Nurses behind bars

(from left) RNs Greg Cox, Dan Hunter, and Jennifer Holland.

By Ingrid Phaneuf

Maybe you’re a fan of the popular television series Prison Break. Or maybe you just don’t want to end up working in a hospital. Whatever the case may be, it takes a special kind of person to work as a nurse in prison, something jobpostings editor Ingrid Phaneuf found out during a recent visit to Collins Bay, a medium-security jail in Kingston, Ont.

It’s no wonder the inmates, guards and nurses, as well as just about anyone who lives in or near Kingston, call the medium-security prison “Disneyland.” If you can overlook the four-storey high grey stone wall topped with barbed wire flanking the central building (built in 1929) and book ended with watchtowers, then the red roofed turrets do resemble somewhere Sleeping Beauty might call home.

But make no mistake, Collins Bay is no fairy tale castle. Housing approximately 250 inmates, none of whom are Prince Charming, the main hall of the building, erected in the early 1930s, is more like a run-down old high school, with posters and photo collages of inmates playing basketball peeling off the cinder block walls.

A series of barred gates lead from the main hall into areas called “ranges” – cell blocks with central areas where the inmates may or may not be allowed to roam free, depending on how they’ve been behaving.

You wouldn’t think a tiny blonde woman, not even five foot tall in socks, would work in a place like this. Not with her shiny fairy princess ponytail. But she does, and within 20 seconds of her coming to collect me at the ungodly hour of 7 am at the prison’s first interior gate (I have to sign in through security and get my bag x-rayed), I’ve got the impression there’s a mind like a steel trap, and possibly muscles to match, attached to that petite frame.

Jennifer Holland, who graduated from Ottawa U. nursing school in 1997 and started working in prisons in 1998, clutches a Starbucks coffee cup as long as her forearm, and is as wide awake as someone who’s been up all night cramming for exams on Stay-Ups.

Maybe it’s the coffee, but Holland’s dark brown eyes have the kind of alert toughness that belies her femininity. “I’m from a military family, so we were raised to be tough mentally and physically,” she explains, when I ask her what kind of person you have to be to choose – as she did – working in prisons over maternity wards.

When I ask her what she likes about working in prisons she says she tried general hospital work for six months and hated it. Too much staff turnover and you never got to know anyone. Also, you never had enough time during a shift to feel like you’d done a good job. Holland likes the autonomy of working in prison. She likes that the doctors, who only come in twice a week, rely on her to do assessments and get their go ahead on treatments over the phone. She also likes the hours.

“Most permanent nurses in corrections get to work day shifts,” she says. Recently promoted to team leader, Holland works 7 am to 3 pm Monday to Friday, with every weekend off. The shift gives her the time to work out after work (which accounts for the physical toughness) and do her banking, grocery shopping etc. In short, have a life on the outside. Of course, dealing with inmates (the word used by everyone who works there to refer to prisoners) is no cakewalk.

“You came on the right day, we’re in lockdown,” jokes nurse Greg Cox, as Holland leads me into the healthcare unit. (Tall, dark and handsome, Cox is as mellow as Holland is wired. He started nursing for corrections 14 years ago, after completing his consolidation at Kingston General Hospital, on the recommendation of a mentor.)

According to Holland, Cox and two other nurses, a “normal” day starts with inmates picking up their own medications at the rollup window of the healthcare unit, which is otherwise only accessible via a locked gate. Because the healthcare unit contains the pharmacy and a safe full of prescription drugs and narcotics, including methadone, it is positioned up near the front of the building’s long central hall, the furthest away from the ranges. Down at the end of the same hall, at the back of the building and furthest away from the pharmacy, is what insiders call “seg” – three segregation units, containing about 14 cells each, for inmates in danger of, or dangerous to, others. Today, some of these cells contain individuals involved in an incident which took place a few days ago, when another inmate refused to pay to use facilities that, at least as far as Corrections officers are concerned, are free. According to what I glean during conversations throughout the day, the gang controlling the use of telephones, showers, washers and dryers, etc. wasn’t pleased, and beat the uppity inmate to a pulp. While the inmate was still awaiting surgery in hospital, the gang members who committed the assault were in “seg” awaiting transfer to a maximum security prison. That’s where the prisoners who act up in mediumsecurity prisons end up, explains Holland.

“Being put in max, medium or minimum [they call the latter “camp”] isn’t just about your sentence,” she says. “It’s about how you act when you’re inside.” Holland knows of what she speaks. Her first prison job was at maximum security Kingston Penitentiary.

“My first day was a holiday so it was a little scary,” Holland admits. “We had to service other area prisons that day so we had prisoners in shackles and with tattoos and shaved heads coming in.

