changing gears at 46 to County Jail? - page 2

Hi All. I am putting my application in for the county jail. I was contracting out my services independently but my husband wants to start his own business and I need to have benefits for both of... Read More

  1. by   nurseT
    Thanks for your advice. I don't think I have a copy of any standards. I did ask about a large notebook that stated Correctional Healthcare, but was told " oh we don,t really use that, that's geared more for DOC. We do hold for DOC but medical is more like a bandaid station.What is the specific name of the standards you're referring to. I definatley would like to look at that. I've got alot of reading to do.
  2. by   jailDON
    National Commission for Correctional Healthcare (NCCHC)

    American Correctional Association (ACA)

    ACA encompasses medical standards along with security and the medical section is very similar to the NCCHC standards.

    I would get a copy of the NCCHC standards if I were you. There's a different one for jails and prisons so be sure to specify when you order a copy. Try their website.
  3. by   smk1
    hey keep us updated this is a really interesting topic!
  4. by   nurseT
    update: I asked the Dr. today if I could type up some standard orders for the routine stuff, he says " sure feel free". I had him on the phone cause he doesn't even come in unless there is an IM to see. I've been treating them on my own, but I did have to call him for a persistant skin infection that has been resistant to keflex x3 repeat therapies that were documented in the record. Sheesh, I'm not a doctor. Thanks for the info on standards. I plan on looking that up soon. What kinds of standard orders do you have?
  5. by   jailDON
    We have nursing assessment protocols so that we can treat simple things without a telephone order. These include: colds, allergies, athlete's foot, withdrawal, rashes, etc. If the person has seen the nurse twice with no improvement, a doctor's appointment is required.

    There is a NCCHC standard that addresses how often you hold regularly scheduled sick call depending on the number of inmates you have. I don't have it right in front of me but I can post it later.

