VERY POOR JUDGEMENT - page 2

by HIPPIECHIKRN

5,085 Views | 19 Comments

We recently had a pt. that went out for a cystoscopy and needle bx. of his prostate. When he returned to our facility he had a foley cath in. (He's had it since March but the approval for procedures and f/u is really slow)The... Read More


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    I 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.
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    While I do think that many of the people in jail are in jail for their respective reasons, I don't agree with the mistreatment he was met with. He is an inmate, but he is also a patient. As his nurse, all he should have been was his/her patient. He has already been judged and is already paying for his crimes. Good for you for noticing him and taking care of that for him. That is what a good nurse does!
    HIPPIECHIKRN and tbrd450 like this.
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    Quote from shell911rn
    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.
    YES! 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.
    HIPPIECHIKRN likes this.
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    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!
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    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?
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    Once again tbrd, as stated in other threads, no one cares about your opinion.
    1. You are not a nurse.
    2. You apparently do not know the first thing about correctional nursing other than (apparently) what you have read.
    3. You apparently have a high opinion of yourself as evidenced by the language that you use, minimizing the recognition of the skill of the nursing staff in correctional institutions and regarding yourself as some self-appointed moral authority on how things should be.
    As asked before....GET OFF THIS FORUM! It is for nurses, and in this specialty, it is for CORRECTIONAL NURSES...not hacks that choose to opine uninvited. NO ONE CARES WHAT YOU THINK!
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    Quote from katkonk
    Once again tbrd, as stated in other threads, no one cares about your opinion.
    1. You are not a nurse.
    2. You apparently do not know the first thing about correctional nursing other than (apparently) what you have read.
    3. You apparently have a high opinion of yourself as evidenced by the language that you use, minimizing the recognition of the skill of the nursing staff in correctional institutions and regarding yourself as some self-appointed moral authority on how things should be.
    As asked before....GET OFF THIS FORUM! It is for nurses, and in this specialty, it is for CORRECTIONAL NURSES...not hacks that choose to opine uninvited. NO ONE CARES WHAT YOU THINK!
    okay, now this time there is no doubt about it. I am definitely picking up a negative vibe from Kirplunk.

    Talk to me Kirplunk, what's going on? What are you so angry about? Why do differences in opinion offend you so much?

    What happened to you? let's talk... what happened?
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    It isn't the opinions, it is the SOURCE.
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    Quote from katkonk
    It isn't the opinions, it is the SOURCE.

    Good. Thank you for you honesty.

    I am the source, for I am Tbrd. While you don't really know me, you know me through my posts -- my words. In fact, you only know me through my words. The words I write are a reflection of my thoughts and opinions. I am the source.

    Why do words hurt you?

    I'm just going to throw something out there, please don't take this as anything more than a possible explanation -- my possible explanation.

    Could it be that the words I write sometimes ring a little too true for your comfort zone? Do they, sometimes, cause you to step outside of your routine perspective and re-evaluate your conventional wisdom on issues? It's not comfortable, is it? When it happens, the wise person recognizes it for what it is -- personal growth.

    The mere fact that it cause negative backlash in (from) you is probably the clearest indicator that you are an inherently wise person, capable of analytical thought, and much intellectual expansion and growth.

    Could I be on to something here? just asking ..
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    Closed for staff review and time out


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