'It's the type of environment you absolutely love or you absolutely hate'

Working with patients with a tendency towards violence or self-harm who have just been sentenced to life imprisonment may be a bit much for some nurses, but not Marieanne Bubb-McGhee.

She has always believed her patients deserve the best possible care regardless of their past. She carries this attitude with her as head of prison, potentially violent patients (PVP) and homeless healthcare at HMP Gloucester - a position connecting her with patients from uniquely challenging backgrounds.

With about 80% of the 323 prisoners receiving some type of healthcare, she and her team of 30 nurses have a hefty workload. She collaborates with the prison and healthcare teams and works with visiting staff to cover all areas of healthcare, as well as dealing one on one with patients to address individual issues.

Alongside this, she is also head of a homeless care unit, which could treat close to 30 patients on a busy day. “There are natural links between the two units in the type of patients and the type of care we provide,” she says.

Ms Bubb-McGhee has always been drawn to caring for those with atypical backgrounds. Attracted to nursing because of its complexity, she enjoyed her mental health placements and during her time in emergency care often worked with challenging patients such as substance misusers or those with a violent nature.

After working with adolescents with learning disabilities, she moved on to a psychiatric intensive care unit where she was conference and education manager for the National Association of Psychiatric Intensive Care Units. Working her way up to managing acute wards, the Gloucestershire primary care trust approached her in March 2007 to help progress its primary mental health element at HMP Gloucester.

During her time at the prison she has faced several challenges - limitations in her work setting, lack of resources and the prisoners themselves.
“We can be restricted in how we can engage with the individuals,” she says. With her team, she is consistently working to overcome these limitations, trying to increase group activities and introduce generic occupational therapy.

“Communication can be difficult with patients, who can be confrontational about their care or the medications they are prescribed,” she says. There are also often language barriers to deal with. But her team works hard to address issues and keep open the communication pathways.

In the homeless healthcare team it is difficult maintaining long-term care for her patients; they aren’t always able to keep regular appointments as they are constantly moving around. “It’s a vulnerable population, but we try to ensure they’re getting the best possible care while with us,” she says.

Ms Bubb-McGhee has worked to continually improve the care of her often-overlooked patients. As one of three prisons in the South West to receive £30,000 from The King’s Fund, she and her team have converted an association area for group work, built a one-to-one room for patient care and created a bigger office in which to operate.

Connecting different areas of offender health is a top priority for her. “I’d eventually like to manage the whole offender health pathway,” she says. “Joining resources and services together will make things much easier and allow us to maintain better care.”

She is the only prison nurse in the 130-strong Queen’s Nurses membership, and feels honoured by that despite the weight of the responsibility to be a pioneer. “Being a Queen’s Nurse enables you to discuss issues, to enact real change and take things forward,” she says.

Ms Bubb-McGhee warns her field is not one to enter lightly. As an intense and difficult environment calling for a variety of experience, background does matter. “It’s the type of environment you absolutely love or you absolutely hate,” she says. “But despite the challenges, if you get one positive result, it makes it all worth it.”

Brianne Ross

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