The inmate had been booked in only a short time before Kaylee was called in to assess him. Officers suspected he was either under the influence of fentanyl or beginning to withdraw. Kaylee, a registered nurse at the Stearns County Jail in Minnesota, had been working in corrections for about a year. She started her assessment.
Mid-conversation, the man fell asleep in front of her. Then he stopped responding altogether. His skin turned blue.
She administered Narcan once. Then again. Two minutes are required between doses, she remembered from training. Another dose. Then a fourth. By the fifth dose, he gasped back to consciousness—then sank again. It took seven doses before he stabilized.
"Two minutes feels like a really long time when somebody's not responding," said Kaylee, who agreed to be identified by her first name to protect her identity.
EMS arrived and asked, incredulous, how many doses she'd given. She told them. But what mattered was that the patient was alive, and he was breathing. All because she hadn't given up.
Only afterward did she realize what had been working against her the whole time: a fentanyl-laced candy tucked inside his cheek. He had been ingesting the drug at roughly the same rate she had been trying to reverse it.
These are the kinds of challenges correctional nurses face every day, often while working with limited resources and minimal support.
Medical teams shoulder one of the most demanding roles in healthcare, both emotionally and physically. In a single shift, they may serve as first responders, mental health advocates, chronic care managers, and comforting presences at the end of life. They might remove a bullet fragment at 3 a.m., intervene in a psychiatric crisis by dawn, manage insulin for dozens of patients before lunch, and reverse a fentanyl overdose like Kaylee did before the day is done.
It is high-stakes work, but deeply meaningful to those who do it. And the care provided behind prison walls extends far beyond them. With roughly 95 percent of inmates eventually returning to their communities, correctional nurses are not only treating patients; they are helping rehabilitate communities.
How does someone end up working as a nurse in a jail?
Correctional nursing is not usually the first career path people think of when considering nursing. While many people aspire to become nurses, it’s far less common to hear someone say, “I want to be a nurse in a jail.”
Most correctional nurses arrive through a side door: a clinical rotation, a friend's recommendation, a career pivot, an unexpected opening at a moment when their previous job no longer fits. Whether they’re employed by the local law enforcement agency itself, a private contractor, or part of a public-private partnership, every nurse has their own story, their own reasoning, and their own "why" for choosing this route.
For Katie, Kaylee’s fellow RN at Stearns County, the door opened during her senior year of nursing school. As part of her public health rotation, she was placed at the jail for clinicals. After graduating, she spent a year in a hospital and quickly realized something most people would never expect to hear from a nurse —
She felt safer inside the jail.
"Believe it or not, I feel safer here," Katie said. "I was getting assaulted at the hospital all the time. Here, it is so much more controlled."
Beyond safety, she liked the breadth. Hospital nursing tends to specialize; you either become an ICU nurse, an oncology nurse, or a labor and delivery nurse. Inside a jail, a single shift can include withdrawal management, wound care, mental health stabilization, a chronic disease check-in, and a true emergency.
"We see acute and chronic conditions, mental health, withdrawal, all of it," she said, “instead of being on a unit at the hospital focused on one area of nursing."
For Kaylee, the path ran through inpatient psychiatry. After three years in a mental health unit, a coworker mentioned that the local jail was hiring.
"He said, 'Hey, this might be something you like,'" she remembered. "And that's kind of how I came over here. I still really like to do mental health, and, well, this is obviously mental health, too."
A landmark prevalence study of Iowa’s prison system found that 48% of inmates had a diagnosed mental illness, and 29% met criteria for serious mental illness. With nearly half of the inmate population dealing with some form of mental illness, jails and prisons often function as impromptu mental health facilities.
For many of those individuals, it is the one place they're actually able to receive help.
However, the path in is only the beginning. Each day inside the walls presents new challenges, opportunities, and experiences. Not every nurse who walks into a correctional facility for the first time understands that yet.
But most of them figure it out quickly.
The job is hard. Just not always in the ways most assume.
Ask a correctional nurse what's hardest about the work, and the answer is rarely what an outsider would guess.
It isn't the population. It isn't the environment. It's the math.
Correctional nurses frequently work under nurse-to-patient ratios that would be unthinkable in a hospital: one nurse to 500, sometimes 800 inmates during a single shift, according to a 2024 study in the Journal of Forensic Nursing. They work with fewer resources, longer waits for results, less equipment, and a thinner safety net than nearly any other nursing setting in the country.
