[canterbury tales]

[quote=canterbury tales;2648827]One of the most important things one learns working for the department of corrections is to protect your license. You completed your assessment and did the right thing. Proctecting our licenses is not as hard when you can recognize an offender in need of care above the level we can provide in our correctional environment.
Cudos to you for a thorough assessment and standing your ground

[CookieCritter]

Originally Posted by MadisonsMomRN

Well, another update. He is back... he has C-diff and MRSA. Great huh? I work this Thursday so I am sure I will see him then.

I am not sure if he is a houseman. He worked in the kitchen but recently was "promoted" to commissary. He was worried about his job.

Thank you ALL for your wonderful supportive comments and wealth of information! Its all a big learning experience. This makes me more knowledgable from actual experience and more confident in my assessment and clinical skills.

Poor fella he's had a rough go of it. I honestly feel bad for him. I agree with him if I was in prison I wouldn't want to lose the commissary job either, thats "cush" by jail standards. I hope he continues to get better. Whew and you must be smiling ear to ear. If it wasn't for your actions and standing up for him, this guy would be dead. Wonder what ole "Reno 911" sarge has to say to you now in between checking his watch. He'll probably never make eye contact with you after this one. He's got to eat his words now. Oh well

[hcmanp]

Originally Posted by avalonlake

Poor fella he's had a rough go of it. I honestly feel bad for him. I agree with him if I was in prison I wouldn't want to lose the commissary job either, thats "cush" by jail standards. I hope he continues to get better. Whew and you must be smiling ear to ear. If it wasn't for your actions and standing up for him, this guy would be dead. Wonder what ole "Reno 911" sarge has to say to you now in between checking his watch. He'll probably never make eye contact with you after this one. He's got to eat his words now. Oh well

Well, don't make the officer feel like he is eating his words ever. The guards all know what is happening. You were exactly right to do as you did. Agree with all who said it's your license, not his. Once the guards know about your skills, you should get a lot less crap from them when you say that somebody needs to ship out. Corrections nursing is tough, but you have what it takes. God bless!

[Yermonator]

Originally Posted by MadisonsMomRN

I work at a state prison and a county detention center... this weekend I was at the detention center.

I had something happen this past weekend that was quite interesting... I had a man come up c/o lightheadedness, nausea and vomiting blood. Ok... I didn't see it but it did warrant an assessment. I pulled his chart. He was on motrin 800mg tid for a shoulder injury. No significat history except he was an alcoholic prior to being incarcerated. I spoke with the inmate and he states he has a history of ulcers. He was clearly pale, clammy and his color was a little yellow to me. I took his vitals... bp 99/50, pulse 100, temp 96 (I took it 3 times). He said that he had been lightheaded as well. I told him to stop the motrin. I asked him what he had eaten and what he had to drink and he said lots of pepperoni and pizza. I thought well, maybe it was sauce that he saw. He started to feel a little better. He said he had Tums and would take those and lay down. I told him to tell an officer if he vomited again or if anything got worse or if he developed new symptoms. Well an hour later I get a call. I told them to bring him up. He stated that he had vomited again and he said he could taste blood. He kept saying "I feel like something busted." His looks spoke for itself. You have so many manipulaters its hard to tell sometimes who is valid and who's not. My gut and assessment said send him out. It was 10:30pm. I called the doc on call and his voice mail picked up. I left a message about my assessment and said I was sending him out. I told security and they were ticked because it was 1) 10:30pm and they were changing shifts soon and 2) the doctor hadn't called back yet. I said "Look, he is clearly sick and I am not risking his health or my license." Sounded mean maybe but I just had a gut feeling. The doc called back and said go ahead and send him... he was already gone. Well I called the day after and found they admitted him. I found out today that he had emergency surgery (he was bleeding internally) and is in ICU... I don't know the diagnosis though. Security actually went to my boss and told them that I made a decision without doctor consent, but I didn't. Well, thats my job late at night with no doctor... My objective opinion was something is wrong. I called the doctor like I was suppose to. The doc didn't pick up so I left a message and he called right back. The doc of course will say yes send them out because they depend on us and we are the ones there, they aren't. Clearly security has no training to make any decisions pertaining to medcial. My boss told them that it was fine that I made the decision that I made... if not, he might have died. I mean sometimes we have to make on the spot decisions based on our knowledge.

Sorry for the book... its just I didn't like the way security acted. They feel like the inmates always lie and sometimes they do. This inmate was a trustee... no history of frequent visits and states he hasn't been sick since being in there (over a year).