“Medium-security is more relaxed,” says Holland. “You hardly ever hear about anyone getting assaulted here. But in maximum security it does happen sometimes.”

On one occasion, Holland was grabbed by a prisoner who pulled her arm through the bars, but was able to pull away. Another inmate threatened to throw a vial of unidentified liquid at her but then thought better of it. And she found verbal abuse more common in maximum than in medium security establishments.

“There are incidents when a nurse can get grabbed, but you always have a guard with you, so it’s over quickly.”

You don’t want to get caught out on a range without a guard, says Holland, although it has happened to her.

“It’s scary, but you just have to stay calm and walk out.” Corrections staff can press charges against inmates who assault them, she adds. “I pressed internal charges one time,” she says. “Those were for death threats. But those were prison charges – they didn’t result in charges in court.”

Prisoners who act up in maximum security don’t get transferred, they just stay put, which is what makes them scarier than those in medium-security. Still, medium-security facilities are no picnic, at least not for inmates.

In Collins Bay, while one gang controls facilities, another controls certain jobs. There’s a lot that goes on in prison that corrections staff really can’t do anything about.

“Most of the time, we don’t witness what happens so we can’t do anything about it, and of course the inmates don’t tell,” Holland says. The best a Corrections nurse can do is just to try to prevent the spread of infectious disease (condoms, lube and bleach for needles are freely distributed, no questions asked), the misuse of prescription drugs (inmates on methadone and narcotics are observed while taking their daily dose to prevent them from spitting the pills back up and giving or selling them to other inmates) and the deaths of inmates due to injuries caused by themselves or others.

Which brings us back to the daily schedule, altered today thanks to lockdown while guards search prisoners and their cells for drugs and weapons. A “normal” day usually starts with inmates coming to pharmacy at 7am to pick up their meds, followed by nurses touring “seg” to check on inmates there (something they still must do when lockdown occurs). Daily health programming comes next – the infectious disease program, which includes educational clinics, blood testing and inoculation for TB, hepatitis and HIV, as well as methadone administration. Clinics with a doctor or a visiting specialist (dentist, radiologist, psychiatrist, dermatologist) also take place daily. Guards are present in the unit at all times, accompanying prisoners in and out, opening and closing the locked gates for staff and patients. Today, with the halls empty except for guards and staff, the sound of gates closing and opening echoes and rolls like waves.

And then there are days that aren’t so quiet. “I definitely feel that I’m needed here,” says Cox. In a previous position at Kingston Penitentiary, he saved an inmate’s life when another inmate punctured his chest close to a lung. While in palliative care unit at Kingston Pen hospital, Cox cared for an inmate dieing of a brain tumour. “That was hard,” says Cox. “It’s hard watching people die alone. And the worst part of watching the inmate with the brain tumour die was that the tumour actually changed his personality for the better. He was a much better person when he died.”

Cox explains all this as he leads me on his rounds through “seg” – where a nurse must check on inmates at least once every 24 hours. We go from cell to cell, including the cells of the inmates who dished out the beating a few days earlier, delivering pill cards (cards with pills encased in plastic bubbles) and asking inmates if they need anything. The lack of personal privacy is oppressive. I avert my eyes as inmates shove their pill cards through the metal mail slots and peer at me through the tiny rectangular glass panes in their heavy metal doors. I don’t want to meet their eyes, even if they’re the ones wearing flimsy prison shorts and I’m in a suit.

Cox does meet their eyes though, and addresses each and every inmate who speaks to him in a gentle and reassuring tone.

“I’m not here to judge them, he says. I’m here to deliver the best healthcare possible.”

Somehow when Cox says it you can believe it. The same goes for Holland.

“We don’t even look up what they’re in for most of the time,” says Holland, when I get back to the healthcare unit. “What’s important is how they act when they’re inside.”

Holland says sometimes people do ask her why on earth she’d want to treat someone who committed a heinous crime, like sexual assault or murder.

“You’re not there to judge them, so it’s better just not to think about it,” she says. Holland is no bleeding heart, but there are nurses who get emotionally involved. They don’t last long, says Holland.

The key is to have strong boundaries, she says.

“I think you also have to enjoy being independent and challenged and making split-second decisions,” adds Dan Heurter, the baby-faced manager of the health services at Collins Bay, as he escorts me out of the building. Like Holland, Heurter has been working in corrections for 11 years now.

“And you’ve got to appreciate the opportunity for change and movement.”

Like Holland and Cox, Heurter worked at a few penitentiaries.

“I like change, so I like to move around,” Heurter admits. Ironically, autonomy and freedom of movement are the biggest job perks for nurses who work behind bars.