Student nurse placements in prison

Student one

“I worked with a wide range of staff throughout my placement including nurses, pharmacy technicians, healthcare support workers and mental health staff. This meant I participated in a wide range of interventions including but not limited to; wound care, dispensing of medication, mental health assessments, attending to emergency calls, and welfare checks. Many of these types of care included very close patient contact, often in their cells or on a wing of the prison. From this, I was able to build relationships with many of the prisoners and learn about their life experiences…. In the case of attending emergency calls, sometimes the prison could be a distressing environment. After intense emergency calls, staff re-convened and discussed each of their roles in the call and emotionally supported one another throughout. Staff’s care for not only patients, but each other was at the core of all of their interactions which resulted in a strong and supportive team that left nobody behind. Despite this, the environment always remained cheery, and staff were never afraid to make each other laugh” (student reflection, 2022).

Student two

"To kickstart my final year as a student nurse, I elected to have a placement in Wandsworth prison – a decision I quickly doubted. As somebody who gets tense phoning the bank, I couldn’t help but become quite nervous when it actually sunk in that I’d be working in one of Britain’s largest men’s prisons. As a young woman with, admittedly, little backbone, I felt overwhelmed when seeing documentaries and the news surrounding work in prisons. On the whole, it looked violent, unforgiving, scary, and filled with ‘society’s villains’. I approached it with the attitude that it simply wouldn’t be the same, nurturing relationship I would encounter caring for a sweet elderly lady on a general medical ward in a little community hospital.

My apprehension was reinforced as I first approached the prison gates, hearing alarms blaring just beyond them and remembering everything negative that I had ever heard about prison life. But once escorted through, I was met with one of the warmest welcomes I’d received in a clinical placement. A sea of smiles greeted me and my fellow student nurse; we both immediately felt part of the team. My first clinical shift was out on the wings with the emergency response nurse, which introduced me to prison nursing face first, in at the deep end, with arguably no diving gear, no goggles and no idea what to do next. However, within the first minute of treating my first patient, I realised that the prisoners were certainly not ‘society’s villains’ as I’d previously been led to believe; they were in fact some of the most vulnerable patients I had ever cared for. With that came a stronger sense of community than I expected, with prisoners looking after prisoners, and a sense of respect between the prisoners, officers and healthcare team. I also quickly realised that, often without people fighting in their corner, prisoners are faced with massive barriers in their access to healthcare, and both the officers and the healthcare team at Wandsworth prison worked tirelessly to uphold their rights.

The wings of the prison are often loud and chaotic, but I’ve not worked in many hospital wards that aren’t like that. I won’t pretend that I wasn’t presented with conflict, stress, and challenges that I’d never encountered before, but it meant that I learnt an incredible amount. Managing opioid and psychoactive substance overdoses, musculoskeletal trauma, hypovolaemia, unstable angina, substance misuse, alcohol detoxing, self-harm, suicide attempts, psychosis, seizures, and severe concussions and using independent clinical assessments and decision-making skills meant that these became some of my greatest strengths. I worked predominantly with the emergency response nurse, meaning we would be presented with myriad health problems, ranging from a measly paper cut to a gentleman with aGCS-3 and respiratory depression. The nature of the environment meant that independent clinical judgement and rapid, accurate assessments were integral. This fostered a fantastic teaching environment, as my practice supervisors would often let me take the lead but continued to support me when I was blaringly clueless, helping me develop immensely.

The nursing team were some of the most autonomous, intelligent, proactive and highly skilled nurses I’ve ever had the pleasure of working with. Many times, solutions could only be met by thinking outside of the box, giving room for the nurses to deliver truly compassionate, person-centred care. In such an overlooked area of care delivery, I feel these unsung heroes deserve more acclaim for the work they do. The stigma and fear surrounding prison healthcare doesn’t do the reality justice, and I would encourage my peers to consider gaining experience in this area. The privilege of working inside Wandsworth prison, learning from incredible clinicians, and caring for an incredibly complex patient group has taught me so much, and since starting there, not once did I regret my decision. I may still be afraid of phoning the bank, but I’m most certainly not afraid of stepping inside prison (Student reflection, 2021).

