Nursing behind bars: specialist postgrad certificate announced for prison work

"Look, we probably need to get you into this environment and see how you respond to it before you can actually make a decision yourself whether or not this is for you," they said to nurse Adam Spicer after his job interview. Unusual perhaps – most people go into a new workplace blind – but not many nurses take jobs in prisons.

Until recently, there were no specific postgraduate training programs for nurses moving into this specialised environment. However, next year CQUniversity will launch the GC in Correctional Nursing, the only postgraduate qualification of its kind in Australia.

Australia has one of the highest prison populations in the OECD at 43,320, and that is growing every year. And with this large captive population comes a litany of serious health concerns.

According to government statistics, two in every five prison entrants have been previously diagnosed with a mental health condition, and one in four take related medications. Approximately one in three prisoners have a chronic physical health condition, and one in five have tested positive for hepatitis C.

However, these kinds of statistics did not deter Spicer, nor did that first trip around Yatala Labour Prison in South Australia. After spending the start of his career in emergency, he felt prepared for the challenge.“I remember the first day. Going through the very large barriers you have to cross between the car park and deep into the middle of Yatala Labour Prison, where the health centre was at that time, was quite daunting," Spicer says.

“However, I always say it's safer to work in a prison than an ED because these people are scanned, they're vetted, there is a very low instance of weapons, and there are very low instances of drugs within the prison system. So you've got a population that's safer to work with."

As the clinical services coordinator at Yatala, Spicer oversaw the staff, service and general healthcare of the prison, as well as doing hands-on clinical work. A “jack of all trades” is how he describes it.

“One of the biggest eye-openers you'll have if you ever move into the prison nursing system is seeing the concentration of a population group that is significantly disadvantaged,” he says.

“As soon as a patient-prisoner comes into a prison, they will see a nurse. They do that initial admission, and that admission pretty much sets up their journey – so, whether they're safe to be by themselves, what type of healthcare needs they have, and so on. Often these people may still be intoxicated or injured after their processes.”

Add to that, instances of childhood sexual abuse, domestic violence, unemployment and “transgenerational incarceration”, mean the nursing environment can be challenging.

Despite some stereotypes of prisons and prison conditions, Spicer takes pride in the fact that he can make a difference to many in this population.

“The majority of prisoners will leave prison with greater health. They've had access to healthcare which they don't access from the outside. They get nutrition, they get warmth, they get shelter and they get medication they normally wouldn't have," Spicer says.

“Dental is a massive issue ...  A lot of this population have very poor oral hygiene and oral dentition. My general feeling is that the prisoners will often leave with better health outcomes.”

Spicer is quick to dispel any sensational notions of prison life, but admits there are experiences that have had a profound effect on him.

“People ask questions like, ‘Have you ever seen anybody hang themselves? Have you ever seen anybody slashed and bleed to death?’ It's that gore that the general population wants to know about,” he says.

“Most of the prison nurses will have been involved in a traumatic event like that, and I certainly have.”

One interaction with a young inmate taught Spicer more about prison life than any traumatic event.

“A young Indigenous prisoner came in and he might have been 19 years old. They were talking to him about things and asking him how he was – this was a mental health assessment – and he said, ‘I'm going okay because now I can see my dad.'

“These are the moments where you see the prisoners for what they are: just people like you and I. They may have run into difficult circumstances, but they face the same problems you and I face.”

Spicer believes that, like any workplace, there could be improvements. Access to specialists is one luxury prisoners do not have. There could be more resources for mental health and drug and alcohol services. And clean needle exchanges would greatly reduce blood-borne viruses, but “there is a separation between correctional staff and health staff” on that issue, he concedes.

Dr Julie Bradshaw, deputy dean of learning and teaching from the School of Nursing, Midwifery and Social Sciences at CQUniversity, says the GC in Correctional Nursing will teach students to deal with the realities that Spicer describes, as well as many other facets of the nursing role, including primary healthcare, chronic disease management, health education and responding to emergencies.

“There will be a focus on understanding offenders, why they are likely to offend, and the effect of incarceration – in particular, how this relates to the Aboriginal and Torres Strait Islander population,” Bradshaw says.

“Students will gain knowledge about licit and illicit drug use, harm minimisation strategies, and treatments relevant to the prison environment."

Overall, Spicer believes the level of health available in prisons is similar to that available to the outside population. He has now moved on to a management role – nurse consultant – liaising across the SA prison system, and he believes the introduction of a grad certificate is great news for the speciality.

“A postgrad cert would be fantastic for correctional nursing, having some structure related to career path – each state seems to have different ideas of novice to expert in the field – as well as some recognition of skill set, and contemporary issues related to it," he says.

“The postgrad education around other primary healthcare fields just does not fit that well with the prison health nurse,” he adds.

“It's fascinating work. And yeah, I'm really glad I made the move.”

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