When I told them I wanted to send him out... one officer looked at his watch and said "Its almost time to go home." I said "well he needs to go and can't wait." The sargeant comes over to me and says is the doctor aware... I said I called and left a message and she'll call back any minute. I didn't back down because she acted like she wanted to wait. I told her that he had to go asap and that he could be bleeding internally... the other officer said "yeah right" I said, "His objective symptoms clearly say something is wrong..."

What a mess. I am glad I sent him!

You go girl. Security would all be pumping gas somewhere if it were not for corrections. It dosnt make them bad guys just ignorant which is way better than stupid

[Vikingkitten]

Not a Corrections Nurse, but a few years ago, I was a Traveller in Northern California, and experienced my first (and hope only) time with the prison population in my professional career.
I was informed I was going to circulate a case (Ortho) on an inmate from Pelican Bay. Found out the Worst of the Worst were kept there. This one , was a multiple murderer (7 I think) of various family, children, spouse (babymomma?) and neighbors. What fun, I thought!
Met the Lt. in charge of the 4 man detail before going in to do my interview. These were some of the beefyest men I've ever seen. Any one , or all of them could have been in the NFL. They made me take off my nametag, my custom scrub hat , put on my mask and a generic paper hat, and was informed not to do anything or say anything that could identify me in the future. Wow! Guess I got the case because I was one of the few males in the OR.
Met my "patient", shackled, four point restraints (sorry if I miss the terminology) and a Guard on each limb, facing the inmate and they never took their eyes off him the whole time.Got through the interview in one piece and left to finish the room before Anesthsia and the Surgeon got there.
When all was in readiness, and I returned to the pt's room to get the Guards in their scrubs . As a last caveat, the Lt. tells me, as we are going out the door (the halls were cleared of all staff and other pts.), that if I tell the inmate to lift his left leg, and he moves his right, to hit the floor, as all of them are going to "Ventilate his a**!" First time for me in the OR with 4 fully armed Guards! Talk about Reality Check! Anyway, it all went well and got him to PACU and then it was their problem.
Anyone have a similar experience, and were they SERIOUS?! Don't know how you all do this for a living, but God Love You All!

[uraqt2]

Wow, what an ordeal. I'm glad that you stood your ground and did the right thing. I sure hope that this was an eye opener for custody and in the future they don't question your skills. Keep up the good work.

[Truegem]

MadisonsMom, how long have you been in corrections? By the sound of it, it sounds like this is the first time this has happened. I have been in corrections for 14 years and let me tell ya, this happens to us on an almost daily basis, the deputies giving us a hard time for sending people out. We have to go by our nursing judgement. Great job! You did the right thing! And even without the doctor's "OK", you're covered because you didn't initiate any treatment, you just had him transported to a place where he could get the help he needed. Whenever the deputies tell me the inmate is faking, I just say "I know, probably!" and smile. But inside I'm thinking "we'll see".

-Gem =)

[hippie4life]

Great Job! I have been a correctional nurse for a long time. I am now in administration but nurse's like you are what it is all about. Doesn't matter if he's hard core or what he has done, he is your patient and you did just what you should have done. I have been called chocolate heart, inmate lover, you name it and I have heard it from correctional staff during my career. It just doesn't matter, they are our patients and we are all they have. Your motto is absolutely true. I had a doc once order me not to send and offender out, I did anyway and he died in the hospital of an abdominal aneurism. He was a full code and I new something was very wrong. I was acknowledged for a job done right and the doc was told if he didnt want him sent he should have come in and done his own assessment. You should be very proud, stick with it corrections needs nurses like you. Followthe rules but take care of the patient.

[VegRN]

Originally Posted by hippie4life

Great Job! I have been a correctional nurse for a long time. I am now in administration but nurse's like you are what it is all about. Doesn't matter if he's hard core or what he has done, he is your patient and you did just what you should have done. I have been called chocolate heart, inmate lover, you name it and I have heard it from correctional staff during my career. It just doesn't matter, they are our patients and we are all they have. Your motto is absolutely true. I had a doc once order me not to send and offender out, I did anyway and he died in the hospital of an abdominal aneurism. He was a full code and I new something was very wrong. I was acknowledged for a job done right and the doc was told if he didnt want him sent he should have come in and done his own assessment. You should be very proud, stick with it corrections needs nurses like you. Followthe rules but take care of the patient.

Wow, you saved that prison from a huuuuge lawsuit. Well done! What in your assessment tipped you off to something being very wrong?

[hippie4life]

You could see his heart beat in his abdomen from the hall. It was so obvious something was very wrong.