In this section, you can read blogs from nurses and nursing students about their time working in prison.

Blog one - Why Nursing in Prison? (RCN)

Blog two - Prison Nursing is a bit like Vegemite. (The National Learning Disability Nursing Forum)

Blog three - Working in a prison - my journey. (RCN) 

The purpose of HM Prison Service in England and Wales is to keep those sentenced to prison in custody, helping them lead law-abiding and useful lives, both while they are in prison and after they are released. They run 109 of the 123 prisons in England and Wales.

You can find out more information about the prison service here.

The other prisons are run by private companies, including G4S Justice Services, Serco Custodial Services and Sodexo Justice Services. You can find information about them here.

See also: A to Z listing of prisons in England and Wales

As of March 2022, there are just over 79,500 people in prison, of which approximately 95% are men.

You can find population statistics here, which are updated weekly.

You can find out more about the wider statistics concerning offenders in custody such as trends in prison receptions, releases, sentencing etc, here.

Of the 123 prisons in England and Wales, only 12 are solely dedicated to accommodating female prisoners. There are different types of prison that make up the prison estate, where prisoners are allocated depending on their security status.

Adult male prisons are organised into four categories, from A (highest security) to D (lowest security).

• High security prisons house Category A prisoners whose escape poses the biggest threat to the public, police, or national security.
• Category B prisons are often referred to as Local or Remand prisons which serve the local courts, or Training prisons which accommodate prisoners on a more long-term basis.
• Category C prisons can also be referred to as Training or sometimes known as Resettlement prisons.
• Category D prisons are known as Open Prisons.

NHS England are responsible for commissioning high quality healthcare, ensuring the safety, equity and safeguarding of people receiving healthcare in prison settings.

You can find more information about commissioning of these services here.

Overall health provision for public sector prisons in Wales, managed by HM Prison and Probation Service is devolved to the Welsh Government, and health services have been provided by NHS Wales, delivered vial Health Boards local to the prison. HMP Parc is a privately run prison, where primary healthcare services are commissioned by HMPPS. See here for further information regarding prison healthcare in Wales.

All healthcare services in prisons in England and Wales are jointly inspected HM Inspectorate of Prisons (HMIP) and the Care Quality Commission (CQC). In Wales, HM Inspectorate of Prisons work with Health Inspectorate Wales (Wales). The HMIP framework ‘Expectations for Male Prisons’ is used to inspect prisons, which you can find here.

You can see the Memorandum of Understanding between HMIP and CQC here.

Further information on the work of the CQC in criminal justice services in England can be found here.

 The CQC have produced a handbook for the providers of healthcare in secure settings, which you may find useful.

Information on Health Inspectorate Wales can be found here, and a link to the official Memorandum of Understanding between HMIP and HIW is here.

You can read HM Inspectorate of Prisons inspection reports, where you will find the section on health services in the chapter on Respect.

Prison health care setting provide many opportunities to explore public health. These include management of infectious diseases (including Covid-19), infection control, vaccination programmes and the management of blood borne viruses. You can find out more information about all these issues here. 

Sexual health is an important area of concern in prison healthcare. The literature suggests that the sexual behaviour of imprisoned men is riskier prior to their imprisonment, with people having more partners, engaging in injecting drug use and/or commercial sex activity, poor use of condoms and high rates of sexually transmitted infection, including HIV and hepatitis. Prison provides a good opportunity for health care professionals to work with people who can be hard to reach in the community such as those with chaotic lifestyles, people who do not routinely prioritise their health, and those who may be homeless and without easy access to healthcare services. Sexual health services in prison were historically provided by staff from community genitourinary medicine clinics but are now often provided by nurses employed by prison healthcare providers.

Primary care in prison is like that provided outside in the wider community. There are General Practitioners working in prison, alongside nurses who work in roles like that of a Practice Nurse in a GP surgery. Prisoners have a wide range of primary care needs which includes all long-term conditions that you would find in the community such as asthma, cardiovascular disease, and diabetes.

