Day in the Life of a Correctional Nurse Practitioner
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“As more people realize the opportunities for NPs in corrections, and as correctional medicine itself moves forward and gets a better reputation, I think more people will be interested in coming into this specialty. This is a respected, up-and-coming field filled with exciting opportunities for NPs.”
Dr. Jennifer Clifton, Family Nurse Practitioner and Faculty Member at the University of Utah College of Nursing
The nurse practitioner (NP) role has changed significantly since its inception in 1965. While the first NPs focused on pediatric care and family health, today’s NPs work in various settings, specialties, and subspecialties. This new crop of NPs is helping expand healthcare access for patients across the country, and shaping the future of nursing simultaneously.
NPs work in settings such as jails, prisons, and detention centers. They care for an underserved, at-risk population, ranging from adolescent through geriatric years. According to a report from the Bureau of Justice Statistics (BJS 2016), prisoners and jail inmates were more likely than the general population to have a chronic condition or infectious disease; another report found that 26 percent of jail inmates and 14 percent of prisoners met the threshold for serious psychological distress (BJS 2017).
Throughout most of history, the standard of care in correctional medicine has been poor, but correctional NPs have helped change it for the better. This is a young and impactful specialty practice area where NPs can play a significant role in shaping the future of the field. To learn more about the work and advocacy of correctional NPs, read on.
Meet the Expert: Jennifer Clifton, DNP, FNP-BC, CCHP-A, FAANP
Dr. Jennifer Clifton is a family nurse practitioner and has been a faculty member at the University of Utah College of Nursing (CON) since 2005. In addition, she serves as a primary care provider in Utah’s Juvenile Justice Services (JJS) clinics, and at the Summit County Health Department. She is also the CON director of primary care and the interim associate dean of faculty practice.
Dr. Clifton speaks nationally regarding various topics concerning juvenile correctional healthcare and serves on the NCCHC Juvenile Health Committee. She also serves on the NCCHC Board of Representatives as a liaison with the American Association of Nurse Practitioners (AANP). She completed the Duke-Johnson & Johnson Nurse Leader fellowship in 2016 and was inducted as a fellow into the American Association of Nurse Practitioners in 2020.
Unique Aspects of the Correctional NP Role
“This is really an exciting place to be,” Dr. Clifton says. “An NP can often be a leader in a correctional setting, more so than they may be in a typical clinical setting.”
In correctional settings, it’s common for an NP to be the voice of authority on medical issues. And that authority may reach beyond clinical care into areas like administration, emergency planning, infection control, and quality improvement. Especially in places where NPs can practice autonomously, it’s not uncommon for the NP to take on a medical director-type role.
“Many correctional facilities are out in rural areas, and they have a hard time finding physicians to work there,” Dr. Clifton says. “But NPs often work with the underserved. It’s what we do.”
Correctional NPs aren’t meant to be a substitute for physicians. Instead, they bring their own unique skill set, which is particularly well-suited to the correctional setting: a compassionate, holistic, patient-centered approach borne out of nursing training and time spent at the bedside.
“It comes down to all the things we learn in nursing school and our experience as nurses,” Dr. Clifton says. “We understand what it’s like to help someone through the worst times of their lives.”
The NP role is an inherently collaborative one, but that takes on new meaning in correctional settings. A correctional NP will still collaborate with other members of medical staff (and most typically RNs). Still, they’ll also need to interact with the non-medical personnel, who have a different set of priorities. Correctional NPs need to be attuned to those priorities and learn how to navigate them to advocate for their patients.
“It can sound a little odd for someone who’s used to working in a clinic, but in these settings, the non-medical staff’s top priority is safety, not health,” Dr. Clifton says. “It can be a different language, and that can sometimes be hard or frustrating, particularly in a crisis.” However, post-Covid, many correctional NPs report a new level of respect and a willingness to collaborate among correctional administration.
Correctional medicine is, itself, young: it was practically non-existent before the 1970s. Prison and jail healthcare was not seen as a right, and suffering was often believed to be part of an individual’s punishment. In 1976, the Supreme Court ruling in Estelle v Gamble established that failure to provide adequate healthcare is considered deliberate indifference and therefore constitutes cruel and unusual punishment, which is prohibited by the Eighth Amendment to the US Constitution.
Litigation since Estelle has brought about significant change in how correctional healthcare is provided and the attitude of policymakers and the public alike. It is now recognized that incarcerated individuals are due the same standard of care as those who are not. Correctional NPs are helping to provide that care, shaping the future of more compassionate and comprehensive correctional care.
