Louise Donehoo, assistant nursing director at Metro State Prison, and Director of Nursing Patrick Dreher stand outside the fence at the correctional facility. On an average day, Dreher and his staff see 120 patients.

But then again, Dreher, an advanced nurse practitioner, doesn't work in a typical health care facility. He is director of nursing for Metro State Prison, a 905-bed prison for women in east Atlanta, and there's no place he'd rather be.

"We see everything here, diabetes, congestive heart failure, HIV, AIDS," Dreher said. "Most of the women have never had a Pap smear, and many have never seen a doctor in their life."

Some will be incarcerated in this correctional facility for a few months — others for more than 30 years. One woman here is on death row.

For Dreher and many other correctional health nurses, the ability to make a difference in the health care of inmates is both the challenge and the attraction of a job many nurses might never consider.

"I came to corrections from a job as director of a nursing home in Florida," he said. "I realized that I wasn't making too much of a difference there, doing the same thing over and over."

A visit as a contract nurse practitioner at a Florida correctional facility intrigued him when he learned that health care for all prisoners was mandated by the Eighth Amendment to the U.S. Constitution.

He was hooked when he learned how many different types of diagnoses he would encounter.

"I love it — it's an interesting business," Dreher said. "On the outside, things tend to be passed on to the specialist. Here, you can see the results of your orders."

Dreher is one of more than 300 registered nurses who work for Georgia Correctional Healthcare, a division of the Medical College of Georgia that serves more than 80 state-run prisons and transitional facilities, and 48,000 inmates.

On a typical day, Dreher, his assistant director, Louise Donehoo, RN, BSN, and his staff of three nurse practitioners and two licensed practical nurses see an average of 120 patients with a broad range of medical conditions. Many of his patients are on psychotropic drugs for mental illnesses.

There is an 11-bed infirmary in the 5,000-square-foot prison health clinic where sick prisoners go for evaluation and 23-hour "lock-down" observation. There also is an X-ray unit and a small pharmacy in the clinic.

As the state's official intake facility for all female prisoners, Dreher will see patients with a variety of conditions before the inmates are sent to their respective prisons across the state. All inmates undergo medical and psychological evaluations, and have their medication needs reviewed.

"Everybody from every county [in Georgia] comes here," he said. "I never fear for my safety. It's very comfortable."

But, he emphasized, "security is the priority here — not health care."

That is underscored by the seven daily lock-down counts, where prisoners must report immediately to their cells to be counted by guards.

Caring for elderly inmates

More than 100 miles south of Metro State is Milledgeville, where five prisons are within close proximity to each other. Elois Warren, RN, director of nursing for Bostick State Prison, has a slightly different set of priorities than Dreher's — geriatric care.

Her current prison population of 666 male inmates include 100 who are elderly, disabled and in wheelchairs. Many of these men are on multiple medications, with chronic conditions such as diabetes, hypertension and HIV or AIDS, she said.

At Baldwin State Prison in Hardwick, Pam Johnson is director of nursing for an all-male, 962-bed prison. About onequarter of her patients are borderline mentally disabled.

What makes her job most worthwhile, she said, are the times she sees inmates helping one another.

"We had one prisoner who came to us who had been shot in the head . . . He could not talk or walk and was in the infirmary," Johnson said.

Over the course of a year, she watched the other inmates try to help him learn to walk. "These guys really cared about each other, and they cheered the first time he stood on his own," she said.

Stories like Johnson's may not be the norm, but neither are the violent images portrayed by the media, like in the recently ended HBO prison drama, "Oz," said Lynn Bill, RN, MPA, CCHP, director of patient care services for GCH.

"We're much more likely to have inmates who injure themselves rounding second base [in the prison yard] than in a fight," she said.

The nation's nursing shortage also has hit correctional health facilities. Bill estimated that she had about 180 openings statewide for nurses.

Recently, GCH began holding openhouse events at the prisons to encourage job applicants and their spouses to take a look at the facilities.

"At job fairs we'd hear, ‘Oh no, my husband would never let me work in a prison,' " said Dan Finn, GCH human resources manager. Letting them take a look at where their spouses might work gives them a better sense of the environment, he said.

Bill added that there are plenty of opportunities for advancement in correctional health.

Inmate care is interesting, said Donehoo, who joined the staff of Metro State five months ago.

"They've done something wrong in society, but . . . they are still human beings, and they still need health care," she said.

For information about correctional health nursing, contact GCH at www.mcg.edu/gchc or call Finn at 706-721-1783.

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