The National Institute for Health and Care Excellence has guidance for practitioners to support management of the physical health of people in prison, which you can find here.

Here is also a NICE Quality Standard to support the physical health of people in prison.

There are high rates of mental health issues in prison, ranging from primary mental health care needs to severe mental illness that requires movement of prisoners to secure NHS mental health services.

As part of their inspection of prison health care services between 2020 and 2021, HM Inspectorate of Prisons noted that in their surveys, more than half of those prisoners who responded, 52% reported having mental health problems.

In 2020, 998 people were transferred from prison to secure hospital.

The National Institute for Health and Care Excellence (NICE) has published guidance to support the mental health care of people in prison and an associated quality standard.

 You can find information about mental health medicines in prison here.

The Royal College of Psychiatry Prison Quality Network has published mental healthcare standards which act as a framework by which to assess the quality of prison mental healthcare services.

The prison population has healthcare needs just like people in the wider community. 30% of people in prison have a learning disability or difficulty. Learning difficulties are a type of neurodiversity, and the number of prisoners with neurodiversity is likely to be higher than in the community.

Neurodiversity is the term used to describe anything that results in people thinking/understanding in a different way to how the brain typically works.

Neurodiversity includes:

• Learning Disability
• Learning Difficulty
• Autism
• ADHD
• Dyslexia
• Dyscalculia
• Acquired Brain Injury
• Stroke
• Dementia, and other neurological conditions.

Sometimes someone’s neurodiversity may contribute to offending behaviour. Nurses working in prison can provide assessments and interventions to support their physical, social, and psychological needs to improve their health, and reduce their risks of reoffending. 

In some healthcare services, there are registered learning disability nurses leading services to support these prisoners, and specialist mental healthcare workers.

The review of evidence relating to neurodiversity in the wider criminal justice system by HM Inspectorate of Prisons provides useful information, see: Neurodiversity in criminal justice system - more effective support needed, say inspectorates

The Autistic Society has been working closely with prisons to provide accreditation for services caring for prisoners with these needs, see: Supporting autistic people in prison and probation services, which details this work and provides useful information about supporting prisoners with autism.

There are people in prison who have healthcare needs that relate to their use of drugs and/or alcohol. There is a range of service provision to meet the needs of prisoners with substance use problems, which includes both clinical and psychosocial treatment. There are also links between these services and those in the community to ensure continuity of care on release from prison if further treatment and support is required. It is also important to appreciate that not all prisoners who have substance use issues arrive at prison with these needs. Some prisoners develop a problem with substances whilst they are in prison.

The Prison Service has a drug strategy which you can explore here.

If this is an area you are interested in, you may find useful the recent report that explores substance use in prison, using a case study approach in five male English prisons.

The number of older prisoners in England and Wales is increasing. As of March 2022, 17% of the population is over 50 years old. The age of 50 is used to define the older prisoner, as it is accepted that this group of people appear more susceptible to an accelerated biological ageing process when compared to the public. It is suggested in the literature that prison ages people biologically by 10 years. Meeting the health and social care needs of prisoners can be challenging as the prison environment is often not conducive to caring for this group of people. The geography of some prisons can be difficult for people with mobility issues where old Victorian buildings have narrow doorways and steep stairs. In addition, older prisoners experiencing a decline in cognitive function will have issues managing daily life in prison, where accommodation and activities are often undifferentiated by age. In some prisons, specialist nurses are in post who focus on meeting the health and social care needs of older prisoners.

In 2018, HM Inspectorate of Prisons published a report that explored the social care provision in prison. 

Since 2014, local authorities have a legal obligation to assess the need for and provide social care to people whose needs make them eligible to receive it. This link provides information from one Local Authority about social care support in prison, with the aim of illustrating how social care in prison works.

You may also find this position paper from Age UK useful to aid your understanding of the health and social care needs of older prisoners.

