What happens when a max security inmate is unconscious in their cell?

Specialties Correctional

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Does a Lieutenant or Captain have to be present before the cell door is opened? When can the nurse enter?

Specializes in I have watched actors portray nurses.

I happen to believe this whole safety thing is well overdone, overused, overly applied, overly reference, and steadfastly becoming a correctional veil under which substandard interventions and care is justified.

I think it serves to justify inappropriate pepper spray application. I think it serves to justify inappropriate restraint chair application. I think it serves to justify overly aggressive and disproportionate responses to "out of control" inmates.

The truth is that it is probably statistically more dangerous to work in the local Emergency Room than it is to work in the typical correctonial facility. In fact, when I read the multitude of posts throughout these correctional threads on veteran correctional nurses advising potential new correctional nurses, all I ever seem to read is how amazingly safe it really is in these facilities. While I happen to think this false safety veil is certainly not exclusive to the correctional environment, it is that environment in particular in which it is permitted to thrive with abandon.

This safety thing is getting out of hand. Just about anything is justified these days on the premise that it was done for safety reasons. It appears to far too often be used as a universal excuse, or justification, for applying scene justice on the part of front line ranks.

Inmates are pepper sprayed for just about anything these days. Anything remotely couched under "disrespect," and ... zzzzzzzz taser time!

I'm not a U.S. Senator. If I were, however, I would do my best to completely overhaul the correctonal system to bring it more in line with professional, humane systems in most of the industrialized world. Common sense would rule the day.

Gone would be the days of:

1. Unfettered and unchecked inmate on inmate abuse, and

2 Surveillance video segments that magically disappear at about the same time the

inmates fall out of bed.

3. Extraction teams aggressively using too much force, and pepper spray

4. Restraint chairs used for too long, and in a punitive manner.

5. Slow response times to inmates down and in need.

6. Correctional officers who stand around and watch three inmates pummel another to

death because it just wasn't safe to intervene.

7. Strip searches conducted as an intentionally humiliating, punitive response

8. Strip searches by correctional officers of the opposite gender

Under my Senatorial watch, there would be a massive overhaul and a ramping up of:

1. Full, impartial, unbiased, close correctional oversight of policies, practices, and conditions. The correctonal community would no longer be permitted to police themselves. We all know that doesn't work.

2. Full prosecution, to the fullest extent of the law, anybody proven to violate the civil rights and liberties of incarcerated citizens.

3. In line with the Rape Elimination Act, a full and accurate accounting of rapes and sexual assaults in correctional facilities. And, further in line with that Act, a legitimate and meaningful avenue for victims of rape and assault to secure immediate safety, and legal recourse (against everyone responsible...including negligent correctional facility staff)

4. And, correctional officers and correctional nurses would actually be accountable under my watch. They would routinely, and actively, have to demonstrate close adherence to carefully crafted policies ensuring timely, humane treatment and intervention. Under my watch, creative case and medical notes, or incident reports, would no longer do the trick. True accountability would prevail.

Specializes in ICU, Research, Corrections.

Well, I guess it's ashamed that felons have lost the right to vote, because

you would be the candidate for them.

I have to agree with my fellow RNs that safety does come before the ABCs in

a correctional setting. This is the domain of the correction officers, not the

nurses.

You are right about one thing, correctional nursing is safer than ER nursing.

Correctional officers ensure that. I would not work PRN pool in a jail if

that wasn't true. There is never a problem with low census like hospitals.

custody secures the scene FIRST. an injured nurse cannot help. be ready to help as soon as the environment is secured, this ensures everyone's safety. then do an assessment, there are many resources to learn a 30-60 second patient survey to determine the problem in emergencies. unconscious? first, assess their pupils with a penlight flashlight. equal and responsive or no? the eyes are the window to the brain and no one can fake pupillary response, but check the record if they have had a know altered pupil from a prior injury, it it very helpful. if unconscious, proceed with nursing emergency protocols until the actual condition is know, i.e. a medical diagnosis. a good, thorough, accurate nursing assessment, documented, is the best thing to do and direct to higher level of care. if it is ouside of your nursing scope, the patient needs a higher level of care. be objective and non-judgmental. The biggest mistake is assumptions, even if you know the patient well. do an objective assessment each time, the outcome will be much better all the way around.

Specializes in I have watched actors portray nurses.
whoah whoah whoah - calm down! As I stated earlier, if you read that, I do not work in a corrections facility. Who is preaching???? So what if I don't work in corrections.... I work in an ER... and anyone can be a "bad guy." What is your point? A nurse is a nurse. Safety is safety. I can browse and post to whichever forum I would like. You have totally misread my post.

