Had something interest happen this past weekend

  1. I work at a state prison and a county detention center... this weekend I was at the detention center.

    I had something happen this past weekend that was quite interesting... I had a man come up c/o lightheadedness, nausea and vomiting blood. Ok... I didn't see it but it did warrant an assessment. I pulled his chart. He was on motrin 800mg tid for a shoulder injury. No significat history except he was an alcoholic prior to being incarcerated. I spoke with the inmate and he states he has a history of ulcers. He was clearly pale, clammy and his color was a little yellow to me. I took his vitals... bp 99/50, pulse 100, temp 96 (I took it 3 times). He said that he had been lightheaded as well. I told him to stop the motrin. I asked him what he had eaten and what he had to drink and he said lots of pepperoni and pizza. I thought well, maybe it was sauce that he saw. He started to feel a little better. He said he had Tums and would take those and lay down. I told him to tell an officer if he vomited again or if anything got worse or if he developed new symptoms. Well an hour later I get a call. I told them to bring him up. He stated that he had vomited again and he said he could taste blood. He kept saying "I feel like something busted." His looks spoke for itself. You have so many manipulaters its hard to tell sometimes who is valid and who's not. My gut and assessment said send him out. It was 10:30pm. I called the doc on call and his voice mail picked up. I left a message about my assessment and said I was sending him out. I told security and they were ticked because it was 1) 10:30pm and they were changing shifts soon and 2) the doctor hadn't called back yet. I said "Look, he is clearly sick and I am not risking his health or my license." Sounded mean maybe but I just had a gut feeling. The doc called back and said go ahead and send him... he was already gone. Well I called the day after and found they admitted him. I found out today that he had emergency surgery (he was bleeding internally) and is in ICU... I don't know the diagnosis though. Security actually went to my boss and told them that I made a decision without doctor consent, but I didn't. Well, thats my job late at night with no doctor... My objective opinion was something is wrong. I called the doctor like I was suppose to. The doc didn't pick up so I left a message and he called right back. The doc of course will say yes send them out because they depend on us and we are the ones there, they aren't. Clearly security has no training to make any decisions pertaining to medcial. My boss told them that it was fine that I made the decision that I made... if not, he might have died. I mean sometimes we have to make on the spot decisions based on our knowledge.

    Sorry for the book... its just I didn't like the way security acted. They feel like the inmates always lie and sometimes they do. This inmate was a trustee... no history of frequent visits and states he hasn't been sick since being in there (over a year).

    When I told them I wanted to send him out... one officer looked at his watch and said "Its almost time to go home." I said "well he needs to go and can't wait." The sargeant comes over to me and says is the doctor aware... I said I called and left a message and she'll call back any minute. I didn't back down because she acted like she wanted to wait. I told her that he had to go asap and that he could be bleeding internally... the other officer said "yeah right" I said, "His objective symptoms clearly say something is wrong..."

    What a mess. I am glad I sent him!
    Last edit by MadisonsMomRN on Jan 24, '08
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  2. 58 Comments

  3. by   DDRN4me
    for you for standing up for your decision and your patient!!!! some times our "gut" is the lbest thing to go on!!!
  4. by   Sabby_NC
    Kudos to you for following your nursing instincts and being a very good advocate for your patient.
    If there should be a complaint it would be against those prison guards. They are also there to perform their duties and not worry about getting off on time.
    That guy owes his life to you. Think about that and smile.
    You did good my friend
  5. by   MadisonsMomRN
    I did call my boss today and talked to her about it. She said that they were talked to. Sometimes I feel like I need to work somewhere else and get out of correctional nursing because most of them think the inmates are not deserving of medical care. Yes... some can manipulate. I just hate it sometimes because I have been called naive for advocating. I am far from naive... I am aware and alert. I do keep that fine line there though, kwim? I keep it professional and call it as I see it.
  6. by   pattilpn2
    Excellent work!!! the EPITOME of what nursing is about!!! i'm sure you slept well!! be proud that you were able and capable of standing up for clearly could have become a nightmare....
  7. by   MadisonsMomRN
    Quote from pattilpn2
    Excellent work!!! the EPITOME of what nursing is about!!! i'm sure you slept well!! be proud that you were able and capable of standing up for clearly could have become a nightmare....
    .

    Thanks! It definitely could have been a nightmare. I kept saying Thank God I sent him out.

    My motto is --when in doubt send them out!--

    He's been in the hospital since last Saturday.
  8. by   pattilpn2
    Quote from MadisonsMomRN
    .

    Thanks! It definitely could have been a nightmare. I kept saying Thank God I sent him out.

    My motto is --when in doubt send them out!--

    He's been in the hospital since last Saturday.
    I am one who likes to follow up on pts too, so please post his condition as you get!! Thanks...Don't forget us....:spin:
  9. by   MadisonsMomRN
    Quote from pattilpn2
    I am one who likes to follow up on pts too, so please post his condition as you get!! Thanks...Don't forget us....:spin:
    I won't forget you!! I may call today and see if he's back yet. I am anxious to know what his diagnosis was. I will post when I find out!
    Last edit by MadisonsMomRN on Jan 26, '08 : Reason: typo
  10. by   AmericanRN
    I am glad you sent him

    While I respect officers (both patrol and detention) they are not nurses and so just like you would defer to them on issues of security they will learn to defer to you on issues of symptoms. Too bad for the sarge who said it's almost time to go home. If they get caught up in a wrongful death lawsuit they'll be home a lot longer then they intended, I'm glad you stuck up for what you knew was correct and true. I saw a similar case a few years ago involving a pregnant female inmate. The nurse deferred to someone else's opinion and the inmate's baby did indeed die on the floor (literally) since no one beleived she was going into premature labor.

    Everyone involved was fired and the correctional officers were let go within weeks (they were vested fully) and they lost everything as far as retirement and were sued civilly as well. They became the epitome of evil as far as public opinion and they recieved even less support from their former co-workers.

    This inmate was not hard core either just some bad check writing type of thing.

    Trust your instincts not all inmates are lying all of the time.
  11. by   AmericanRN
    Quote from MadisonsMomRN
    .

    Thanks! It definitely could have been a nightmare. I kept saying Thank God I sent him out.

    My motto is --when in doubt send them out!--

    He's been in the hospital since last Saturday.

    I like your motto and it rhymes!!!

    As someone else pointed out the sarge doesn't need to worry about what time they're getting home. Thats what their parity pay is about and they would do well to remember that next time they're concerned about getting home on time. Hahahah no such thing as getting home on time in certain fields and they knew that when they took the job.
  12. by   MadisonsMomRN
    WOW.

    I found out the he had an ulcer that perforated! Very serious condition. I don't understand... he denied pain when I asked him. I did read however that some people do not have pain just the nausea and vomiting. He had a pretty involved surgery, repairs etc and a lot of antibiotics.

    No wonder he was in ICU...

    He is doing better though. They aren't sure when he will be discharged.

    I will find out more when he's actually discharged back to us and I see his paperwork from the hospital.

    All I can say is **whew**. It really does feel good to make a good judgement call without seeing all of the symptoms involved... and just based on the assessment.

    It makes nursing so worthwhile to see that I played a part in him getting the proper care he needed in an emergent time of need (obviously when no one else agreed.) SO SO glad it was a positive outcome.
  13. by   JailRN
    Good for you!!! We nurses need to trust our 'gut' feelings and not back down just becaues the detention satff doesn't like it or is inconvenienced by our decisions!
  14. by   JailRN
    Again, good for you...the nurses are the ones with the license to loose, not the security staff..they need to learn about liability, liability, liability.............you trust your judgement and your gut.....

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