Just as in the wider community, there are people in prison with dementia, which can cause significant issues with day to day life in prison. The Royal College of Nursing has published a useful guide to help staff support people in prison with dementia.

Some people in prison develop palliative care needs. It is recognised that this is not limited to older prisoners specifically. However, experience suggests that some older prisoners who are nearing the end of life do sometimes choose to die in prison because they have no links with their family, and prison is where their friends are. If you are interested in finding out more about end of life care in prison, there are links here from Hospice UK and NHS England that will be useful.

See:

Hospice UK. Dying Behind Bars
NHS. Dying well in custody charter and self assessment tool.

Each prison healthcare service will have someone working as the Head of Health Care, and there is often a senior nurse who is the Clinical Lead. To find out more about opportunities for placements in a specific prison, the university placement team and/or student can contact the Head of Health Care or Clinical Lead by telephone at the prison they are interested in linking with. You can find the number for the prison online, see: Prisons in England and Wales

Ask for the healthcare department and then to speak with the Head of Healthcare or Clinical Lead.

Each education provider will have their own arrangements for training and supporting practice assessors from prison healthcare settings. Some offer face to face training and ongoing support, others provide training either on-line or via e-learning, with follow up support whilst students are on placement.

The Nursing and Midwifery Council has published standards relating to student supervision and assessment in practice. Here you can find out more about what is expected of a practice assessor and how they should be prepared for their role.

This link from the NMC, provides further supporting information on the standards, and notes the prison setting as an area suitable for student nurse learning.

E Learning for Health also provide online Practice Educator and Assessor training, which you might find helpful to look at.

Each education provider will have their own requirements regarding how the prison healthcare environment is assessed to ensure it is a suitable space for students and can support their learning. The age and fabric of the building can be a challenge for healthcare providers, but this should not deter organisations from having students. Working with university colleagues to identify areas in the prison environment which could be developed to better support learning will benefit both current staff and students planning to come on placement.

Further information regarding the suitability of the learning environment can be found here.

The University of the West of England has some useful information about the quality assurance of professional practice placements, which you may find helpful.

There may be several reasons why a more traditional student placement may not be appropriate in some prison settings, indeed, some students may not want to have a longer placement. However, there are other ways to introduce prison healthcare to student nurses. It is important to be creative and consider how best to showcase the work of prison nurses whilst considering the importance of the wider team caring for prisoners, including prison officers and the prison environment.

Taster Days

Some settings provide a ‘taster day’ where student nurses can visit the healthcare service in a prison, speak to the healthcare team and get a sense of what prison healthcare involves, what it looks like and what the nursing role comprises. During this visit, it is important that the student can get a good idea of how the healthcare team works with the wider prison staff group. The visit would include observing all areas where healthcare is provided, plus in person visits to the wider prison including residential wings to meet officers and see where prisoners live, the education department and workshops to see how prisoners spend their time, the kitchen to talk with prison staff about food provision, the gym to see what physical fitness opportunities there are for prisoners, the chaplaincy to ascertain how they can support prisoners and senior governors to find out more about the running of the prison. A visit to the security department can also be helpful to provide space for discussion about how security issues can impact on the nurse patient relationship in prison, and how bed watches and outside hospital visits are managed from a prison perspective.
Other options to consider when thinking about providing a prison experience for student nurses can include very short placements of 2 or 3 days, sometimes called ‘Spoke’ visits. This gives students the chance to see how prison healthcare works, and what the environment is like without having to commit to a longer placement.

University Lectures

Another option to raise awareness of prison healthcare amongst student nurse colleagues involves providing a teaching session or lecture for students at their university. This can take many forms, and again, prison nurses and their academic colleagues will need to be flexible in their approach. Experience suggests that student nurses enjoy hearing from practising clinicians, so a joint lecture with academic colleagues and clinicians can be very engaging. Examples of lecture content could include ‘A Day in the Life of a Prison Nurse’ or focus on the prisoner patient by describing their journey through the criminal justice system and their engagement with healthcare services whilst in prison.