Hey, word to the wise.... take it from me, outside views don't appear to, ...how shall we say..umm.....always seem welcomed in this speciality area of Allnurses.

Specializes in Acute Care Psych, DNP Student.
Hey, word to the wise.... take it from me, outside views don't appear to, ...how shall we say..umm.....always seem welcomed in this speciality area of Allnurses.

:rolleyes:

What sort of mindset do you need to work in a maximum security prison? As a female nurse arent some of the inmates a bit scary - I mean what about those under a capital sentence? How do you work with those type of inmates knowing their fate?

Specializes in I have watched actors portray nurses.
:rolleyes:

I think this happens because correctional staff tend to walk in two worlds. The first is one in which their authority is virtually indisputable (on the job). The second is one in which dialogue is presumed open, equal and corresponding feedback is wide (off the job).

There have been some interesting studies conducted on what happens, over time, with correctional staff. The effects and outcomes of daily stressors were examined. Everyone knows that the correctional environment is stressful. For correctional officers, in particular, prison life is filled with confrontation, manipulation and force. His/her integrity is challenged regularly. For correctional nurses, counselors, educators and administrators, working within corrections the impact can be greater. Correctional staff in these supportive roles have been shown to experience greater impact. It has to do with their respective roles in the environment. For correctional officers, the focus is simple and single. It is security. Everyone is an inmate, and an inmate potentially worthy of a full can of pepper spray. However, correctional workers in the supportive roles struggle with conflicting principles. They are providing service to "patients," "counselees," and "students," who just happen to also hold the status of "inmate." For correctional nurses, for example, the dilemmas are always just one more incident away. They have less wiggle room and freedom to slide the slippery slope of descent into the core "us" vs "them" mentality permeating custody culture. Those in supportive roles (nurses, educators, counselors, administrators) provide service to, and advocate for, these.....umm... these...what are they called... um... PEOPLE.

It has been shown that correctional stressors can cause health issues, chronic underlying tension, higher divorce rates, and shorter life spans for those choosing it as a career.

What we do for a living impacts our life.

It has been shown that, in general, after several years on the job, correctional officers tend to begin to tighten discipline at home. One of the studies I can remember addresed this impact -- an officer began to treat his children differently. For example, when he suspected his pre-teen son had something he wasn't supposed to have, he handled it like a shakedown. He locked his son out of his bedroom and then he proceeded to tear the room apart. Teachable moments become command decisions. Teachable moments become shakedowns. Officers begin to withold information from their spouses. While secrecy is quite instinctive on the job, it is usally a deal breaker in marriages. In one of the studies, officers realized they began ordering their families around, instead of communicating with them. They began to suspect manipulation and deceit at ever turn. Distance sets in.

Eventually, outside the barbed wire, what used to be perceived as friendly discussion and/or debate began to look like antagonistic challenge, preaching and ulterior motive. Everyone is suspect.

The correctional environment is unique in society. The power imbalance between humans that exists inside is like no other in any other setting. Power is intoxicating, especially for the weak-minded. Inside the walls stress can be high and immediate, and human suffering can be deep and plentiful.

Inside, some nonviolent offenders become violent ones. Some counselors begin to see every one as deranged. Some nurses begin to see everyone through the "manipulation" lens. Everything and everyone is suspect.

excellent and well said tbrd. one exception.. nurses are not in 'supportive roles'. Our roles are primary and mandated by law. custody perceives us as 'guests' and refuse to recognize the lawful authority we have under our licenses. This is a very core to the problems you describe:yeah:. Kudos to you.

Specializes in Occupational health, Corrections, PACU.
So you put your life before theirs????? What a noble nurse........I commend you. Yikes! Curious if one day your philosophy will ever cost you yours.

SABC sounds about right to me.

That is because he (tbrd) is not a nurse, and has no idea what correctional nurses actually do, since he has not been there.

Specializes in I have watched actors portray nurses.
excellent and well said tbrd. one exception.. nurses are not in 'supportive roles'. Our roles are primary and mandated by law. custody perceives us as 'guests' and refuse to recognize the lawful authority we have under our licenses. This is a very core to the problems you describe:yeah:. Kudos to you.

Good point. the "supportive" perception is not by design, but rather it reflects the natural consequences of delivering service (care) to patients within the custody culture that dominates the environment.

