Not every nurse is willing to accept a lower salary and potentially risk their safety to work in a correctional facility, but veteran correctional nurse Stephen Goux, MSN, RN, AFN-BC, swears there’s no better feeling than being trusted enough by a youth in juvenile detention to help with a crisis.
Often, that relationship starts at the juvenile correctional facility’s initial intake assessment. This usually takes place within the first 24 hours after the child arrives at the facility. During the time, nurses assess for drug or alcohol use, sexually transmitted disease, tuberculosis, suicide potential, medication use and the risk of harm to oneself or others.
Though it sounds like a simple screening, the lack of resources at most correctional facilities complicates the intake assessment process. Goux, formerly employed at the now-defunct Regional Detention Center for the State of Georgia Department of Justice and now treasurer of the International Association of Forensic Nurses, said correctional staffing shortages impose hurdles on even conducting that initial assessment.
“The juveniles needed a correctional officer to accompany them for medical screening,” explained Goux. “Staffing for correctional officers is chronically low and they need one officer for every seven youths. So, medical needs would fall to the bottom of their to-do list and education was always prioritized.”
Detecting Drug Use
Abuse of drugs and alcohol is a perennial problem in juvenile detention facilities and nurses’ role is subtle.
If a youth is obviously under the influence of drugs or alcohol, they’re immediately rerouted from the correctional facility to the hospital. During the initial intake screening, nurses ask about drug or alcohol use and conduct a mini-assessment to check for dilated pupils.
“The correctional side would conduct random drug tests,” clarified Goux. “The state didn’t want to put us in the position of looking like bad guys.”
Possibly because of this trust, many youths admit to drug use to nurses. “A lot of the time, kids are proud of using drugs and they’re often more honest than adults,” commented Goux. “We also review the arrest report and see a lot of marijuana and alcohol reports. We’re starting to see more ecstasy use.”
In a perfect world, nurses never have to deal with withdraw symptoms because anyone under the influence is immediately redirected to the hospital. However, it’s unfortunately common to have nighttime intake under an inattentive officer who missed the signs of being under the influence.
“We’d then recognize the signs of the inmate going through withdraw,” said Goux. “When the youth is withdrawing from heroin, we can prescribe methadone but the challenge is making sure the drug stays in the hands of the appropriate juvenile and isn’t passed to someone else.”
Just as when they’re administering any prescription, staff checks under the tongue of the juvenile receiving the medication as well as that of the next youth in line to make sure the pills weren’t passed.
Uncovering Abuse & Pregnancy
All too often, nurses are among the first to learn about an inmate’s pregnancy. Judges usually impose lighter sentences with home monitoring if they’re aware of the pregnancy condition. Much of the time, the pregnancy isn’t discovered until the urine screening for the intake assessment. Other times, the youth first reveals her condition to the nurse.
Though it’s rare to have a pregnant female in her later months in juvenile detention, Goux said it’s unavoidable in the case of a violent crime. Only one inmate has given birth at the facility during his tenure.
“Our physicians are pediatricians so pregnant females have to be transported for regular obstetrical visits,” he noted. “We’d get her chart back so we could keep up with her progress. Pregnant females got extra meals for calories and an extra mattress to combat back pain. If she had to be handcuffed, it was always in the front so she could protect from a fall.”
Sometimes the pregnancy is a result of sexual abuse. Whether the abuse resulted in a pregnancy, was associated with the crime or occurred years ago, screening questions have been equired since the Prison Rate Elimination Act, which was enacted to protect inmates from abuse within the facility. Goux said females are more apt to disclose prior sexual abuse.
Questions about self-harm are also mandatory and Goux said any hint of suicidal intent is taken seriously, in spite of the fact that youths are more apt to seek attention by claiming to be considering suicide than their adult counterparts. Nurses and mental health staff are the only personnel qualified to place a juvenile on suicide watch, which entails moving to an isolated cell without any belongings and donning a suit that won’t rip and therefore double as a hanging device. Staff monitors patients on suicide watch from an outside window every 15 minutes and a medical evaluation takes place every 12 hours.
Infectious diseases like staph infections, MRSA, lice, scabies and tuberculosis are also all in a day’s work for nurses in a correctional facility. “People think correctional nursing is just giving out pills and following doctors’ orders. But it’s a culmination of public health, emergency and med/surg nursing,” he remarked. “You have to be educated on different skills and conditions.”
As much as Goux likes the variety in the job, it’s the bonding with troubled youths that keeps him in the specialty. “A lot of kids will only talk to a nurse,” he shared. “They don’t want to talk to someone who has been mean. You’re seen as a caring person who can help.”
Robin Hocevar is on staff at ADVANCE. Contact [email protected].