A ‘Day in the Life’ session could include discussion around the nurse’s role in the following:

1. Comings and Goings (reception screening and pre-release activity)
2. Specialist Clinic Provision (sexual health, wound care, long term conditions, substance use etc)
3. Routine Health Provision (vaccinations, medication reviews, NHS Health Checks, AAA screening, physiotherapy, podiatry etc)
4. Emergency Response (code red and code blue protocols, emergency response expectations).

Student nurses should always express interest in a prison placement rather than be randomly allocated. To some people, prisons and prisoners can be frightening and anxiety provoking.

Universities often have different ways of identifying students who have an interest in taking a prison placement. Some will ask students to express their preferred placement areas at the start of their course whilst others link the placement to a particular module, or space in the overall placement themes, for example, a community placement or elective.

It is also important to ensure that the motivation of the student to undertake a placement in a prison is centred on professional curiosity/genuine interest and not just out of general curiosity, or to get close to imprisoned family/friends/public figures.

To this end, we would suggest that once a student has expressed an interest in a prison placement, there is a mechanism in place to discuss their motivation and expectations. The University of Leeds who currently supports student nurse placements in prison, asks all students who are interested in the placement to complete a short form which asks them to consider which prison they want to go to, what experience they have which they feel is relevant, and why they are interested in the prison setting. There is a named member of staff at the university who then speaks to students to gather more detailed information and discusses student expectations of the prison placement. If appropriate, the student is recommended for a prison placement, and subsequent processes are commenced.

Security Vetting

Security vetting is a necessary part of preparing for a placement in prison. These checks are a requirement of anyone who plans to enter a prison establishment on more than three occasions. Until these security checks have been completed and HM Prison and Probation Service (HMPPS) has advised that a student is cleared enter the prison, their placement cannot start.

If a student is concerned about anything in their background or history which they feel may be an issue with obtaining security clearance it is important that they speak with the placement provider prior to the start of any vetting process, as concerns can then be addressed at an early stage.

With adequate preparation, planning, and very careful attention to detail and deadlines, the process can be successfully navigated and should not be viewed as an obstacle to a successful prison placement.

What happens?

Once a placement has been agreed for a student, the healthcare provider will formally request that HMPPS starts the vetting process.

The student will then receive an email directly from the prison with all the information and links needed to complete the checks. Failure to comply with all requests in the vetting process will result in a student not being able to undertake their prison placement.

During the vetting process, the student will need to provide a range of information which includes basic personal information, a Disclosure and Barring Service (DBS) certificate, suitable documentation to prove their identity and right to work in the UK, information about their past employment and residential addresses. In addition to the online process for vetting, students need to be aware that they will also need to present their documentation in person at the prison.

Effective pre-placement contact with a student can make all the difference to their experience of a clinical placement. Ensuring that a student coming to prison healthcare settings knows what to expect and arrives prepared, is important to ensure that the student feels safe and has a positive experience and first impression of prison healthcare.

Prior to a student coming to the prison on a placement, it is important to make sure that good support for them is in place. Students will have already contacted the service to secure the placement and undertake security vetting, therefore, their arrival should be well planned. However, there are practical things to consider ensuring that the student feels as comfortable as possible on their first day. All staff on duty in the healthcare department should know the student is arriving and that it is their first day. The student should be allocated a practice assessor, and it is this person with whom the student will link with to support their learning, however, ALL nurses should provide the student with support and learning opportunities. This is very clear in the NMC Code, paragraph 9, which states ‘Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues’.

On the first day of a placement, it is important to make sure that the prison staff at the gate know that a student will be arriving. Remember that a student may be a little anxious about coming to the prison, so it is vital that their arrival and entry into the establishment is a smooth as possible. Consider meeting the student outside the gate on their first day and help them through what can be a very daunting experience, in person.

