Advice Needed for New Corrections Nurse!

  1. Hello Everyone! I am a new graduate RN. I applied to several hospitals and other avenues of employment, and receieved and accepted a job offer in correctional nursing.
    I am hoping for some good advice of any sort. While I thought I'd get a preceptorship like in a hospital setting, I am getting 6 days instead, and I have been told I will shortly be the charge nurse on my shift!
    I have no experience but what school offered, and feel very inadequate for the job. Can anyone tell me what areas I need to concentrate on in a prison setting? I am happy brushing up on what I need to know in my spare time.
    I work at a level 4. It is a big change from doing med passes and care for one or two patients during clinicals, to giving meds to 100's of I/Ms, or being in charge of the entire infirmary!
    My biggest concerns are giving safe and competent care to my pts, and keeping my butt out of trouble as well! During the interview I was told they could "teach skills", but I don't know just what I'm really going to learn in 6 days!
    Thank you all in advance for any tips or suggestions-I think I'll get a lot of good experience if I can hang on!
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    About WhirlyGirl

    Joined: Sep '10; Posts: 13; Likes: 2


  3. by   cchezem15
    I, too, am a new grad (LVN) starting out at a local county jail tomorrow! They said I would get about 2-3 weeks of training and I am still a little nervous. A lot of places (other than the hospital) do not give long trainings to new grads - this is what I found out while doing interviews. One place was going to have me train one day and boom be out on my own. I am thinking that I am going to really have to hit the ground running and soak up all that I can while I can. Of course, I am sure that we will have people around us to ask questions if the need comes along. I will definitely be probably annoying whoever is training me with questions!

    Best of luck to you!!!
  4. by   TIGERT
    I am so sorry to hear that you are struggling with orientation schedules........every place is different. But here is my advice, for what it's worth:
    When i started nursing 7 years ago, we were given "whatever" we neded to feel safe and ready to go on our own, 12 weeks to start then reasses to see if we were ready or not. Some new nurses took 18 weeks. Others were ready at 12. but either way if you were honest about your feelings, you could sculpt and individualize your own orientation. Today, even acute care nurses are given 6 weeks and then they are expected to work on their own, with maybe a mentor in the same hall for quaestions.
    In correctional nursing, i have no idea what goes, i oriented until i felt i was ready and even then, that was ready, not a pro at it, knowing i could call anyone for help and the on call administrator 24/7. I think I oriented 6-8 shifts, as an experienced nurse a year ago.
    SO, Take advantage of being a new nurse and stick up for yourself. It is a rare gift that you get to say "I am new and unsure of how to do this, can you help me?" Anyone who doesn't help you is worthless. My friends/coworkers always joke about holw long you are a new nurse. We figure for the first 5 years you can say you are a "new nurse". I am sure that isn't the norm. Nursing is everchanging. You have a lot to take in right now. Do your 6 shifts, see how you feel. At that point, make a list of what you feel you need more experience with and what you feel good about doing on your own. Always show the good and bad: What you know and what you need to learn. Make goals, set time limits. The director of nursing will appreciate that. Let her know that you need a couple more shifts at the end and then re-evaluate after those shifts. Keep your list and goals handy so you can make notes and changes as you go. Be honest about your feelings and need for more time at the end of orientation or nearing the end, leave it alone now.
    AND being a great charge nurse isn't knowing all the answers, IT'S KNOWING WHERE TO FIND THEM. You can cross that bridge when you get to it.
    But embrace the opportunity to have a REAL reason for asking questions and not knowing. It is a gift. I used to work with a lady that had a been a nurse for 25 years but would ask me, as a new nurse, questions about what meds to hold or should she call the doctor for a BP of 74/20. It was so annoying, I wanted to scream "I don't know, you tell me."
    Have fun! You will learn so much.......AND read the book "Games criminals play and what you can benefit from knowing them" or something like that, do a search for "Games Criminals play", you medical dept should have several copies. If not, I borrowed mine from the local library.

