I trained as a nurse, and from early in my training I knew where I wanted to work: in a prison. I have always had a non-judgmental approach to people and was drawn to working with individuals whose lives had been shaped by the social determinants of health; poverty, trauma, marginalisation and inequality. Prison felt like a place where nursing could reach people that other services so often fail to reach. I worked hard towards that goal, and when I finally qualified, a prison nursing post felt within reach.

Then a door closed that I hadn't expected. For health reasons I was unable to take up clinical prison work. It was a significant blow.

What came next was a funded PhD at Bournemouth University, and with it, a different way into the world I had wanted to enter.

My research explores how prison officers experience working with older men in prison who are dying. My background is nursing. My research is not about nurses. The more I have immersed myself in this work, the more I have come to understand something I hadn't fully appreciated before: just how much is placed on the shoulders of prison officers, and how little acknowledgement or support they receive for carrying it. A population we cannot ignore.

The prison population in England and Wales is ageing rapidly. In 2025, there were 394 deaths in prison custody, of which 224 were due to natural causes, the highest number recorded outside of the COVID-19 pandemic. People aged 50 and over accounted for 86% of all natural cause deaths. Prisoners die at a median age of 67.5 years, compared with 86.7 in the general population. Behind these numbers are real people dying in real cells, and the people most consistently present with them are not nurses or doctors, they are prison officers.

The invisible workforce

Before beginning my primary research, I conducted a scoping review of existing evidence. The finding was striking, not because of what was there, but because of what was not! Across two decades of literature, not a single study had examined prison officers' experiences of end-of-life care as its primary focus. Their experiences, perspectives and emotional lives had been consistently overlooked.

Four themes recurred: an expanding informal caregiving role without training or recognition; the tension between custodial and caring duties; significant emotional strain with little support and structural constraints that make good care difficult even when officers want to provide it. Most troubling: none of this appears to have meaningfully changed in twenty years.

What "care" actually means on a prison wing

Should a prison officer provide care, or should they be caring? These are not the same thing. Nurses provide care; structured, professionally defined, underpinned by training and regulation. Prison officers are not nurses and should not be expected to be. But they are human beings working closely with people who are dying, and something happens in that proximity that goes beyond the custodial role.

One of my participants never once used the word "care" to describe his work. In another interview, it appeared only once: "We're not set up to care for them." He was not describing an absence of compassion but a structural failure, an institution configured around security, asked to hold the weight of end-of-life work without the tools, training or recognition to do it.

What I have learned from sitting between two worlds

The officers I have spoken with are angry at systems that do not support them, at institutions that have watched their role expand without acknowledgement and yet, in the same breath, they speak with genuine warmth about the men on their wings who are dying. One officer described years of accumulated knowledge, evident compassion, and behind all of it, the expectation to absorb whatever the role demands and get on with it. No support. No debrief. No mechanism to process what he had witnessed. I find that humbling.

Why this matters for multidisciplinary practice

If you work as a nurse in a prison or forensic setting, you share a building with people carrying something that rarely gets named. Prison officers are present in ways that healthcare professionals often are not: through the night, on the wing, in the moments before and after clinical contact. Effective multidisciplinary working has to extend to the landing.

The data already makes one thing clear: the gap between what prison officers are asked to do and what they are equipped and supported to do is not a gap healthcare professionals can afford to ignore.

Prison officers and nurses in custodial settings are, in many ways, already working alongside each other, often more closely than either system formally recognises. The people on the landing are already part of the care team. What is needed now is for that to be acknowledged, supported, and built upon. They deserve no less and neither does the older person in prison who is dying in their care.