Student Handbooks/Information Books

Some prison healthcare providers have developed information books or handbooks to support students on placement. Information in these books includes pertinent security information, details about the prison and the healthcare service including staff roles and responsibilities, some definitions of prison jargon/terminology, and a blank timetable for students to complete, and a general induction checklist. In addition to the usual areas covered in an induction into prison healthcare, it might be helpful to provide a glossary of prison terms, detailed information about personal safety, the importance of security awareness and the use of social media. There is more detailed information about these areas in the ‘during a placement’ section of these webpages.

Travelling

Just as in any setting, there are some practicalities to consider when undertaking a placement in a prison. It is important to think through how you will get to the prison, particularly at different times of the day. Many prisons are located outside of towns/cities, sometimes in quite remote areas, where public transport links can be limited or non-existent. There is often car parking available at a prison, however, prisons that are in city/town centres frequently have very limited parking, so it is worth checking.

Uniform

You should have a uniform, provided by your university to wear. It is important that you wear appropriate clothing in a prison, so you are easily identifiable. You should not wear jewellery for infection prevention control and safety reasons.

What can I bring into a prison?

All staff and visitors to prisons are advised to only bring essential items with them. This might include:

• stationary to carry out role (e.g., pen, notepad etc.)
• paperwork required to carry out role, where this cannot be access electronically
• feminine hygiene products
• prescribed medication, but not more than will be needed for the duration of the shift/visit
• food and soft drinks to last the duration of the shift/visit – wrapped in cling film or paper and not tin foil (if required)
• clothing required for the shift/visit (e.g., clinical uniform to change into, a coat if it is cold/wet etc.)
• a bag big enough only to hold the essential items being taken into the prison
• some prison sites require staff to use a prison issued bag that has a clear front to allow for bag checks upon entering and leaving the establishment.

Everyone entering a prison can be searched, so be prepared.

Prohibited items

It is important to understand that there are items which are NOT ALLOWED into a prison.

These include:

• mobile phones, chargers
• any computer equipment
• cameras, video recorders, audio recorders
• smart watches, Fitbits, wearable tech
• SIM cards, memory sticks, any other data transfer device
• unauthorised drugs
• alcohol
• cigarettes, tobacco, lighters, matches
• metal cutlery
• glass containers
• mirrors, including makeup compacts with mirrors built in
• aerosols
• chewing gum
• blue tack (or similar)
• tin foil
• wire
• explosives, weapons, or ammunition of any description (including imitation)
• tools of any description, including scissors, pen knives
• manicure sets, including nail files, tweezers, clippers, nail polish, polish remover
• clothing with offensive logos
• umbrellas
• chemicals or cleaning equipment
• large amounts of cash.

Please note that this list includes mobile phones. It is important to note that taking a mobile telephone into a prison is a criminal offence. If you take a mobile phone into a prison, it will be dealt with very seriously.

As this article shows, there are serious consequences.

The full list of prohibited items should be available in the entrance area of the prison. If you cannot see it, ask for a copy. If you have any of the listed items on your person at that time, you must notify the staff in the entrance area. You will either be directed to return such items to your vehicle or to secure such items in a locker provided by the secure setting. If you use a locker, you will be issued the key to keep on your person during your visit and to allow you to retrieve the items when you leave. Lockable storage space for staff and visitors is sometimes limited in prisons, so it is advisable not to bring anything with you that is not permitted. If in doubt, ask about storage before you arrive for your placement.

You might be concerned that you will be hard to contact during your placement, should anyone need to be in touch urgently. Therefore, it is suggested that you give people the telephone number for the main switchboard of the prison. They can then ring the prison and should ask to be put through to the healthcare centre or explain that they need to contact you urgently so a message can be passed to you.

You may be anxious about what a placement in a prison might mean for your own personal safety. Many people who work in prison will tell you that they feel safer working in a prison than they did working in an Emergency Department. Both prisoners and prisons can have a general reputation for being dangerous, however, trouble is infrequent and there are processes and procedures in place to keep you and all staff safe.