    Have fun and take care of you first.
  5. by   NottaSpringChik
    I think you should take it as it goes and if you don't feel confident or capable of delivering care in the environment and with the support available to you, speak up!! Maybe they just mean you will be on the med pass by yourself, or doing sick calls or H&P by yourself. As a new nurse you should definately have support and other nurses with which to consult any time you need it. I think in general, nursing is a team activity and many times experienced nurses consult with one another. In corrections you often have a lot of atonomy. Some places do have advanced providers (NP, pysicians, PA) available all of the time to ask questions or call in for a consult; otherwise they are available by phone.
  6. by   nursingtodo11
    I've been working in corrections for a few months now. I wasn't sure how I was going to like it, but, it's been an extremely valuable learning experience. A few things I've learned are:The inmates are not all "bad guys"They are, however, criminals. No matter how much you may sympathize with one, there always needs to be a clear and defined boundary. There is an unbelievable amount of drug addiction and mental illness that goes untreated on the outside. I often wonder how the inmates life might be different if they obtained treatment.TRUST YOUR GUT! If you feel uncomfortable in a situation, let a CO know, they are there to help and are very protective of the staff!Always question a heroin addict who also drinks "a liter of vodka a day." I have yet to meet an inmate who is a heroin addict AND an alcoholic.They do, however, like their benzos.Listen to the story, but always check the vitals! I personally prefer not to know the details of why a person is locked up. It will not change my course of treatment and I'm not there to judge. The most important piece of advice I can give is to listen to the more experienced nurses. Go with them to respond to emergency on the floors. You've got the knowledge you need but I guarantee that it's nothing like clinical in school!Good Luck!!
  7. by   WhirlyGirl
    Everyone, thank you all for your advice! I am finding it a mixed bag-some nights I have some backup, and people have the time to help. Most times we are short staffed, and I am on my own. One night this week we were short staffed and I was in the infirmary, I didn't have a CNA, and had 4 hospital returns, 2 admits (which filled the infirmary to capacity), and two walk ins.
    All I can say is while I "handled" it, the paperwork ended up being a total mess! But everyone else was pressured too. So I tried to wade through it myself, and it didn't go the way I would have liked.
    The best I could do was relay to day shift (also new!) what I needed help finishing (she didn't know either), and to tell someone more experienced.
    Some nights I walk out feeling good, some nights incompetent, and some nights mad (For the last time-"No-you can't have vicodin with your Q-ball, so quit asking me!").
    With that many patients it is hard for me (especially without a CNA most nights) to balance pt care and paperwork.
    I can see that the more I learn, the more I will do, and I am working for the day it all clicks!
    Thank you to everyone who replied, the words of the experienced give hope to the new.
  8. by   joanna_rn
    Wow, I'm only getting 3 days of orientation when I start next month. Any more advice would be greatly appreciated!
  9. by   rodsos
    Quote from joanna_rn
    Wow, I'm only getting 3 days of orientation when I start next month. Any more advice would be greatly appreciated!
    I got 5 it was crazy ?.....You can always ask more if you are not comfortable.
  10. by   delilas
    I may be a little late, but my take:

    Stand your ground on your assessments. When I first went corrections, other seasonsed/jaded nurses butted in a lot and would insist an inmate was malingering or faking. Don't let others second guess your own assessments.

    There are a few good websites about pitfalls, traps, and other parts of correctional nursing. One of my favorites was Correctional Nurse . Net - read up! There is a lot of information on security vs medical, which is an issue that may plague you till the end of your days in corrections.

    Never enter an area if you don't feel safe. Just today, I refused to enter the holding room of a new intake who was high on god-knows-what. It is not worth your safety!

    Get to know your officers and what their "areas" are. For example, I know which ones are okay with me making my life easier (like letting my infirmary patients bathe instead of shower when I ask) and which ones will stick very strictly to protocol every time. I also know who truly has my back if a situation were to become dangerous.

    Talk to your COs about everything! I learned a ton of information about the prison and security measures just by talking to them when things were slow.

