When Heather Pendleton and her family decided to move from Utah to Arizona, she had a choice to make.  She could give up her job as a nurse at the Salt Lake County Jail and find a new one closer to home.  But after five years of working in correctional healthcare, Pendleton had grown to like it - so much so, that she opted to commute from state to state by plane each week to preserve her position at the jail.

Pendleton expects that her family will relocate back to Utah within the next few years.  In the meantime, she says it's worth it for her to travel across state borders to hold onto a job where she enjoys the atmosphere and is continually broadening her horizons in the healthcare field.

"You learn a lot working in a correctional facility," said Pendleton, who has seen inmate-patients with cardiac problems, diabetes, substance abuse issues and mental health conditions during her tenure at the jail.

But, unlike Pendleton, too few nurses entering the healthcare profession know what corrections has to offer them in terms of clinical experience, according to Mark Ellsworth, the jail's Health Administrator.  Many nurses never even consider working in a correctional facility when they are looking for employment.

"The vast majority of nurses don't even know that corrections is an option," said Ellsworth.  "People just have really no idea what corrections involves as a professional offering to them.  They have no idea what is available here in the jail or in the prison system."

Ellsworth said, because correctional facilities house so many different types of people, healthcare professionals working in those settings gain experience treating a variety of physical conditions and many mental health problems, too.

"In many instances, corrections has a larger mental health population than the state hospitals do," Ellsworth said.

But, still, hospitals are where most nurses who are fresh out of school look to work, he said. 

"I think, in nursing, hospitals traditionally have the upper hand," said Ellsworth, explaining that when nurses are in school, hospitals are emphasized to them as a typical place of employment.  "I think hospitals, just because of that initial orientation, hold an upper hand on recruiting and holding onto people, but even they struggle, I know - at least in our market."

Ellsworth said that there is a shortage of qualified nurses across the country and even hospitals feel the effects of that. 

"I think that is standard, not only in corrections, but in every aspect of nursing right now," he said.

But, according to Ellsworth, prisons and jails face an even greater challenge in recruiting nurses because colleges typically do not expose students to correctional healthcare or send them to facilities to gain some clinical experience while they are still in school.  

"A lot of colleges are anxious to place students in places like this if you can show to them that you can provide a good clinical opportunity for [students]," said Ellsworth.

But many schools don't consider corrections as an option, he said.

"I don't even think a lot of the instructors in most nursing schools are familiar with what is available to them [in corrections]," said Ellsworth.

And because people aren't familiar with the corrections world, they are likely to have formed an impression of what it's like to work in a prison or jail setting from what they hear in the media, he said.  Correctional administrators then face the challenge of convincing people that it is safe to work with inmates in a secure facility.

"Once you get them into the facility, I think, [some] of the next things that, traditionally, people need to overcome are issues about safety," said Ellsworth.

Pendleton admits that she was, at first, apprehensive about going to work in the Salt Lake County Jail because she was concerned for her personal safety.  But her fears were quickly allayed once she began working there, after a friend who was also employed there, encouraged her to jump on board.

"It's scary not knowing what you are getting into when you hear the word 'corrections,'" said Pendleton.  "[But] the unknown is more frightening than reality.  Once I came into the facility [and] saw what the atmosphere was like, I [became] very comfortable here."

And Pendleton said that jail management has gone out of its way to keep its employees satisfied with their jobs, which is why she did not resign when her family moved out of state.

"Our management has made it possible to keep everyone pretty much happy with their jobs," she said.

Ellsworth said that, to keep staff content and retain employees, jail officials have, for one, tried to keep nurses feeling challenged on the job, so they maintain interest.

"In some environments, it's easy to let people not feel challenged or engaged in their professional endeavors," said Ellsworth.  "You want to make sure that you are keeping them actively engaged professionally."

To achieve that goal, managers at the Salt Lake County Jail place nurses in some less-traditional roles to give them a wide-range of experiences.  Ellsworth said they do patient histories and physicals and work closely with the doctors to enable them to learn more.

"It's a way to get the nurses a little more engaged clinically in what they are doing at the jail," he said.

Another way administrators at the Salt Lake County Jail keep nursing staff happy is by offering them flexible schedules.

 "When nursing polls are done relative to satisfaction on job, money is not the most important issue to nurses," said Ellsworth.  "It's their schedule."

Because Pendleton is able to work her three 12-hour shifts three days in a row, she is able to commute back and forth from the jail, despite living in Arizona.  And she is thrilled that she has been able to stay at the Salt Lake County Jail, where she hopes to finish out her career.