I need some advice from some experienced jail nurses. I interviewed for a position at a jail recently, and it is likely that I will be offered the job. It is for a part time psych nurse. During the interview, I was told some things about the position that bothered me. I didn't ask for clarification at the time, but I want to know if this is standard practice. This job is with a regional company that contracts with that particular jail. The administrator of the medical program told me that I will be seeing patients and determining if they need medication. She mentioned various protocols and drug formularies, but stated that I can pretty much order whatever I wanted and start administering it. I wouldn't have to wait for the MD to sign off on it, but that he would sign off on anything I ordered as long as it wasn't anything "crazy". Isn't this practicing medicine without a license? I only have a BSN and RN license. Is this standard practice at a jail? The nurse decides what the inmates need and then just gets the MD to sign off on it. Please, I am very interested in this position, but this is worrying me.
I work for a state prison system. We have numerous protocols for dealing with various situations, which have been approved by the appropriate physicians. The purpose is to allow nurses to deal with minor medical issues without having to call a physician every time. We have a physician on call after hours for situations that exceed what can be dealt with using a protocol. However, none of our protocols involve psychotropic medications.
I would be very leery of this job, because it sounds like a setup. I see some very serious scope of practice issues in the protocols you are describing. Many psychiatric medications can have very serious side effects, and even with my many years of mental health nursing I would not be comfortable ordering the medications myself.
Last edit by Orca on Nov 5, '09
Having worked in mental health for a long time, to me it seems very irresponsible to have protocol orders for psychiatric medications. I would also be nervous about the doctor automatically signing the order "unless it is something crazy". This tells me that the doctor is not properly evaluating the inmates these medications are going to. I would not want to have to defend this practice in court - which is where they are headed if they keep issuing medication like this. Also - who defines "crazy"? If the doctor took a disliking to the nurse he could hang the nurse out to dry - not that it would be that difficult given how this company operates.
My take on it is that this outfit operates on the cheap. They don't want to pay the money for a decent doctor, so they have found someone who cares little enough about his/her license to blindly sign off on orders written by someone not qualified or licensed to prescribe medication. If something goes wrong, you can bet that the nurse will be the first one to fall - and you would have no real defense.
Everyone I've told about it said it sounded like she didn't like me questioning things.
They're looking for a lap dog who will just blindly go along with the program and not rock the boat. I could not run away from this job fast enough.
Last edit by Orca on Nov 6, '09