"Other hospitals and facilities think we can do everything medically that they can do," Katie said. "We are very limited on our resources. We can do a lot more than people would think, but nothing in a super timely manner. We can do X-rays, but we don't get the results for two days. So if it's emergent, they have to go to the ER. We've had ERs send patients back to us, like, 'Oh yeah, they're going to jail, they'll be monitored 24-7.' Nursing's not here 24-7. And it's a totally different monitoring than they get in a hospital."
On top of the resource gap, the medical complexity is staggering. Nurses are managing chronic illness, untreated infections, severe substance withdrawal, and complex mental health presentations in a population that has often gone without care for years.
And then there is the human weight. The repeat bookings. The patient who left two months ago, seemingly doing well, but comes back through intake hollowed out by another relapse.
"While they're here, we try to do everything to set them up for success, get them sober, get them established," Katie said. "And then they come back a couple of weeks later, they relapsed, stopped taking their meds that we got ordered for them that were working so well."
Both Kaylee and Katie work diligently to live by a skill that their profession demands but that almost no nursing program teaches: learning to hear what isn't being said.
"The inmates like to try to find out information about us," Kaylee said. "It might just be a simple, 'What color is your car?' As a new nurse, you're kind of naive to that. You say, 'Oh, I drive a black car.' And then a week goes by, and they ask you more about it. They're trying to figure out things."
Katie put it more bluntly: "I didn't really realize that until I started working here, how much they try to use everything you say against yourself. Just being able to see through the manipulation."
It's a stress unique to correctional nursing, often described as the "spillover effect" of correctional work: the toll of holding therapeutic care inside an institution whose primary mandate is custody and security. Nurses are asked to do clinical work in an environment built for control.
The two values do not always agree.
Misconceptions can be just as challenging as the work itself.
For those who work in corrections, the public conversation about correctional healthcare tends to start in the wrong place. When jails make the news, it is almost always for what went wrong: a death in custody, a missed assessment, a lawsuit. The result is a near-permanent assumption that nurses inside jails either don’t exist, don’t care, or aren’t doing their jobs.
“With the suing and the malpractice, especially in the news, when you hear about deaths or incidents in jails, it kind of goes back to that,” Kaylee said. “Like they’re not doing their job, or they don’t care about the inmates.”
The other half of the misconception sits even closer to the surface: the belief that the people inside don’t deserve care in the first place. This may seem to contradict the first misconception; however, it centers around the idea that they are not being treated as the public believes they should be.
“A big one is people on the outside don’t see inmates as people,” Katie said. “They’re like, oh, they don’t deserve anything. They’re in jail. They broke the law. A lot of our inmates are wonderful people who just got caught up in a bad situation.”
It is the same logic that drives outrage when a facility serves decent food, or builds a more humane unit, or invests in mental health resources for its population. Why are we doing this for them? It is a question that rarely holds up under examination.
Substance use disorder is a medical condition. So is the bipolar disorder driving someone’s seventh booking. So is the diabetes a homeless patient hasn’t been able to manage for years. So is the wound. So is the heart condition. So is the pregnancy.
A nurse cannot, ethically, decide who is and isn’t worthy of treatment based on the charges on a booking sheet. That isn’t how medicine works anywhere else, and it is not how it works in a jail.
“If we could just take a look at the underlying mental health piece of things and treat that,” Kaylee said, “I think we would have fewer people making bad decisions. People aren’t very supportive of building a new homeless shelter, but those things are needed for people trying to get back on their feet. The human decency in corrections is very difficult for some people.”
The other misconception belongs to the medical world itself: the assumption, sometimes from the very hospitals that nurses transport their patients to, is that a jail clinic is a substitute for a hospital.
In reality, it is not.
Correctional nurses work with limited diagnostics, limited staffing windows, limited specialty access, and almost no overnight coverage. They are trained to stabilize and escalate. They are not built to be a substitute for the ER.
Despite all of this, nurses keep coming back.
For a job this hard, in a setting this often misunderstood, what brings a nurse in for another shift?
The answer, almost without exception, is the turnaround.
In corrections, the change can be staggering. A patient who arrives in a full psychotic break—disorganized, terrified, with no self-control—can, with the right medications and the right time, re-enter the general population a few weeks later and engage with other people. A patient with a deep, infected wound on intake can be stabilized, dressed, healed, and leave the facility in materially better physical condition than when they arrived. A patient withdrawing from fentanyl can be safely brought through the worst days of his or her life with medical oversight that, on the outside, might have been difficult to afford or find at all.