    Are you getting your intake screenings, physicals (by the 14th day for jails and 7th day for prisons) and chronic care clinics done? If not that would be a place to start as well as holding sick call.
  6. by   jailDON
    Another idea: Instead of reinventing the wheel, why not borrow nurse protocols from another facility and have your doctor sign off on them?
  7. by   nurseT
    No, when the nurse who was leaving oriented me she said the inmates are entitled to a physicial from the doctor after 14 days if they want one. All they have to do is ask. It is written in the inmate handbook that way. Most of the inmates aren't there long enough for that. The initial bookin process has select medical questions incorporated into it that is labeled medical screen. If the inmate denies having any health problems then there is no reason to seek out the inmate for medical. Every am when I go in I take all the previous evenings medical screens from new arrests and review them. If the inmate indicates a health problem or need for medications, I first see when they go to court.If they are going to court that day then I set the screen aside and wait for the outcome of court. The inmate may get released. If they will be staying I go from there. If there is a pressing need such as a serious medical condition then I put them on my list of inmates to see that day. I then review all the medical request forms, most of which are repeat drug seekers " I'm nervous and can't sleep, get me something to help me with my nerves before something dumb happens". I write back, "It's normal to be nervous and unable to sleep in a stressful situation such as being in jail, and our Dr. says he will not prescribe meds for a normal condition". Then I show it to the commander who writes," If something dumb happens" we can take care of that". I put the legitimate requests on the list to see them and then prioritize.I conduct sick call daily. Some days there is nothing so no sick call. If I can't take care of the problem I will place them on sick call for the Dr. We do not have a chronic care anything. If we have a pregnant female that looks high risk the county tries to get the female released or transferred to another agency (DOC) who can provide the medical tx needed. We are really a bandaid station. Probably 90% of the population is young and healthy and never turn in a medical request before they are released. If they are on hold for DOC they will first be transported to RDC which holds the inmate for 2wks and does a thorough medical assessment befor going to DOC. I will call some of the surrounding co jail nurses and ask if they have a nursing protocols I can borrow, that's a good idea. Thanks
  8. by   cindyrn1
    First of all let me tell you, you have a great job with much potential. Second of all, you seem to be doing a terrific job making this job work for you. I have been a psych nurse for 14 years and have done every area of psych to include Forensics but Correctional nursing is so different. I am new to the field like you and YES there is political issues as well as your own nursing issues that you run into everyday. I learned a few valuable lessons the first few weeks I was at my job in the prison and these lessons helped me know what I need to do versus what they tell me to do. We are nurses FIRST. Our license is on the line no matter what we do. We are responsible for the assessments and directing those that need it to the doctor, hospital or whatever. It's hard having an officer tell you that a particular IM doesn't need any help when you know they do. My psychiatrist told me one day that no matter what other people tell you to do or ask you to do, always know that YOUR assessment of the situation is what counts. When you get those orders for that IM, it's your name on the order along with your physicians. I learned really quick that just because a social worker tells me that an IM's meds need to be changed doesn't mean that is what I do. I do all my own assessments and go from there. We have another big job and that is determining who is actually needing our services versus just pulling our leg. You will learn that part of correctional nursing as you go along. I work soley with women in a Women's Maximum Security Prison. Women are so notorious for trying to get what they want when they want it. You can do this job, just tell yourself that you are the nurse and what you do is based on your excellent judgement, insight and knowledge. One thing to remember, we can't change the system all the time but we can sure try to make it better. I do know that YOUR assessment of that IM makes a huge impact on what we do with them when they get to prison. I will leave you with this one scenerio we ran into with a county jail: an IM was having severe headaches etc. Tylenol was given in jail. This helped a little but IM was still very sick. It was time to ship to prison system and IM still was having some severe complaints. We get the IM and after a few days, symptoms she was having in the jail worsened. There was very little information regarding the problems i the jail and she ended up in ICU at a hospital for a very serious life threatening illness. Your job is very important for the prison system. You are the first step in making sure that our prisoners receive the medical attention they need before coming to the BIG house. This particular prisoner should have never come to the Prison system as she needed to be hospitalized first. She could have infected hundreds of other IM's and we would have had a real epidemic on our hands. You have an important job and just know that if you ever need to talk about what you are doing or have any questions you can always write me and I will try to help you out. I love what I do and hope to stay in this area of nursing until I retire. Congratulations on getting your new job and hang in there. They need you and you can make things happen around there. Correctional nursing is not like hospital nursing. You are your own boss and you have a lot of responsibility that goes with that. Take advantage of your new career field, learn all that you can and do what you know best.......take care of those that need your help. Good luck to you!

