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Why nursing in prisons

Warren Stewart 4 Nov 2020 Nursing in Justice and Forensic Health Care

This blog is a personal reflection on my motivations for nursing in prisons and my reasons for maintaining an interest in it. It's about the challenges and things I've enjoyed about it over the years.

Many people have asked me over my career, 'Why nursing in the prison service'? It's a reasonable question; it's an organisation in relative crisis and from a nursing perspective, it hasn't always been held in the highest esteem by comparison to the other nursing specialisms. It's a question that has prompted me to reflect on what got me into prison nursing and more to the point, what has kept me with it, as a nurse, a nurse manager and currently as a researcher. From a reflexive perspective, there are a number of complex reasons, but perhaps the most obvious reason is the incredible difference between prisons and virtually any other walk of life.

I've experienced a lot of change since starting as a uniformed Health Care Officer in 1996. On my first day, I encountered three rather burley blokes in slightly ill-fitting, undersized tunics, in a unit that was built when Queen Victoria was a lass. 'How's this going to work, I thought to myself?' I've seen the responsibility for prison health care change hands, from the Home Office, to the NHS, to NHS commissioned private services. Changes have occurred through external reasons, for example austerity measures, and within the population through the increasing use of new psycho-active substances and demographic differences. Over the years, I developed an appreciation of the history, traditions, socio-materiality, in summary, the culture of prison life.

In essence nurse-patient relationships are fundamentally the same, you will encounter individuals with all kinds of vulnerabilities, this is something every nurse will recognize and I'm sure, want to respond to. There is a constant churn of people, all with their own stories; people who have experienced all kinds of trauma, disadvantage and distress. The In-patient departments where I worked could nearest be described as male acute assessment wards, but they were so much more than that. You'd find the full range of holistic needs; every presentation under one, extremely diverse roof.

Prisons are places of coercive power, but in a sense, everyone is influenced by it equally. The regime is heavily structured, but this also brings some benefits, it helps to commodify time and contain anxiety. Prisons aren't covered by the Mental Health Act so there were less difficult discussions in relation to medication or stoppage of leave. Despite the austere environment you learn to appreciate the small pleasures, for example, a morale boosting toasted bacon sandwich with the team on a Sunday morning, or a late-night televised football match with the patients during a night shift.

The challenges for nurses in prisons are many. Nurses are positioned at the interface between the opposing ideologies of 'care', 'custody' and increasingly 'efficiency', these are tensions we embody in our practice, tensions that influence our actions and decisions. Our role is to promote health, but we function in the context of the crime control apparatus. We absolutely need to develop our security sensibilities to maintain everyone's safety but equally need to know when to use our nursing knowledge to inform and challenge authority.

The exposure to the frictions associated with multi-disciplinary working is unlike anything I've ever experienced in ordinary clinical settings; relationships need to be constantly negotiated. However, there was a tangible sense of inter-dependence with the officers who, by and large, demonstrated their own brand of good will and compassion, often under very difficult circumstances. All staff and prisoners need a special kind of resilience to survive in the hyper-masculine environment.

In summary, it's a rich environment for learning and a rich environment for caring. I learned that 'a little bit of extra effort' in support of individuals can go an extremely long way. There are a lot of needy people and there is lot of good work to be done but there is reciprocity and a good deal of hope amongst the daily drama. Creating change can be difficult, but it is possible.

Warren Stewart

Warren Stewart

RCN member, Nursing in Justice and Forensic Health Care Forum

Senior Lecturer, Mental Health Nursing, University of Brighton

Warren is a Senior Lecturer in Mental Health Nursing; much of his clinical and research experience is in secure and forensic settings.

Page last updated - 06/04/2021