Caring for everyone: My journey in correctional medicine

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Growing up, my father was in law enforcement, and my mother worked in Court Administrations. I often listened to their conversations about the people my dad would arrest and my mom would then process through the court system. The frustration of seeing an offender for multiple offenses can be exhausting. Surely, there must be a way to help these people? Caring for everyone, regardless of what they have done, is paramount in my line of work.

I chose to advance my career in nursing and received my educational foundation from Augsburg University in downtown Minneapolis. Their nursing program emphasizes eliminating health inequities through peaceful, just, and collaborative actions that uphold and improve human potential. One of my first professors was Katie Clarke, a true mentor to me. She listened to my concerns and assisted with helping me get into a clinical setting at the local jail with their medical agency. The jail administrator at Douglas County jail, Jackie Notch (now retired), had been a long-time role model of mine and welcomed me to assist in any way.

Making a plan

During this time, I spent many hours in downtown Minneapolis working at the Central Health Commons, an Augsburg-run health center for the homeless. I was feverishly working on a foundation of what a reentry program may look like for inmates. I had multiple conversations with previous offenders to learn about jail culture and what other facilities do to assist in helping prisoners reenter society.

This experience served as the foundation for my thesis. I worked at the Douglas County Jail to gain helpful knowledge about correctional care. To this day, I continue to volunteer my time at the facility. I started in January 2018 as a student intern and completed my Doctorate of Nurse Practice project there. During this time, I collaborated with inmates to envision what a reentry program would look like for them upon their release from jail. I focused on the top ten resources that are needed when reentering back into the community. It was modeled much like the discharge of a hospital patient. That discharge started at the time of booking.

An average day

When I arrive at the jail, I enter through two locked doors. I then proceed down a hallway and enter the locked medical unit. Once I am in the medical unit, I complete various tasks for the staff nurse. These tasks range from counting medications to filing paperwork. You might be surprised to hear that much preparation goes into caring for inmates. It isn’t going from cell to cell with a medical bag. A medical unit in jail is usually operated much like a standard clinic.

Inmates often come into jail at their sickest. They don’t usually seek medical treatment; the jail is their only stable healthcare. You need expansive knowledge of infectious disease, mental health, and drug dependency. The current jail tasks depend on the number of inmates booked for the day and the degree of illness within the jail. For example, the 70 inmates in jail could all be fine and not have any chronic diseases. You could be managing five inmates with uncontrolled diabetes, two inmates on suicide watch, and three inmates suffering from drug or alcohol withdrawals. Every day is different, and you continually have to pivot to the conditions of the jail.

Caring for everyone as equals

I think one of the hardest things in correctional care sometimes is putting aside your biases. I went into correctional care because I feel everyone deserves healthcare. Sometimes these institutions are the sole health care providers for some of the nation’s sickest people. Yet through my research, I’ve observed the quality and quantity of care provided across correctional institutions to be unclear.

Within the United States, the American Public Health Association, the American Correctional Association, and the National Commission on Correctional Health Care outline the standards for inmate care. Yet, policies and standards are still unclear. It’s also difficult to determine just what each organization is doing to maintain the quality of care across facilities.

Why keep going back?

My university days are over, and my thesis is published, but my duty to others never stops. Correctional Care is really a way to give back to my community. Several social determinants are strongly associated with poor health. In the United States, being non-white, low-income, undereducated, homeless, and uninsured are among the strongest predictors. Individuals in jails and prisons exhibit these predictors of poor health disproportionately. As a result, inmates typically share several health profile characteristics, including mental health disorders, drug dependence, infectious disease, and chronic conditions that may be affecting the greater community. This work gives me the chance to educate inmates while incarcerated on daily hygiene practices, healthy eating habits, and how to navigate the health care system in their communities.

I enjoy working side by side with the wonderful staff at Douglas County Jail. They truly do an amazing job at caring for inmates and making a difference. Inmates often say, “the people here actually care about you.”

Ashley Steen knows how important it is to care for everyone!

Ashley Steen, FNP, DNP

Thanks for reading, and remember, everyone deserves to live without illness or injury. Caring for everyone makes our society whole.

Ashley Steen, FNP, DNP

Tri-County Health Care