Nurses are at high risk of facing violence at their workplace. They treat all patients, regardless of a patient’s history and background.

However, when it comes to prisoner-patients, are nurses equipped in protecting themselves from a physical assault perpetrated by this category of patient?

In one case, which took place in a US hospital in May this year, a prisoner-patient who was unshackled to use the bathroom took two nurses hostage. The corrections officer, whose handgun was snatched by the prisoner, allegedly hid in another hospital room.

Witnesses said that the guards had been distracted by their own cell phones and laptops. Furthermore, the prisoner had freely used the hospital phone. One of the nurses was raped. And after a four-hour stand-off, the prisoner was shot dead when the SWAT team stormed in.

Prisoner-patients in a correctional environment pose a unique set of challenges

In a correctional setting, the nurse may be the sole healthcare provider attending to the patient. The environmental and cultural challenges that arise are unlike a typical healthcare setting.

However, just like nurses from different specialties, it is generally understood that prison nurses must learn quickly to adapt to their role.

Generally, no specific requirement is needed to be a prison nurse. An online job search for nurse vacancies in the Singapore Prison Services listed a nursing qualification as its pre-requisites.

Prison nurses rely heavily on correctional staff to ensure an optimal security level, so that they can carry out their nursing duties well.

Nevertheless, extreme violent patients do exist – and when an attack unfolds, it could be too late to reverse the situation.

Earlier this year, in one incident in the UK, a prisoner assaulted a warden and hit a nurse on her back with a chair. The prisoner was later deemed to be an extreme threat to the public and had the assault charges against him dropped.

Unions, which the victims were members of, were outraged over the decision, which is currently under review by the authorities.

Securing the hospital environment: How tight is the security?

In a hospital setting, prisoner-patients pose a different kind of risk. They are placed under the same roof as other patients and healthcare staff, although there may be dedicated sections.

Nurses render their care with the knowledge that these prisoner-patients will not turn their back against them. After all, their condition must have turned bad enough to require medical attention and facilities, which are not found in the prisons.

Herein, lies a vulnerable edge – especially when security is lax just because the patient is deemed “too ill” to do anything violent.

Preparing for any violent situation in the workplace

Policies must firstly be firmly in place and implemented across the institution. It is critical that all staff in the team assigned to the patient must carry out their roles and responsibilities with high vigilance.

Standards and protocols must be strictly adhered to, including deploying extra security for certain situations. Additional measures like duress alarms and body cameras can be a deterring tool for would-be violent offenders.

Generally, training on how to handle violence should be provided for all nurses; particularly for those who are expected to handle prisoner-patients. This could include basic self-defense techniques and negotiation skills.

A prisoner-patient can take advantage of a situation with any lapse in security. Inventories that nurses handle every day – like medications and sharp equipment – can easily create opportunities for those who are scheming for an escape.

Hence, nurses should develop not only good common sense; but excellent assessment and problem-solving skills. They should also continuously develop their communication skills and establish a professional relationship with the prison guards or correctional staff.

Continuous learning can prove useful in any unforeseen situation. For prison nurses, in particular, while a certification is not required for such a role – this is made available through the National Commission on Correctional Health Care and the American Correctional Association. All in all, nurses must always be prepared to expect the unexpected in their line of work – including violence at the workplace. MIMS

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