    We're there to help inmates - physically and mentally. But never let it slip your mind that a large portion of the population is manipulative and/or malingering. Never let an inmate "use" you for extras - even an extra band-aid to them can be establishing a broken rule that they'll use to manipulate you further. Know your protocols and follow them accordingly! A nurse got walked here 3 weeks ago for giving out too much OTC allergy medications to some inmates.

    Learn what meds they can abuse. You'd be surprised! IE -albuterol inhalers? They can be sprayed on a surface, and when dried, they scratch it up and snort it. Advair diskus is similar (but worse, because they can remove all the parts of the diskus, but it appears intact). Allergy meds are very popular here to get high on (so much so our formulary only allows even benadryl to be written once every two weeks, and it can NEVER be given OTC anymore).

    If you're expected to respond to emergencies, bone up on your anticipated actions for seizures, chest pains, drug withdrawal, overdoses, stabbings, hangings, and anaphylaxis. ACLS is never a bad idea if you're expected to be a responder without a doctor. We don't have a crash cart in my prison, but we carry an AED and suction machine to all emergencies, along with an assortment of other equipment, epipens, etc. Know the signs, how to treat, and how to call for help.

    Know tattoos! Know the signs of a fresh one, the signs of an infected one, and what your prison's policies are on new tattoos. For example, our requires an exam form filled out, captains office to be notified, and blood to be draw for HIV/Hepc testing. Then the inmate is usually put in segregation as punishment.

    Ditto for fights, accidents, and use of force. There is usually a different form versus what you may use in Infirmary or Nurse Sick Call.

    I could probably go on forever - Correctional Nursing is definitely a horse of another color! I'll stop there. You're always free to ask me any questions or PM me!
  11. by   cchezem15
    delilas definitely knows what she is talking about! I agree with you 100%. I did not know about the albuterol inhalers! We give those out KOP at my jail. Hmmm.
  12. by   valzRN
    I have worked in corrections for over a year and this is what I have found to be true. First and foremost, keep your officers on your side. You ALWAYS need to be able to trust your officers in every situation imaginable. Another tip... nursing is completely different in a correctional setting. Some things may happen and you just need to turn a blind eye to it... again, that goes back to keeping your officers on your side. There is corruption in the facilities. I know that as nurses we want to be sure that our pts are well taken care of and such, but it's different on the inside. There must be boundaries, and correctional nursing is much like vet nursing... you have to know what your s/s are for what they are telling you is wrong. They like to BS... a lot of times, they just want to get out of their cell so they make up something to come down to triage. For instance, one biggie is "chest pain." Ask all the pertinent questions, when did it start, how long does it last, what brings it on... and don't use big words. Many of these people are un-educated and they don't understand our words. Dumb it down, par say. Almost on a kid level. They may complain of something that is completely unrelated to the s/s that they are telling you. That's when you know they are full of it. Another thing they like to do is fake seizures. Oh that's a fun one! My advice... take 2 ammonia sticks, shove one up each nostril. Sounds bad, but if they are faking, they WILL react. You need to know all your s/s of a REAL sz. If you don't, they will get you every time and then once they are in the infirmary, then you have the practioner jumping on you because there is no need for them to be there. Another tip, always keep it professional. Don't let your guard down for a minute. Don't worry about what they say to you and if it bothers you that much, send them to the tank, slap a DR on them... when they get charged for sexual harrassment, they tend to shut their mouths a bit. Don't let them get to you. Correctional nursing is a different kind of nursing. Not all nurses can handle it. You have to have a backbone and be strict and stern or they will take advantage of you. That's the last thing you want, then you get no respect and that's the ONE THING that you have to have in a place like that. Respect. They are all about that. You can be nice but stern. You will have to learn what works for you. Never show emotion to them either. Like I said, you can't let them know that what they say and do affects you.. that shows you are weak and then they spread it around to other I/Ms and then they play on that. Like I said, not all nurses are cut out for this type of work. I loved it and I miss it. I was laid off (along with 5 others) due to budget cuts. I really want to go back... Good luck on your endeavor and I hope that you enjoy it. It does have it's rewarding moments.