Whilst on a placement, you will always be with prison healthcare staff, and not left alone. You can rest assured that the prison where you are carrying out your placement has a responsibility to keep you safe, as does the organisation facilitating your placement. At the start of your placement, you will be given an induction to the environment. It is important that if you do not understand something, or you have any questions, that you ask. No one working in a prison wants you to be confused, concerned or worried. If you do feel uncomfortable or anxious, you must let the nurses you are working with know, so they can help and support you. Also remember that your university will also have a concerns process and support available to you if you feel you need it.

Whilst there are processes and procedures in place to keep you safe, there are things that you are expected and/or recommended to do to ensure your own personal security:

• Never give out your personal details unless it is a requirement of your placement.
• Do not discuss your personal life in areas of the prison where prisoners and patients may overhear.
• If you use social media, ensure your profiles are private, and not available for public viewing.
• Report any concerns you have about your personal security immediately, no matter how minor.
• Report to the prison Security Department if you know or recognise a prisoner or patient in your site from outside the prison.

If you feel at all uncomfortable whilst you are on placement in a prison, because of something you have seen or heard from staff, prisoners and/or patients, it is important that you speak with your practice assessor or other healthcare colleagues on duty. You may see and hear things that are commonplace in prison, and which prison staff are more used to, but which are not often experienced outside of prison. These can sometimes be upsetting, so it is important to remember that there is support available to you at the time whilst you are on placement, and if needed, after you have finished your placement.

It is important that you seek support if you feel at all uncomfortable in this setting.

In addition to ensuring your own security and wellbeing whilst in the prison, you have a duty to protect the security of others. This includes your patients, colleagues and your friends and family.

You should not discuss someone else’s personal details whilst you are in the prison, unless that person has given explicit consent for you to do so, and you have ensured the appropriate level of privacy and confidentiality.

Do not talk about someone else’s personal information, situation, or details in an area where it could be overheard by prisoners, patients, or other people. For example, talking about what you did on your days off, or what other people have been doing, can provide some useful information for prisoners wanting to know more about your personal life.

Do not disclose personal or sensitive information about a person in prison to anyone unless it is for the purpose of caring for and treating that person.

If you become aware of a threat or potential risk to someone else’s personal security and safety – such as a prisoner or patient making a verbal threat to a member of staff, or a member of staff intimidating a prisoner or patient, you have a duty to report that to the relevant Security Department and Nurse in Charge immediately.

To protect yourself, your patients, your colleagues, and the security of the prison, you must not discuss your placement on any social media. You can revisit the Nursing and Midwifery Council guidance on the use of social media.

Safeguarding is everyone’s responsibility. Safeguarding means that a person’s right to live in safety, free from abuse and neglect is protected.

Staff working in prisons have a duty to safeguard people, care must be taken to protect those who are least able to protect themselves. People in prison can be seen by staff at an extremely vulnerable time in their lives. Safeguarding is a fundamental aspect for anyone caring for people in prison to prevent harm and abuse.

A vulnerable adult in prison is someone who may need care due to their age, illness, or mental health issues, at risk of self-harm, suicide, been affected by trauma or because of a learning, physical or other disability. They may not be able to take care of themselves or be able to protect themselves from exploitation or harm and therefore can be at risk of abuse or neglect. It is important therefore that their individualised needs are considered and assessed, and they are protected by those caring for them. Healthcare staff and teams working in prison are trained to support, assess, and plan effective care individualised for people who are vulnerable.

Students should (as part of their placement) understand the organisations safeguarding policy and how they can report a safeguarding concern and who the safeguarding lead for the prison is. Students should immediately report any safeguarding concerns or incidents and document these accurately as per the organisation policy.

Organisations should ensure that student nurses are supported to report any safeguarding incidents, and this is covered as a key part of their induction and orientation.

HM Inspectorate of Prisons has set out safeguarding criteria they use to inspect prisons, based on human rights standards, that examine all aspects of life in detention.

You can also find a short on-line course on safeguarding in secure and detained settings here.

Prevent Duty

This is the duty in the Counter Terrorism and Security Act 2015 on specified authorities, that includes healthcare organisations to have due regard to the need to prevent people from being drawn into terrorism. It is about preventing radicalisation of vulnerable people as part of organisation safeguarding responsibilities.

