[shell911rn]

Correctional nursing can sometimes feel like you are . You are stuck in the middle between custody, inmates, nursing administration, and medical doctors and it feels like the only person who is on your side is, well, YOU. I even had another NURSE go behind my back and talk to a physician to cancel sending an inmate out who had severe abdominal pain because she had seen the inmate the night before (along with a different doctor) and they had felt he had been faking it. The inmate had gone mandown several times that day before I arrived to fulfill my four hours of mandated overtime (lucky me) to again have this inmate go mandown. My assessment of an elevated temperature, tachycardia, tachypnea, and a hard, hot, red abdomen had me second-guessing the "assessment" of perfect vital signs and normal abdomen of the previous shift's nurse. Custody fought me each step after I contacted the doctor to send the inmate out because the other nurses didn't feel there was anything wrong with the inmate. Now it was me versus other nurses and custody I finally told one officer to "Shut-up" and walked-away to tend to the inmate (16 hours on the job will do that to ya). So I'm thinking this is done and over with. Until I get a call back from the doctor to cancel the transfer, that the inmate will be seen in the triage and treatment area by the same nurses who saw him the night before so that THEY could assess if there was a change in the inmate's condition. The inmate refused to be transferred to the triage and treatment are where he felt he hadn't been treated fairly (which I tended to believe was probably the case given some of the nurses there) which left me in a predicament. If I sent him back to his cell, he would only continue to go mandown and the next mandown might be a critical emergency or full arrest (I suspected peritonitis, which if it leads to sepsis, has a pretty high fatality rate). I attempted to talk the inmate in to going to the TTA hoping they would see what I was seeing and send him out. Another C.O. who came on for the new shift who also saw something wasn't right with this inmate tried to help me convince the inmate as well. The inmate was not going for it. So I tried to get the inmate to sign a refusal for treatment, hoping to get him to change his mind, and also knowing full well if he didn't, that this was not the end of this and I'd be seeing the inmate again (probably to transfer out as an emergency) but when the inmate said "I'm not refusing treatment, I'm just refusing to go to the TTA" a lightbulb went off in my head. I called the doctor back and said "Doc, he's not refusing treatment, he's refusing to be seen by the nurses in the TTA again." The doctor finally had to agree to send the inmate out, bypassing the TTA. Report from the officers who went out with the inmate=emergency surgery due to a perforated bowel. In hindsight, I wish I would have just gone over the doctor's head and sent the inmate out considering the doctor allowed other nurses who were not even present to assess the inmate to second guess my assessment and nursing judgement. It took me hours to get this inmate out between the back and forth with the doctor, TTA, inmate, and custody finally putting together a team to send this inmate out. I'm lucky the inmate didn't die in front of me considering this had been brewing for at least 24 hours. Total hours worked for the day=19 hours by the time everything was said and done and I was officially relieved. Sure, I once again gained the respect of many in custody staff. But even when you gain their respect, you have still have to listen to the ******** and moanin' about doing your job. But like someone else said, one moment, you are doing too much for the inmates, then the next moment, not enough. As long as you go home at the end of the day knowing in your heart that you did the right thing by the inmate and by your license, it don't matter what anyone else thinks (including those in nursing administration who also like to nit pick what you do or don't do because you forgot to fill out this or that insignificant piece of paper for auditing purposes, despite the fact you saved an inmate's life). Correctional nursing can be thankless at times and more than thankful at others. It's not for everyone.