Think about it, .. most people working in a correctional facility are not medical providers. Most people working in a correctional facility are there "to protect society."

Correctional nurses caring for patients, teachers educating students and counselors counseling clients are far too often perceived as peripheral to the main game in town, so to speak. They are far too often perceived as "supporting" cast on the correctional stage. However, in truth, their real value and impact is marginalized, seemingly by design.

When we examine the grand scheme of correctional focus, it is those "supportive" positions that truly do the most for people facing a future outside the gate someday. Those "supportive" roles have the real responsibility of correcting the correctional inhabitants on a stage of massive consequence -- futures are precariously fragile. They often hinge on small, unnoticed moments and experiences culminating in self worth or self loathing. Did you ever notice that some of these inmates seem to just become one with their correctional environment lifestyle -- they begin to see themselves only as convicts. In the "Us" vs "them" mindset that permeates most facilities, they begin to identify with the "them." And, they seem to be okay with that. That is not okay. That is a person making "peace," so to speak, with his self loathing.

A nurse treating an inmate like a patient -- like a person -- can mean longlasting things to that person not easily recognized or appreciated. A teacher treating an inmate like a student can expand minds. A counselor valuing his inmate client with the dignity of human healing can turn hate and anger in to dreams for tomorrow.

However, a correctional officer with rountine, dehumanizing detachment premised on an indoctrination of distrust and fear, a full can of pepper spray, and a lifetime quest for respect, can easily bring the masterpiece of rehabilitation to full reversal in a matter of seconds.

There is quite possibly no other place in society in more need for constant and vigilant advocacy than the typical correctional facility.

Somewhere in one of these correctional threads I read a post by a correctional nurse who explained that upon taking the job at her facility she made it immediately clear that she would not tolerate abuse -- she spoke up clearly and made it understood that she would not turn the other way or accept the unacceptable. She was willing to put her principles on the hiring line, so to speak, and accept that the employment chips would fall where they would. I remember reading that and thinking ... wow... that took some courage. I wish I could now find that post and let her know how much I respect that action.

The correctional environment is primed with daily opportunities to make or break your character and integrity. That is especially true for those in the "supportive" roles -- for it is you who have the very real burden of treating people like people, and do so within the strong opposing winds of custody culture.

Specializes in I have watched actors portray nurses.
So you put your life before theirs????? What a noble nurse........I commend you. Yikes! Curious if one day your philosophy will ever cost you yours.

SABC sounds about right to me.

No, I'm not that noble. I wish I were. Frankly, I don't have the constitution for prison life, neither the jumpsuit version nor the uniformed version. For one thing, I just know I have to be allergic to pepper spray. While I never experienced it myself, I know I'm allergic to just about everything else and, well, lets just say it is a safe assumption. Also, I don't think I could ever get used to nutri-loaf. I'm not all that fond of regular meatloaf; although Paradise by the Dashboard Lights is a great Karaoke song!

I'm probably allergic to nutri-loaf (Incidentally, is that word hyphenated?) Also, for what it is worth, I don't think I could ever get used to walking around in my underwear all day...what's up with that !?!

Yes, I certainly do hold my life before others' (except my children); and that is why I'm not all that noble.

However, I'm not prepared to adopt such a degrading and dehumanizing quip, albeit masked as a sound, noble philosophical mantra like "security first, breathing second." At best, it is merely distasteful and unprofessional. At worst it is a genuine red flag on real practices within shadowy corners of a dehumanizing "correctional" stage.

"security first, breathing second"

Those four words speak volumes, don't they?

Specializes in Advanced Practice, surgery.

However, I'm not prepared to adopt such a degrading and dehumanizing quip, albeit masked as a sound, noble philosophical mantra like "security first, breathing second." At best, it is merely distasteful and unprofessional. At worst it is a genuine red flag on real practices within shadowy corners of a dehumanizing "correctional" stage.

"security first, breathing second"

Those four words speak volumes, don't they?

Yes they do, and I think it is extremely difficult to understand what the nurses who work in corrections face unless you have actually worked there. Looking at your profile your not a nurse and from your own admission you don't work in corrections.

I am a nurse, but have never worked in corrections, I wouldn't envy any nurse having to wait to administer first aid. However "security first, breathing second" this is not really any different to any basic first aid that is taught

Safe approach,

Airway, breathing, Circulation

In a hazardous environment this safe approach is vital, an injured rescuer is of no use.

In my opinion, this security first, is no different to a first aider at a RTC asking the question "is it safe to approach" if it's not safe, don't approach

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