By Lisa Wraith, Bsc (Hons), Msc, RNA, Queen’s Nurse, Head of Healthcare HMP Lancaster Farms, Spectrum Community Health CIC

 The COVID 19 pandemic has placed increased pressure on the nursing workforce globally and the United Kingdom (UK) workforce has insufficient staff to meet patient demand¹. Nursing vacancies in the UK are estimated to be 50,000 in the National Health Service (NHS)²  and significant workforce recruitment challenges persist across all area of healthcare impacting staff and patient safety³. The NHS Long Term Plan has committed to investing in staff recruitment and retention including more nurses³. However, the question is, can Health and Justice settings benefit from these additional nurses and attract them to vacancies in an area where recruitment and retention has been historically challenging⁴.

Placement experiences as a student offer insight into the role of the nurse in Health and Justice settings and in 2003, I was able to spend four weeks as a second year student in a local Young Offenders Institute as an elective placement. When I told my mentor in the district nurse team that I was going on the placement their response was “is that not a waste of time, running around a prison?” However, during this placement I was made to feel part of a collaborative team, observing the delivery of primary care based services and emergency care to a population of 500 15-21 year old males. I was able to work on a daily basis with mental health nurses and substance misuse teams delivering holistic person-centred care. When I took my first staff nurse role in a category B local prison a sister who had offered me a post on a surgical ward said “I think you will regret that decision”. I have not regretted this at all. All through my career I have had comments from nurses and health professionals who have never worked in the prison environment say that prison nurses “de-skill”. This is simply not true, but a common misunderstanding of the role, expertise and competencies of prison nurses.

The prison environment can be challenging environment for care delivery, nurses within the health and justice setting develop appropriate skills to adapt to this⁵. Not only do Health and Justice nurses develop clinical skills associated with their own branch of nursing, they also develop expertise in providing holistic person-centred care. The NHS Plan³ recognises that many people on the criminal justice system have greater and more complex healthcare needs than that of the general population and have not accessed appropriate healthcare provision in the community. The NHS England and Her Majesties Prison Service partnership agreement⁶ set the priorities for healthcare delivery across this sector to improve continuity of care pre, post and during the person’s time in custody. This included; reducing health inequalities, ensuring the delivery of safe, legal, humane and effective healthcare services, improving the health and well-being of the prison population, supporting rehabilitation and addressing health related factors associated with offending.

The role is incredibly diverse and no two days are the same for healthcare professionals working in the prison setting. Nurses deliver clinics which mirror community provision; wound care, phlebotomy, managing Long Term Conditions as well as triaging and treating minor illness and injury. Nurses also provide response to medical emergencies and care for people who have self-harmed, those in need of end of life care, support patient safety and risk management.  Nurses play a key role in coordinating care that ultimately influences the health and social care outcomes for people in prison⁶. Nursing in prison settings offers a long and rewarding career, with opportunities to continually develop and learn new skills and extend scope of practice^4,5. The development of a strong professional identity is needed to attract more nurses into this settings and aid recruitment and retention⁴.

References

1. The Kings Fund (2022) The NHS workforce in England is in crisis: urgent action is required to tackle a vicious cycle of shortages and increased pressures on staff, which has been exacerbated by the Covid-19 pandemic. Available at NHS workforce: our position | The King’s Fund (kingsfund.org.uk)
2. Royal College of Nursing (2020) Staff Safety at risk unless nursing shortages are addressed https://www.rcn.org.uk/news-and-events/news/uk-staff-safety-at-risk-unless-nursing-shortages-are-addressed-170920
3. NHS England/ NHS Improvement, 2019 The NHS Long Term Plan available at NHS Long Term Plan » The NHS Long Term Plan
4. Goddard, D., De Vries, K., McIntosh, T., Theodosius, C (2019) Prison Nurses Professional Identity. Journal of Forensic Nursing: 7/9 2019 – Volume 15 – Issue 3 – p 163-171
5. Choudhry,K; Armstrong, D; Dregan, A(2017). Prison Nursing: Formation of a Stable Nursing Identity. Journal of Forensic Nursing: 1/3 2017 – Volume 13 – Issue 1 – p 20-25
6. The NHS England and Her Majesties Prison Service (2018).  The NHS England and Her Majesties Prison Service Partnership Agreement 2018-2021 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/767832/6.4289_MoJ_National_health_partnership_A4-L_v10_web.pdf#:~:text=A partnership agreement has been in place to,and delivery of healthcare in prisons in England.