The head of healthcare and the nurses that you are working with will explain how they are trained to recognise vulnerabilities in people to being drawn into terrorism and the prevention of prison radicalisation and how and where to report concerns.

The GOV UK website has useful information about Prevent, which you may find helpful.

If you have any concerns on your placement about any aspect of the Prevent agenda you should raise this immediately to the nurse in charge.

As part of a placement in prison, students may be able to visit other areas of the criminal justice service to be able to view the prisoner patient journey, from arrest through to release. Some prisons will have good links with colleagues working in police custody, courts and in liaison and diversion teams, so these may be areas that can accommodate a visit from a student nurse, and something to consider in line with the learning needs of the student.

There are nurses working in police custody suites, nurses working in court and in liaison and diversion teams, all of whom could be contacted to ascertain if a student visit would be appropriate.

See this link for more information on roles in wider criminal justice services.

Bromley Briefings Prison Factfile. The Prison Reform Trust (PRT) is an independent UK charity working to create a just, humane and effective penal system. They publish useful reports about many aspects of prison life, but of particular note, is their regular publication ‘Bromley Briefings’, which provides a useful summary of the facts about prisons and the people in them.

GOV.UK. Positive Practice, Positive Outcomes: A handbook for professionals in the criminal justice system working with offenders with a learning disability. A best practice handbook for criminal justice professionals working with offenders with learning disabilities and learning difficulties.

NHS England Health and Justice Inclusive Workforce Programme. The aim of this programme is to improve the recruitment and retention of a larger, more diverse, inclusive and representative workforce for all health and justice services and programmes.

There is also an Introduction to Health & Justice Careers online module, which consists of one session and is intended to help learners understand the health and justice services commissioned by NHS England and how they support their respective client/patient groups; understand the range of roles within each type of service; understand where to find out more information about these services and role opportunities; reflect on personal career options and opportunities and reflect on personal knowledge, skills and development needs.

For more information and to access the session, please visit the Introduction to Health and Justice Careers programme page.  You will need to register with eLearning for healthcare before accessing the session if not already registered. See: E Learning for Health Care: An Introduction to Health & Justice Careers

Independent Advisory Panel on Deaths in Custody, prison related publications. The independent Advisory Panel on Deaths in Custody is an advisory non-departmental public body co-sponsored by the Ministry of Justice, the Home Office and the Department of Health and Social Care with the central aim of preventing deaths in custody.

Nuffield Trust. The Nuffield Trust is an independent Think Tank, who publish evidence-based research and policy guidance, including prison health publications.

Health and Justice Research Network (HJRN). The Health and Justice Research Network (HJRN) is a multi-disciplinary network of academics and clinicians, based at the University of Manchester. Their research focuses on the health and social care needs of people in contact with the criminal justice system, screening and identification of health needs and risks, pathways of care in the criminal justice system, and implementing and evaluating novel health services and initiatives to improve the health of people in contact with the criminal justice system.

Prisons and Probation Ombudsman. The Prisons and Probation Ombudsman (PPO) carries out independent investigations into complaints and deaths in custody. You can find links to their fatal incident and learning lesson reports.

Royal College of General Practitioners Secure Environment Group. The Royal College of General Practitioners Secure Environment Group has published some excellent resources for practitioners working in secure environments.

Royal College of Nursing Justice and Forensic Forum. The Royal College of Nursing Justice and Forensic Forum supports RCN members working in the field.

Royal College of Nursing - Criminal Justice Services. The Royal College of Nursing has published clinical pages for nurses and healthcare support workers who practice in justice and forensic settings.

SOLDA-CJS. Support for offenders with learning disability and/or autism in the criminal justice system.

Worldwide Prison Health Research and Engagement Network. The Worldwide Prison Health Research and Engagement Network is an open access collaborative forum for everyone interested in prison health globally, aiming to improve the health of people in prison through the equitable development of the evidence base and through capacity building initiatives for health.