Quote from LorrySchoenlyRNPhD
This is an awesome thread! I just re-read an article on nursing autonomy in corrections. We have to initiate great autonomy in practice due to being 'the only game in town' on so many levels.
Kudos for your fine work!
Lorry, This "autonomy" is a bit scary isn't it? What are your thoughts on how well-placed this "autonomy" really is in the typical correctional environment?
In another thread somebody was kind enough to provide the following definitions:
Main Entry:
au·ton·o·my
Pronunciation: \-mē\
Function:
noun
Inflected Form(s):
plural au·ton·o·mies
Date: circa 1623
1 : the quality or state of being self-governing;
especially : the right of self-government
2 : self-directing freedom and especially moral independence
3 : a self-governing state
Let's analyze the second definition: "
Self-directing freedom and especially moral independence."
When we discuss this within the context of delivering humane, morally true, and ethically adequate care to fellow human beings, there is always a danger in failing when delivering that from a platform of singularly autonomous perspective. This is particularly true when we are dealing with humans that are caged, and stripped of most free society rights to insist (with legitimacy) on full consideration. Caged humans, stripped of rights, have no options for second opinions. It is dangerous when there is only one perspective, one voice, one anlaysis and one conclusion dictating the medical intervention, care and treatment of a caged human. Should she/he fail the patient, the correctional nurse runs the risk of a stern reprimand, possible job loss and even, albeit very rarely, criminal prosecution. The patient runs the risk of unnecessary suffering, lifelong health deterioration and even, albeit very rarely, death.
It is dangerous when there is only one "self-governing" perspective on the medical intervention, or lacktherof, that flies well under the radar of free society.
- There are no patient family members stopping by your nurse station to remind you of their loved ones' past conditions, or allergies.
- There are no call bells buzzing you away from your phone conversation with your spouse, as you discuss your families dinner options for the evening.
- There are no pesky physicians wondering around checking, and correcting, your work.
- There are no second diagnostic opinions, unless you as the sole, self-governing, morally independent, on-site medical provider actively seek them out.
- There is no anxiety over persistent patients' questions, in any meaningful and potentially consequential manner, on the perceived standard of care received.
- There is no danger of your co-workers (often, consisting mostly of custody-minded folks harboring pent up sadistic tendencies and ever waiting for legal opportunities to empty their pepper spray cannisters), questioning the legitimacy, or accuracy of your medical work.
The autonomous nature of the prison/jail nurse role is very real. It is uniquely so.
The Correctional Nursing specialty area of Allnurses if filled with threads containing posts that often describe correctional nursing as "
the best kept secret in nursing."
While the closed off, locked down, autonomous correctional environment can be a stage for incredibly decent, above-standard, morally superior, and
unnoticed care delivery, it is also the very setting that facilitates and tolerates (unnoticed) the complacent, lackadaisical, and often callous disregard for humanity that is seemingly too often free to thrive with abandon, producing
substandard care delivery.
Autonomy is dangerous. It is dangerous in environments of incarceration for people everywhere including places like Abu Ghraib, and, well... places in the United States. It is a dangerous and scary concept, this correctional "autonomy."
Proper care, accountability, strict oversight and common decency are more crucial in the correctional environment than in any other medical environment. Unfortunately, it is the typical U.S. correctional enviroment that far too often places these well below the vote-securing priorities of "security." Too often, more time and money is spent on developing and purchasing the latest, greatest torture devices (pepper spray, tasers, stun belts, restraint chairs, etc.), and devising new, creative legal logic to administer them, than is spent on ensuring the delivery of fundamentally proper and humane medical service that minimally respects the dignity of humanity.
Let's dig a bit deeper on this "autonomy," shall we?
- One self-governing and morally independent person -- one nurse -- has the power and authority to ensure patients get what they need
- One self-governing and morally independent person -- one nurse -- has the power and authority to ignore patients and ensure the don't get what they need.
- One self-governing and morally independent person -- one nurse -- has the power and authority to claim his/her patient is lying, and thus justify the denial of care.
- One self-governing and morally independent person -- one nurse -- has the power and authority to believe the correctinal officer when he/she tells him/her that the patient received the broken nose, fractured jaw, bruised testicals and broken toes when he "fell from the top bunk."
umm..... lets' dig a bit deeper on this "autonomy," shall we?
Definition 2) "
self-directing freedom and especially moral independence?
What happens when the correctional nurse is immoral? What happens when the correctional nurse is Lynndie England?
Is Lynndie free to self-direct inadequate, abusive, negligent medical care in an immoral, autonomous manner free from governing oversight? By extension, therefore, is the degraded, humiliated, abused, suffering patient just a phone camera click away from relief?
That freedom should not exist. That autonomy should not exist.
Why does it exist? Is it because we, as a society, think so highly of correctional nurses that we afford them this massive responsiblity and conclude it is well-placed? Or, does it represent nothing more than the tax-paying will of John Doe public, through his elected officials, to minimally throw money at the human dignity of the 2 million+ incarcerated Americans?
umm.. good question Tbrd!
In my opinion, generally speaking, the correctional community is beginning to wake up to the fact that this really was no big secret all along -- it was nothing more than the will of the public. On-site physicians cost big dollars. Adequate health care costs big dollars. Necessary staff numbers cost big dollars. Human dignity appears to have a price.
Historically, the correctional community has been known to produce protocols, policies, manuals, handbooks, guide sheets, and philosophical mantras like adolescent field bunnies on Viagra. This has traditionally been done in an effort to protect the correctional "autonomy." .. to keep this proverbial "secret," secret. And, that is why one entering the field learns quickly to fully embrace, memorize and repeat (often while asleep) the "
fair, firm and consistent" mantra like mindless pole-parrots on turbo-charged catnip.
Security rules the day.
The irony is that there is probably no safer place for a free citizen to work, and no more dangerous a place for a convict to dwell than within the typical U.S. correctional facility. The system now lacks all the necessary safeguards and accountability checks to warrant the current inadequacy of the single, autonomous correctional nurse paridigm.
For whom is this "dream job" so dreamy? For the nurses? or, for the patients?
Jul 27, '10 by diane227I would have irrigated his foley right from the start when his urine output dropped and kept irrigating it PRN. These patients actually need to have a three way foley and be on CBI.HIPPIECHIKRN and tbrd450 like this.
Jul 28, '10 by tbrd450Quote from shell911rnYES! No other place is medical advocacy more necessary than in a facility in which the single medical provider -- the nurse -- is the only game in town. No patient option exists here for second opinions.Nurses often forget or feel uncomfortable "telling" on physicians to their supervisor or chain of command when the physician doesn't give an order for something, but we have to remember we are patient advocates. This is a very important part of our job, especially in corrections. If you remind the physician that you will document and/or notify the supervisor and/or make suggestions about what you think should be done, the physicians will change their tune and give you orders. Unfortunately, there are still health care professionals out there in corrections who believe all inmates are faking it and thus, they withhold treatment, sometimes to the detriment of the patient/inmate.HIPPIECHIKRN likes this.
