Forensic nursing: RN practice in prison populations

Registered nurses seeking autonomy and variety in their practice setting may want to consider the field of forensic nursing as an option.

Simply defined, forensic nursing combines the bio-psycho-social education of the registered nurse with the assessment and treatment associated with abuse, violence, criminal activity and traumatic incidents.

Forensic nurses work with a range of populations from pediatrics to geriatrics in a variety of settings including psychiatric units in hospitals, sexual assault examining units, coroners' offices, geriatric units, and frequently within the provincial and federal correctional systems.

Fifteen years ago, registered nurse Barbara Moreland applied for a part-time job in forensic nursing and is now the health care manager at the Fort Saskatchewan Correctional Centre. "I continue to be intrigued with the challenges of this kind of nursing," says Moreland. "It has satisfied my need

for independence and I like dealing with offenders who have some really serious issues that may not be addressed in the community. I'm very proud of what we do."

In the correctional setting, patients present the same problems found in any general practitioner's office but generally with a greater incidence of infectious diseases, substance and drug-related problems, mental health and trauma issues. Doctors typically visit correctional centres only a few hours per week, so forensic nurses regularly apply excellent assessment and counselling skills, act on broad standing orders and make referrals to dentists, psychiatrists and other medical specialists.

"It requires an independent spirit and lots of confidence and common sense," says Moreland.

Dorothy Latimer has been a nurse at the Edmonton Institution since 1994, first as a staff nurse and now as clinical coordinator. A federal maximum-security institute, the Edmonton Institution houses inmates serving sentences of two years or longer.

"What I particularly enjoy is the opportunity to work with a young, healthy population where there is some room for health promotion," says Latimer. "I also like being in a controlled environment with a stable population, much like you would find in a nursing home. Here, we can get to know the inmates as people and build rapport over time."

But looking after the health of offenders is not for everyone. "Nurses must be willing to dismiss the offence and focus on the health of the offenders." says Ion Grigoriu, health care manager and director of the assessment and treatment unit at the Calgary Remand Centre. "Our job is not to judge these individuals."

Forensic nurses must also be prepared to function in an environment where security is front and centre. Grigoriu cites an unlikely but true example from the literature about an offender who faked a hanging and then took the nurse as hostage. Generally, though, nurses here seem comfortable with the level of security on site.

"I've never had a problem," says Moreland. "You're surrounded by security staff, always carry an emergency buzzer and if you're concerned, you know a correctional officer will be there in seconds."

There are no recognized educational prerequisites for the job beyond the professional RN designation, although related psychiatric courses offered through the university and colleges are considered helpful. Perhaps the most important prerequisites for anyone interested in forensic nursing include nursing experience and life experience. "It's the kind of job where there is a lot of autonomy and with that comes responsibility," says Langis Bernier, chief of health services at the Edmonton Institution. Registered nurses in both provincial and federal correctional institutions come to the job with solid experience in emergency, neuroscience, psychiatric nursing or other nursing backgrounds. "Obviously, continuing education is also important," says Grigoriu. "You have to keep your skills current because you may be the only one available to answer in a medical emergency."

Forensic nurses enjoy flexible working arrangements not usually found elsewhere in the community. A mix of full-time and part-time opportunities is available and many staff also hold additional part-time nursing jobs elsewhere. Depending on the facility, the hours of work are generally confined to days or evenings and only occasionally nights during the unlikely event of a large-scale disturbance.

Forensic nurses not only appreciate independence, interesting work, and flexible work arrangements but also the opportunity to make a difference in small ways. "Some of our offenders have had really rough lives," says Latimer at the Edmonton Institution. "One of our nurses recently showed an offender a snapdragon from the garden. He didn' know what a snapdragon was and she made a little mouth out of part of the flower and asked `Have you never made a snapdragon talk?' It's little moments like this that help make an impact on the lives of the people here and provide us with satisfaction." RN

Copyright Alberta Association of Registered Nurses Oct 2002
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