career in corrections. "They all thought 'Oh, the inmates are going to eat you alive, Mom,' " she said.

Their worry was well-intentioned, albeit needless. For one thing, Daugherty said she doesn't get involved in disciplining inmates. "We're not there to judge them. I don't know why most of them are there. I don't want to know."

Her dangerous days as an RN were on the outside, as a home health nurse and with a public health bureau in the Allentown-Bethlehem, Pa., area. "Some of the areas I went into as a home health nurse were so bad that I needed police escorts," she said. "I also had an area I went into where I had to go between 6 and 7 in the morning because if I went too late, everyone was awake and it was too dangerous. I always had my cell phone with me and my pepper spray. I'm so much safer in the prison than I was on the street."

Furthermore, most inmates realize that nurses and hospital staff are there to help them, Daugherty said.

The public misconception is that you can always get a job in prisons because they're desperate, but that's not the way Daugherty works. Edna Mahan struggled for a while with the national nursing shortage, but it's nearly at full staff now. "I set standards very high," Daugherty said. "If I don't think they'll fit in with my staff or that they have the assessment skills they need and I don't think they're dependable, I don't hire them. I only want the best."

Occasionally, when things become particularly stressful at the hospital, Daugherty said she takes walks across the grounds, populated with deer and geese, to the chapel and small cemetery that dates back to the 1800s when Edna Mahan founded the prison for pregnant women. In a way, Daugherty is stepping back to her roots.

"My grandmother worked in this prison," for a few weeks, training as an officer, Daugherty said. "She told me stories about it when I was a little girl. And I thought 'Oh my gosh!' I couldn't imagine my sweet little old Irish grandmother working in a prison. And here I am."