“If you want to be challenged every day, develop your confidence and skills, and feel supported by a very special team, there’s no better place. You’ll be unfazed by anything in your nursing career after this,” said James, practice educator and experienced Band 7 nurse.
He emphasises the variety of conditions presenting – “we treat whatever comes through the door – there is no filter” – and also the in-depth learning and development opportunities.
“You need your A, B, C, D, E set of skills here immediately as a nurse – but we make sure we prepare and equip you for what is a unique role in a unique environment. You’ll go on to experience the widest range of nursing work including initial assessment and screening in reception when prisoners first arrive; emergency response; inpatient unit; clinics; primary care; mental health and substance misuse.”
The variety of work and conditions – “we have to do a lot of specialisms in quite a lot of depth” – is another reason why the Offender Healthcare Service’s investment in training is so vital.
“Your induction can last up to six weeks and is comprehensive,” explained James, “It covers everything from knowing your way round the different areas of prison, understanding the systems and culture of a security-led’ environment, and all the St George’s competencies expected of any nurse.”
That’s just the start of learning though. Every Friday there are 90 minutes training sessions, often drawing on the experience of clinicians from St George’s. Recent sessions have covered areas as varied as resuscitation updates, complex neuro presentations, bowel screening and chest x-rays for TB. Lengthier sessions have included full-day sessions on self-harm or potential suicide, Blood Borne Viruses and long-term conditions.
Nurses joining the Offender Healthcare Service also have the option of joining the Rotation system, which involves six months in each of the prison, an older people’s rehabilitation ward, and in the community as a district nurse. This also includes a series of short courses all bearing credit at Level 7.
“There is so much experience and support shared within the team and by St George’s consultants in specialties we refer into, that you can really develop your clinical skills. You can also go on to specialise in areas that really interest you.”
“You learn absolutely everything and anything all under one roof,” said Band 6 RCN Jason Cooper. “Because health care here is very much a nurse-led environment, you get a lot of autonomy and opportunity to make decisions, with a close and massively supportive team right by you to help.
“We are dealing with so many different presentations, and constantly improving our clinical knowledge. It is almost like 30 different types of nursing in one role.”
Jason took to this unique nursing environment from day one, earning his Band 6 promotion in just six months.
Learning and development opportunities were key: “Induction was comprehensive and a great start to journey of rapidly expanding my knowledge,” he explained.
“For example I had no previous experience of substance misuse issues – you wouldn’t necessary as an RGN. I have developed awareness of mental health conditions, working with different teams here. There is also a very good preceptorship scheme here and continuous training opportunities.”
Jason was first attracted to working in the prison environment when he heard the Head of Offender Healthcare’s at HMP Wandsworth speak during his nursing degree.
“I thought it could be an amazing experience, and I would be challenged in new ways. I soon realised every day would be different. Some in my cohort at university were sceptical, but can now see that not only was I the first to reach band 6, I have gained a range of nursing experiences inside a year that some people may not get in a decade.”
He is also quick to highlight some of the ways prison nursing has provided new challenges.
“I have had to improve my assertiveness skills very quickly. You also have to realise that security always comes first. However you develop good relationships with prison officers, and assertiveness and mutual respect is key. You’re working in a truly multidisciplinary team every day.”
Jason added: “We get the opportunity to make decisions using clinical knowledge and instincts. In many ways, it is like working as an autonomous or independent nurse practitioner. I think the range of skills you get here will help you anywhere.”
“I would encourage everybody to give working in offender healthcare a go as it is challenging, rewarding and no two days are the same,” said Paula (Pauline) Davis.
She is also looking forward to the challenges, as Wandsworth becomes a predominantly remand prison, meaning an even greater throughput of prisoners.
Paula, a Band 5 Pharmacy Technician, had previously worked in another London prison, and very much sees prison pharmacy as a way of impacting on people’s lives in a positive way.
She said: “Many prisoners do not have regular access to healthcare on the outside, possibly due to being homeless, drug or alcohol abuse or language barriers. That is why our job here is so vital and we can really make a difference.
“What inspired me to join the team at Wandsworth was that it was a rapidly expanding service which is trying to set the standard for offender healthcare. Working in this environment can be challenging and difficult at times, but also very rewarding.”
Reflecting on some of the challenges, Paula added: “One of the main reasons people choose not to work in a prison is that they are concerned about safety. As pharmacy professionals we just deal with prisoners as patients, on a daily basis. We know that security is our top priority, and many systems and processes are in place to ensure staff safety.”
In addition to her main responsibilities of medicines administration on wings, dispensing and checking prescriptions, and patient counselling, Paula has benefited from opportunities for additional professional development at HMP Wandsworth.
“We are all allocated different specialties; mine is respiratory. We work not only to improve our clinical knowledge but to also counsel and advice prisoners on their medications, and help with any issues on compliance and lifestyle changes. I have gained so much by being able to focus on this specialty, and help tackle any associated issues across the team.”