UK: "A day in the life of a Prison Nurse"

My day starts at 07.30am, when we receive handover in a multipurpose room off one of the wings. It’s a Victorian prison: space is tight. A lone cockroach scuttles back into the safety of darkness. At night only cell doors are locked and it’s always odd to walk through open gates.

After the night nurse’s handover allocations are made. E1 hatch, H wing, Seg. We have lists of the names of those for release or attendance at court but they are never correct. Since only a few people have access to the National Offender Management system and there are few available PCs in the prison itself, we often don’t know where prisoners are. We might ask officers, but are usually met with shrugs or ignored altogether. The substance misuse nursing team are responsible for medicating all prisoners on opioid substitution treatment (OST) throughout the prison: theoretically they’re housed on one or two wings but in practice wherever there is a free cell. We will be radioed by prison staff later if we miss anyone – everyone in the team has a radio and turning it off, leaving it anywhere or even detaching it from your key belt can get you dismissed.

In our prison medications are administered through ‘hatches’; tiny rooms, part cupboard – often former cells – with a door and gate. Some gates are covered with sheets of Perspex leaving only a small gap – I prefer these to open bars. In the hatch we start measuring out litres of Methadone into glass flasks and back again. We prepare the dispensing machine and software – ‘Methasoft’. It requires purging, flushing and test dosing – there’s also a fingerprint scanner which is brilliant when it works but frequently doesn’t. It will never work for those who have purposely burnt off their fingerprints. The administering of medication can be tense depending on what else is going on in the prison and it helps to be able to detect any fractious undertones. If we feel unsafe we don’t walk through the wings at all – most of the clinical areas and hatches can be reached via alternative routes. An average day might see water or medication spat or thrown at us but the majority are polite enough. Once unlock starts a queue forms. There are the usual issues, requests and excuses. They couldn’t come earlier because they were asleep, on a visit or at an appointment. They have court and want to be served first, last or through their cell door hatch (never allowed under any circumstances). They need more or less Methadone, they have no ID card or can barely able to stand through intoxication. Any perceived discrepancy in how you deal with issues will be noted & can cause big headaches later. It can even put colleagues in danger, so consistency is essential.

Concealments of tablets and liquids are part of prison life and can be both ludicrous and innovative. Officers rarely supervise hatches correctly either due to lack of training, indifference or fear. A common method used is that of distraction. It can be pleasant – ‘you smell nice today’ – humorous or just abusive. We’re only human and can all fall for various tactics at times.

Drugs are rife in prison and even those prisoners who deal them are under little pressure to maintain subtlety around their activities due to the lack of consistency in punishment and the camaraderie between certain officers and prisoners. All drugs – however innocuous – have around ten times the value in here than on the outside. Everyone knows who the main dealers are. Getting sent to prison just to deal in these coveted sellers markets is not uncommon. In an economy where there is little to trade and even less to do it’s unsurprising they’ve become their own currency.

Whenever a ‘bad batch’ of drugs gets into the prison and is smoked, the coded radio calls for immediate medical assistance go out. We aren’t supposed to enter cells alone, but with officers scarce we have to make a choice. Wait, and potentially miss the chance to save a life or go in and potentially risk our own? I go to help, but there aren’t enough working BP machines and our team has no thermometers – we just do our best. Prisoners crowd round jostling, laughing. Some try to help.

A big hatch serving a hundred men can take around three hours, often longer. After this it’s over to healthcare to document. We use Systm One – the same system many GP practices use. We deal with requests from the doctors & NMPs, discuss any prison issues or alerts and review our patients on the wings. Most are locked up by this time and getting a cell unlocked in order to check vital signs is difficult. Smashed or blocked observation hatches means we’re forced to rely on brief conversations through doors.

I spend a lot of time reporting, because three forms on three different systems have to be completed. I can see why people don’t bother. Our nursing managers do their best but they are no match for prison directors who have little to gain from acquiescing to clinical demands and often show disdain for clinical staff to the point of dislike. We are on their turf.

We have lunch in the healthcare wing. There are several part-time GPs, most of whom also work at local practices. They have regular ‘slots’ and one covers first night reception – a nurse and HCA are based here each weekday afternoon. Reception is in the main entrance building. There’s an officer’s station with the holding cells opposite plus an extra one-person cell for ‘Rule’ (sex) offenders. They are always polite but they are the ones no one wants to see. There’s a long questionnaire we need to complete for everyone entering the establishment but many are too exhausted, despondent or angry to complete it, preoccupied with getting a meal and shower. One appears psychotic. He is standing on a table, laughing and chattering incoherently to himself whilst fiddling with the strip lights. We call the mental health ward – an RMN will attend to assess him. There may not be room on the ward and he might have to go to the wing regardless. Many men are suicidal; they will go to a normal wing.

Others in the team cover afternoon meds hatches. Only one nurse is needed in each and it’s a good chance to catch up with patients and provide health education. Those on anticoagulants are given the syringe and inject themselves. Some request analgesia daily either to sell or stockpile or because they just don’t understand how much they need. It’s hard not to empathise with the numerous complaints of toothache, stomach upsets and skin infections which are hardly surprising considering the squalid conditions.

At around nine the night nurse receives handover and we leave. Many cells have defective toilets, broken windows, no electricity or even lighting – but all are still used. The men have already been locked up for nearly three hours – but we’ve been on our feet for thirteen. I feel angry that their living conditions are so poor and no one seems to care, but this is part of why we work here – we want to make a difference.