"We've had a few that smear feces or eat their feces, just super mentally ill," Katie said. "And when we're able to get them on meds … just seeing the turnaround, how well they're doing. Eventually, they become compliant because they realize they're feeling better. They start taking their oral medications, they're able to be moved to a normal housing unit, interact with other inmates, and go to [support] groups. Those ones really stick with you. From eating their own feces to functioning in the general population. That is a really cool success story."
For Kaylee, the part that keeps her grounded is hearing what happens after release. In Stearns County, that connection comes through the Community Action Team, or CAT, a partnership between local law enforcement, probation, and Central Minnesota Mental Health Center that tracks people with significant mental health needs as they move in and out of the system.
"When they aren't doing well, we kind of get updates on that," Kaylee said. "But when they are, we get emails: 'Hey, this person's doing really well.' That's probably the most rewarding."
Continuity-of-Care models such as these are still rare across the country, but the data is clear about why they matter. A 2018 study in the Journal of Addiction Medicine of jail populations on medication-assisted treatment found that inmates who continued on methadone during their stay were more than 32 times more likely to engage with a community treatment provider within one day of release than those forced into withdrawal. That continuity is associated with fewer new charges and lower reincarceration.
"I hope I don't see you again" is a phrase heard often in corrections—spoken by nurses, officers, and other staff alike—and it's said with genuine compassion. The sentiment isn't negative. It reflects a shared hope that the person walking out the door stays out, rehabilitated and thriving, instead of caught in the revolving cycle of return.
What a nurse does inside the building does not end at the gate. They want their patients set up for success on the outside, too.
The impact of correctional nursing reaches further than most people realize.
Success looks different in this profession. It means a patient survives intake. It means a withdrawal is managed safely instead of ending in a body bag. It means a wound is closed rather than left to fester. It means a serious mental illness is identified, treated, and stabilized—sometimes for the first time in that person's life—so they leave the facility on a different trajectory than the one they arrived on.
It also means a calmer facility. Officers know it. Wardens know it. The research backs it. When medical and mental health needs are being met, the temperature of the entire institution drops. A 2021 study published in the International Journal of Offender Therapy and Comparative Criminology tracked misconduct across multiple housing units in a correctional facility over two years and found that units organized around therapeutic care saw significantly lower rates of serious inmate misconduct, fights, crises, and use-of-force incidents.
The work that nurses do is not separate from the safety of the building; it is one of the load-bearing walls.
When a nurse stabilizes mental illness, they are not just helping one patient. They are interrupting a cycle that, when left untouched, will keep producing new bookings, new ER visits, new victims, and new costs to the community on the outside.
What advice do new correctional nurses need to thrive in this position?
There is a particular kind of advice that only a correctional nurse can give. It is not technical. It is not in any textbook. It comes down to two things: keep listening, and keep your guard up… at the same time.
"Hear out all of your patients and listen to their stories," Katie said. "Try to understand where they're coming from. You learn a lot from the inmates. Obviously, stay on your toes because you are inside a jail, but also enjoy it. It is a fun job. It's totally different than anything else."
"Keep an open mind," Kaylee added. "As a nurse, you want to help everybody, and you think the best of people. But working in corrections, not everybody is nice … As a new nurse, you see the best in everybody and hope for the best. Here, you have to figure out how to medically take care of them, but also the boundaries and the safety aspects."
Ultimately, the job is about helping a population often forgotten.
The public conversation about jails and prisons rarely includes the medical wing. There is no mainstream public image of the correctional nurse: no procedural drama, no nightly news segment, no national appreciation week most people could name. The work is mostly invisible because the wins are mostly invisible. A patient who walks out stable does not make the news. A wound that healed does not make the news. A psychotic break safely managed does not make the news.
But the absence of a story is not the absence of the work.
Every day, in every state, correctional nurses are doing the quiet, unglamorous, and often thankless labor of keeping the medical wing of a jail running swiftly.
Katie and Kaylee are in this profession because the turnaround is real. Because the success stories—even when only a handful ever make it back to the people who treated them—are worth it.
"Just because people make bad decisions, they're still human," Kaylee said. "They do deserve a chance. A lot of our people have made bad decisions, and they've come out on the other side, and they're the same people walking in the grocery store with you. They're part of the community."