"Gate 4, open!"

The guard shouted to the gate operator and the massive barbedwire gates of Metro State Prison slowly opened. I was about to go inside one of Georgia's prisons — an all-women's facility in east Atlanta. Inside were 905 jump-suited inmates whose crimes ranged from shoplifting to murder.

I admit I was a little apprehensive, but I was also curious. Why would anyone choose to work here? Wouldn't they feel unsafe?

The first question is posed regularly by the peers and friends of nurses like Patrick Dreher, Pam Johnson and Stanley Bishop, who all manage nurses at Georgia state prisons. All had left nursing jobs on the "outside," intrigued by what they found on the "inside."

Indeed, the "whys" were answered more completely because of the challenges offered in their "locked-down" work environment. A microcosm of the human condition appears in prisons; many inmates are getting health care for the first time in their lives. From HIV and AIDS to diabetes and heart disease to appropriate prenatal care, a full-fledged, albeit security-minded, health care system operates behind the barbed wire of the state's correctional institutions.

One of the more startling things I learned during my visit was that the Eighth Amendment of the U.S. Constitution guarantees health care to prisoners. That guarantee came late in the 20th century after the amendment was tested in the U.S. Supreme Court.

Prisoners now have the only constitutionally mandated right in the nation to receive appropriate medical care. That's an irony I'm still grappling with — not that inmates shouldn't receive health care — but that in order to get free and appropriate medical care by law in this nation, you have to be incarcerated.

And providing health care is what these nurses do — to a diverse population that includes the mentally ill, the disabled, the elderly and juveniles. These are "clients" not inmates, and the staff doesn't look at the them in terms of their crimes, but rather their edical conditions, said Dreher, who heads up nursing at Metro State.

While it would be disingenuous to discount prison violence, those are more exceptions than the norm, these nurses say. The rule is much less dramatic — but a lot more interesting — than their old nursing jobs "on the outside," these nurses say.

There's no doubt that the nursing shortage has affected correctional health nursing managers, who often must work harder than others at recruitment. Lynn Bill, director of the state correctional institutions' patient care services, said she has openings for anywhere between 180 and 200 registered nurses and licensed practical nurses.

There are opportunities for quick advancement, she said. And it is safe to work here, maybe safer, these nurses say, than working on the outside, where there are fewer controls.

"I feel safer here than I do pumping gas at the local convenience store," said Bishop, manager of nursing at Scott State Prison in Milledgeville, which houses more than 1,000 male inmates.

Johnson, who also works in Milledgeville at Baldwin State Prison, has more than 900 male inmates, and echoes that same sentiment.

"When you are working at 2 a.m. in the ER, you don't know who is going to walk in that door," she said. "Here, correctional guards are ready should an inmate act out."

Dreher said he feels "very comfortable here." For him, the biggest change from his old job as a nursing home director is the impact he feels he is making.

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