  9. by   nurseT
    to cindyrn1: Thank you for the information and encouragement. I really appreciate any advice I can get. I know what an inmate needs are after assessment and what needs to be done. It's looking like I won't be able to do everything I would like to do for an inmates healthcare do to the politics. If I am notified that an inmate is going to DOC I gather all the information I can and the medications and send with transport officer. I will even call the nurse and give some report so they've got something to start with. However, the CO's could care less about medical. I was aware of an inmate scheduled transfer on the weekend and left all his medical and meds in a bag for the officers. When I came in the next morning, there it sat on the table in the exam room where I left it. They just go " oh, oops". I'm not sure about the headache story details. But all of our new inmates C/O HA unrelieved by tylenol and insist they get oxycontin or TYL#3. Unless they start showing neuro S/S, nothing more is done. We had an inmate who fell on the floor clutching his chest, drooling out the side of his mouth, the whole ball of wax on a holliday with no nurse present. Co's sent inmate to ER. Inmate must have done the same thing to the ER staff too cause they ran all sorts of tests including a cardiac cath and all tests came back negative. His bill was around 7,000.00. The county has a fit over that kind of stuff and the inmate was given MSO4 at ER, the standard for CP, which is exactly what he wanted, IV to boot! So what can ya do?
  10. by   cindyrn1
    [I] Well you seem to be quite aware of some of the tricks of the trade already! ha ha. When I did Forensic Psych nursing, the patients (we had to call them patients because they were guilty by reason of insanity) would do whatever they could to go to the hospital to get pain medication, surgery or have tests done. They would fake everything they could to get what they wanted. There was nothing we could do to stop their actions, but we did start doing more treatment in the facility, hold them back from doing things they enjoy (because they were soooooooo sick) like smoking etc. That stopped a lot of the faking. But with Borderline personalities, they didn't care what they had to do to get what they wanted. But after they spent days at the hospital getting all those great drugs, they would come back to me with nothing but a Tylenol order! I have found in the Prison system that seizures are a biggy with the women. They fake them, have an emergency called, go to the ER and nothing is wrong with them. Well you and I both know what goes on in a true seizure......so the Prison system has stopped making such a Huge ordeal out of a possible seizure and have learned to deal with them in the facility and the fakers have literally stopped having seizures now. As you can tell, politics are big in the corrections system, but if you are doing what you are suppose to be doing as the nurse, that is all that matters. I simply stay out of the political stuff and find something more to focus on. I just turned 40 years old and know now that I am never going to change the world or be able to make everyone better. I have accepted the fact that I am only here to make sure the IM's meds are correct and that they will be able to function in society when they are released. Some of them have been in trouble for years and I can't change them in a few months. So, I do the best that I can and leave it at that. You have a big job. But the jail is very fortunate to have you. It's hard to find a nurse that will work the county jails. We in the Prison system Thank you for doing what you do! Take care and have a great weekend.
  11. by   jailDON
    Because you are the manager of the unit and not a nurse assigned to accomplishing a peice of the puzzle (i.e. sick call) I am trying to outline the most basic services that your clinic should provide.

    It sounds like you are in a jail, not a prison. Offering the physical before the 14th day must be done and documented whether the patient allows the physical or refuses. Even the healthy ones need to be offered STD testing at the time of physical according to NCCHC standards.

    Intake screening must be done as soon as the inmate is booked.

    Chronic care patients should see the doctor within 30 days of booking and at least every 90 days after that.

    I'm not saying I have it all figured out!! We are constantly fighting the "squeekiest wheel gets the oil" situation. Sometimes the nurses are giving healthy drug-seekers all the attention when there is a 79-year-old sitting quietly with uncontrolled hypertension and diabetes.
  12. by   nurseT
    jaildon: Yes I'm in a county jail. Iam told that there is a difference in some rules to healthcare requirements between prison and a county jail, but I'm new so I don't know what the difference is. I have been searching but probly in the wrong area since I'm coming up empty handed. The worst thing about this job is not the nursing but the environment. I feel intimidated by the commander who insists on treating me like one of his hourly employees. He makes me clock in even though I'm salary and insisted I be there 8hrs because if I left when my job was done it would cause the secretaries and the CO's alot of anxiety since they can't leave. So it takes about 4-5 hrs to complete my tasks and I'm stuck in the jail for the next 3-4 hrs with nothing to do. The commander has lockdown every day from 11a-1p and the CO's will not let me see IMs during that time because it's the CO's quiet time / lunch time. So I have to go in early to get sick call done and stock the med cart before 11a. I can get all my paperwork done during lockdown, but there just isn't enough to keep me busy. It seems almost like a nursing home where the cna's run everything but in this case it's the CO's. Maybe I'm just feeling sorry for myself, but I don't even think it's legal to have an exempt/salary employee and also treat them like hourly. I do not get OT or Comp time and no compensation for being on call 24/7. Any county jail nurses out there and what's it like for you. I spoke with another county nures who only visits her jail 1xwk and is on call the rest of the time.
  13. by   cindyrn1
    Who is your immediate supervisor? Who hired you? If you are salary, then why should you have to clock in? Sounds like you are being harassed by your co-workers. If you work over 40 hours then that's overtime.......federal law. And since you are salary, you can leave when you want to! I would be doing some talking to someone and I would do it really soon.

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