Carolyn Clark: Perspectives from a public health correctional nurse

Carolyn Clark had multiple jobs and careers before becoming a nurse. She was a social worker out of college, managed restaurants, and worked as an on-site apartment manager while working at an emergency vet shelter and going to school for the prerequisite classes needed to apply to veterinary school. But when she didn’t get into vet school, she used all the science credits received to pivot to nursing. To make her application to nursing school stronger, she took a 12-week phlebotomist training through PIMA Medical Institute and then worked as a phlebotomist at Virginia Mason. She graduated from nursing school in 2009 and became a public health correctional nurse in 2014 for the King County Correctional Facility (KCCF). Between this jail and the Maleng Regional Justice Center in Kent, an estimated 1,500 inmates are incarcerated in King County.

What do you like about public health correctional nursing?

I like working with people who have been disenfranchised while helping stabilize those with serious illnesses through the medical, dental, and mental healthcare we provide, both in the jail and with referrals in the community. Sometimes there is a silver lining to getting arrested, because it helps people figure out what to do with their life going forward.

We are making a difference in people’s lives, and I, personally, try to make a difference in every patient I encounter.

The thing that I most like about working at the jail is that it reminds me that at the end of the day, we are all human. Individuals in the jail have the same needs, wants, hopes, and dreams as individuals outside of the jail. Anyone who thinks they could not ever be incarcerated, think again; anyone can make a mistake, and the human brain is fragile. The jail is a good place to check one’s biases.

Overall, the job that many other nurses and I do is a difficult one, but having so many capable and caring co-workers to do this job with me helps make it a more tolerable one.

Why jail nursing?

When I came out of nursing school in 2009, it wasn’t easy getting a job. The job market was crashing, and people weren’t retiring because of the recession. I started out working in the emergency department of a hospital, but I didn’t like the work. I felt like I was getting thrown into everything, and it didn’t feel safe. I was looking to get out of hospitals/acute care, and I stumbled into home health, where I learned excellent skills, like working independently since I was the only RN on site with a CNA for a few years. Then, one day I was driving home with a friend from the King County Nurses Association who told me I should look into jail nursing. As it happened, there was a job fair the following week that I was already attending, so I ended up meeting with a job recruiter from King County and applied. It was a lengthy process, taking a little over two months to apply and be hired.

What is it really like working in a jail?

Working at the jail is one of the safest jobs for nursing. Although we work with some erratically behaved and, possibly, dangerous individuals, we have trained correctional officers whom we work very closely with to do patient care.

The best part about this job is that one day is never the same as the next. Being at the jail is like working on a contained Navy ship; it is its own little world. Nursing and providers can’t leave because we need to be onsite if there is an emergency, but we get paid for our breaks.

The jail is in a 12-story building in downtown Seattle with housing for the inmates on floors 2 and 3, and 7-11. The other floors are where the nursing, psych, release planners (social workers), and SUDS (substance use disorder specialists) have their charting spaces, as well as the medical and dental clinics, laboratory, and X-ray areas. Additional floors have offices for DAJD (Department of Adult and Juvenile Detention) leadership, the officers’ roll call room, the kitchen where the meals get prepared, and an area where staff can eat.

What happens when an inmate first comes in?

When inmates come into jail, it’s through the ITR (intake, transfer, release) area. Since they are often inebriated on street drugs, alcohol, or both, it can be challenging to get baseline history. But unfortunately — and fortunately — many are repeat offenders, so we already have information on them in our system. Nursing sees every single person coming into jail. We get a complete medical, psych, and dental history. And we inform the patients how to access these same services in the jail through a daily system called “triage” using kites (a request for service). Kites are white for justice and pink for medical. Medical, social workers, and DAJD have kites. The medical kites are also used for psych, dental, and prescription-refill requests.

How are psych patients handled?

Unfortunately, outside of Western State Hospital, KCCF has the most mentally ill patients, and the jail is not really the place for them. The majority of these patients can live among the general population inside the jail, but we do have three distinct types of psych housing units — housing for patients with suicidal ideation, housing for the decompensated (those who are losing the ability to maintain one’s state of mental health, typically due to some kind of stress), and housing for those who can be housed with others. The jails have a robust psych team to work with these individuals, and nursing plays a huge role in their care as well.

What is a good day like?

A good day is when everything flows from task to task without a lot of chaos, and we are fully staffed. However, things can unravel quickly because of interruptions both insignificant and emergent, turning a smooth day into a chaotic one.

What is a hard day?

When the workload is too much to get done in eight hours, much less 12 (my daily schedule). When due to short staffing, you can be drowning from a heavy workload, but there’s no one to throw a line because they are drowning, too.

What do you do for self-care?

I am a big proponent of self-care. If I do not take care of myself, how can I take care of others? Some examples of my self-care practices are meditation (I have been doing this regularly for over six years and really like the app Insight Timer), regular exercise like stretching and calisthenics at home, and taking walks with my dog, Nari, and husband, Brad, and depending on weather, sometimes with our cat, Doris, in her stroller. I also eat well, mainly a plant-based Mediterranean-style diet. I believe in the power of social connections and maintain a lot of close friendships and have a lot of fun with them and my husband when I am not working. Like most people, I have had short bouts of illness in my life and realized quite young that without good health, life is incredibly difficult, so I try to control the factors in my power related to my health.

What was some good advice you got about pursuing nursing? Any advice you have for newly graduated nurses?

Get into any program, even if it isn’t your first choice. Education is invaluable. I am glad that I took that advice, because the first program I got into was at North Seattle in the LPN program. After four quarters there, I was able to go to South Seattle for the then-existing RN Ladder program. The advice I would give to new grads is to take any nursing job. Nurses are told over and over to get into “med-surg” before pursuing another field of nursing, but there are many ways to nurse and many fields to work in. Acute-care nursing isn’t the right path for everyone.

Do you have any worldly advice?

Things work out; you just need to keep an open mind and not get caught up thinking a certain way. That is what helped me to my next point in my wonderful life.