“It’s a relatively new area of healthcare, and it’s different,” Dr. Clifton says. “You can’t treat illnesses in corrections the same way you treat illnesses outside of corrections, and there’s a lot of room for research, impact, and growth with NPs.”
A Typical Day for a Correctional NP
A typical day for a correctional NP will vary dramatically based on their setting: the needs of patients in a juvenile detention center are different from those in a high-security prison. In the juvenile detention center where Dr. Clifton works, the average length of stay is only seven days, so she and her team look at their patients not as incarcerated individuals, but as people who are on their way back into the community. In addition to her clinical practice, Dr. Clifton will work with parents, guardians, home placements, and other resources for her patients.
“I have a number of friends who are community health nurses, and I’ve been encouraging them to come to our National Correctional Conferences because so many of the topics intertwine,” Dr. Clifton says.
On a typical clinical day, Dr. Clifton will see a mix of patients referred to her by a team of nurses. She’ll also follow up on patients she’s seen before, either for an acute illness or a chronic condition, and perform physical exams on new arrivals at the facility. Outside of direct clinical care, Dr. Clifton will meet with facility administration and follow up with other medical and non-medical staff members.
“In my practice, the correctional NP comes in and plays the role you’d often see a physician play,” Dr. Clifton says. “You are the health authority.”
Advocacy Issues for Correctional NPs
Advocacy is written into every NP’s DNA, but it’s particularly important when dealing with vulnerable and underserved patient populations like those in correctional settings. That advocacy could, in part, be practicing and promoting trauma-responsive language, as rates of PTSD are exponentially higher among incarcerated Americans than in the general population. It could also be lobbying for funding of STI screenings, as Dr. Clifton successfully did in 2015, or instituting screenings for sexual abuse and human trafficking.
“When we see these patients, maybe they’ve been picked up for drugs, but when we dig into it, we find out that they’re actually victims, and we try to get them resources,” Dr. Clifton says.
Correctional NPs are also focused on advocating for the NP profession as a whole, particularly in the fight for full practice authority. To practice to the full extent of their training and education, NPs need full practice authority at the state level, but they also need it at the organization and policy levels. Subtle changes in policy terminology can make an enormous difference: outdated policies stating that a physician or psychiatrist must perform a certain procedure should be reworded to more inclusive terms that extend to primary care or psychiatric-mental health NPs.
“In the National Commission, we have standards for prisons, for jails, for juvenile healthcare, and for mental healthcare,” Dr. Clifton says. “I was on the task force that rewrote the standards for juvenile healthcare, and I repeatedly advocated that NPs be allowed to practice to the top of their license, understanding that that will look different in different states. While much remains to be done, the most recent juvenile standards contain elements of parity not seen in previous editions.”
In multidisciplinary correctional health conference settings, Dr. Clifton is sometimes the only NP in any particular committee, and there’s still plenty of education needed around what today’s NPs are able and educated to do. But things are improving.
Nursing schools are becoming more aware of the value of correctional settings for student NPs. In correctional facilities, NP students can hone their health assessment, physical exam, and motivational interviewing skills. Students also learn to directly address difficult topics such as adverse childhood experiences, sexual activity, and drug use.
NP students can serve as valuable resources, teaching incarcerated individuals a variety of subjects. Students gain critical experience working with an underserved community, seeing first-hand the disparities of social determinants of health.
“As more people realize the opportunities for NPs in corrections, and as correctional medicine itself moves forward and gets a better reputation, I think more people will be interested in coming into this specialty,” Dr. Clifton says. “This is a respected, up-and-coming field filled with exciting opportunities for NPs.”
Resources for Correctional NPs
To learn more about the work and advocacy of correctional NPs, check out some of the resources below.
- American Association of Nurse Practitioners (AANP): With over 121,000 members, AANP is the largest organization for nurse practitioners, working to improve patient care and advance NP practice.
- American Correctional Nurses Association (ACNA): Officially formed in 2019, the mission of the ACNA is to advocate for correctional nurses and the patients for whom they care.
- Journal of Correctional Health Care: Published by the National Commission on Correctional Health Care, the Journal of Correctional Health Care is the only national, peer-reviewed scientific journal to address correctional healthcare topics.
- National Commission on Correctional Health Care (NCCHC): An independent, nonprofit organization dedicated to improving the standard of care in the field of correctional health, NCCHC also offers certifications for NPs and other health professionals.
Matt Zbrog is a writer and researcher from Southern California, and he believes a strong society demands a stronger healthcare system. Since early 2018, he’s written extensively about emerging topics in healthcare administration, healthcare research, and healthcare education. Drawing upon interviews with hospital CEOs, nurse practitioners, nursing professors, and advocacy groups, his writing and research are focused on learning from those who know the subject best.