Nursing roles in health and justice services

In this resource, we look at each of the main areas of the justice system where nursing staff work and consider the main nursing roles available in health and justice. 

Nursing staff work in diverse roles across the justice landscape in the UK. This includes sexual assault referral centres, prisons, immigration removal centres, courts and police custody. 

Nurses working in health and justice services need skills in managing acutely ill patients, with both mental and physical illness. They will also need an awareness of therapeutic interventions to address distress and support with lifestyle changes.

They will work as part of a wide-ranging multi-disciplinary team, including police officers, prison officers, probation staff and other health care professionals. They should also be able to work across agencies to ensure holistic quality care. 

Due to this evolving area of practice, there may be other roles in this area of nursing than the ones identified below.

Sexual assault referral centres (SARC)

Sexual assault nurse examiner (SANE)/Forensic nurse examiner (FNE)

The SANE/FNE is a registered nurse who works with people who have experienced sexual violence. They usually work as part of the team in a sexual assault referral centre, which is a specialised medical clinic for children, young people and adults that have been sexually assaulted, including rape.

This nurse will provide telephone advice to patients and colleagues and undertake holistic assessments, including sexual health, mental health, and safeguarding. They also conduct forensic examinations to obtain evidence that can be used to support a court case. They provide trauma-informed care for patients to ensure they are supported both medically and emotionally following sexual assault.

Nurses working in this setting may be employed directly by the NHS or by an independent health care provider commissioned by the NHS.

Police custody

Custody nurse practitioners (CNPs)

CNPs, also known as ‘clinical forensic nurses’, work autonomously in police custody to manage the health care needs of patients (‘detainees’) following their arrest. This is legally required under the Police and Criminal Evidence Act 1984 (PACE) and has been the responsibility of NHS Scotland to provide in Scotland since 2014.

The responsibilities of the CNP are wide-ranging and include clinical care of emergent conditions, crisis management, acute alcohol and drug withdrawal and presentation of mental health disorders. The maintenance of minor injuries, illnesses and long-term conditions is also key to the role.

The nurse is highly skilled in professional curiosity, assessment and decision-making to care for vulnerable people who may also need support for their mental health, alcohol/ substance dependency, safeguarding, gender-based violence and suicidal ideation.

The CNP provides advice and guidance to the custody team regarding levels of observation and whether the detainee is fit for detention, interview and court, and release. Practitioners are responsible for providing medication (including the use of patient group directions) to prevent withdrawal symptoms and manage existing medical conditions. This includes reviewing detainees after they have received hospital care and recommending when a specialist mental health assessment is required.

The CNP is also responsible for the collection of forensic samples (including venepuncture), which follows strict protocols to ensure that evidence is admissible in court. Record keeping must be detailed and accurate, as the CNP may be required to write statements or reports.

Nurses working in the police custody setting come from a variety of different clinical backgrounds including adult (acute, emergency and community care) and mental health. Experience of working in environments that are unpredictable, require quick thinking and a calm approach is essential.

CNPs are employed through the NHS within Northern Ireland, Scotland and Wales. Police services in England have contracts with independent health care providers who supply CNPs (apart from two constabularies who directly employ CNPs) and other health care practitioners, including paramedics.

Courts

Liaison and diversion practitioners

Liaison and diversion practitioners can be registered mental health and/or learning disability nurses. They will attend police custody suites and magistrates' courts to provide assessments, advice and identify robust care pathways for individuals where a potential health vulnerability has been identified. They also provide the police and court services with information to inform the most appropriate next steps for the person and support people as they make their way through the justice system.

Prison

Prison nurses

Prison nurses provide health care in all UK prison settings for both male and females. Prison nurses’ roles vary from a generalist role to more specific specialist roles, which may include general, mental health, substance misuse, women’s health, children’s nursing and learning disability nursing. There are also opportunities for registered nurses working in prison to be employed as advanced clinical practitioners (ACPs) and practice development nurses (PDNs).

Prison nurses work as part of multidisciplinary teams delivering emergency care, primary care, including triage and walk-in direct access. Some prisons also have inpatient units, where nurses provide care. With the increasing ageing prison population, prison nurses sometimes provide palliative and end-of-life care and support people with complex long-term conditions, often further complicated by substance misuse and/or pre-existing mental ill-health.

Health care assistants (HCAs) and health care support workers (HCSWs)

HCAs and HCSWs often lead on health promotion activities in justice settings, such as smoking cessation or hypertension and venepuncture clinics. They may also support the delivery of sessions for long-term conditions. In some prisons, HCSW and HCA provide personal care for people assessed as needing more support with their care needs.

Registered nursing associates (RNA)

RNAs work in some prisons. Their role is similar to working in the wider nursing community, where they contribute to and implement care packages, help with health promotion and wellbeing clinics, as well as supporting patients with their activities of daily living and personal care.

Immigration and removal centres

Immigration and removal centre nurses

Immigration centre nurses provide health services to people detained under the Immigration Act by the Borders and Immigration Agency. Their work includes all aspects of primary care in general and mental health.

Several immigration centres also offer substance misuse treatment. This requires nurses to have specialist substance misuse and non-medical prescribing qualifications.

Immigration removal centres are run by both public and private sector agencies. Some have inpatient facilities.

Youth justice services

Youth justice nurses (YJNs)

Young people who are in contact with the justice service, either through the police or courts, will be supported by a youth justice team, who will often refer to a YJN working with the team. The YJN will carry out a general health assessment which covers a wide range of areas including alcohol use, drug use, mental health, physical health and sexual health. The YJN provides a care plan for the person and works with other agencies and professionals to support them and promote health. Some youth justice nurses also offer preventative support to reduce the risk of young people becoming involved with youth justice services.

Young Offender Institutes (YOI)

YOI are for people aged between 18 and 21. Nurses working in these settings support and promote the health and wellbeing of young people. Nurses will do many of the things that they do in a prison setting but focus on the health needs of young people.