[MadisonsMomRN]

I have been working at a medium/maximum security prison for about 3 weeks. I am a little nervous at the way they do their insulins.

We have an east dispensary and a west dispensary. The inmates come to the dispensary and are held in the "bull pen". (The east side has about 60 diabetics that require finger sticks/injections.) Then one at a time they come to the nurse and receive their insulin. The nurse sits at a desk and the inmate sits in front of them. The nurse draws up their insulin and the syringe is handed to the inmate for them to administer themselves. Then when they are done they put it in the sharps box that is sitting on the desk. I have asked why they do it this way and I get "We havent had any problems yet... so this is how we continue to do it." I have not gotten a rationale yet.

Is this normal practice? I am just curious because I do not trust these guys.

[MadisonsMomRN]

Is this a silly question? Just curious. Am I the only one that would feel uncomfortable with this? Maybe its something I will get used to.

[MrChicagoRN]

What part of it that you are feeling uncomfortable about?

[MadisonsMomRN]

I guess the fact that I am handing the inmate a syringe. There is a lot of AIDS, HBV, etc... one stick and I am toast. I know there is a 2 hour window etc. Yes there are correctional officers there sitting across the room but that won't help me if he sticks me and they jump on him or pepper spray him. Most of the nurses "trust" these guys. I don't know them so I guess that is why I am nervous about it.

I guess its because I am new to this?

Is this common practice?

[kmruddrn]

I have worked corrections for 6 out of my 10 years in nursing. I have only worked supermax/max security prisons in which we administer the insulin ourselves. There are many inmates that come to our prison that have told me that the institution they came from let them stick themselves. So, in answer to your question, apparently this is common practice. The best advise I can give you as a nurse is always go with your gut. If it feels wrong to you--it probably is. My biggest concern of course is safety--weapon wise, and disease transmission. Those people who you refer to that "trust" inmates need to find another job. My opinion.

[MadisonsMomRN]

Originally Posted by kmruddrn

I have worked corrections for 6 out of my 10 years in nursing. I have only worked supermax/max security prisons in which we administer the insulin ourselves. There are many inmates that come to our prison that have told me that the institution they came from let them stick themselves. So, in answer to your question, apparently this is common practice. The best advise I can give you as a nurse is always go with your gut. If it feels wrong to you--it probably is. My biggest concern of course is safety--weapon wise, and disease transmission. Those people who you refer to that "trust" inmates need to find another job. My opinion.

You are absolutely right about the "trust" issue. YES, safety is priority with me and that is what I was taught in training. They only stick one inmate and that is because he is legally blind and cannot do it himself. When I do bring up my concern I get the "We have been doing it like this for years" and "If they try anything the co's will be on them like stink on sh#t" and another one is "These guys no better than that" Um, yea... which does not make me feel better because like I said before, the damage would be done if they try to stick you with the used needle.

Other than that I like it there.

[VegRN]

Originally Posted by MadisonsMomRN

I guess the fact that I am handing the inmate a syringe. There is a lot of AIDS, HBV, etc... one stick and I am toast. I know there is a 2 hour window etc.

I don't mean to minimize your concerns as they are valid. Nurses can and do get stuck by needles and do contract diseases however, the "one stick and I'm toast" bit is not accurate.
First of all, all health care providers should be vaccinated against Hep B and have a titer drawn if indicated.
Chance of contracting Hep B after an exposure is 30% but if you have the vaccination, this shouldn't be a concern.

Chance of contracting Hep C after a Hep C infected needle exposure is 1.8%
The changed of being contracting HIV from a needle stick is about 0.8% if you are stuck with an HIV positive needle. The rate is even lower if you receive the post exposure prophylaxis.

In addition, the smaller the needle, the lower the chance of contracting these diseases.

These rates are from the CDC, they have lots of information for Health care workers r/t needle sticks.

At my institution, nurses give the insulin injections (max). There have been 3 incidents in the past 5 years of nurses being stuck with needles at my workplace. 2 have been negative, the 3rd one is pending. One stick was with a hep c pt and an insulin needle, the nurse was giving the insulin, was rushing and didn't activate the safety device and stuck himself. 2nd case, nurse was starting an IV, missed, didn't activate the safety device, was rushing and stuck herself. This case was with a deep stick, moderate bore needle with HIV/Hep C positive pt and she came back negative.

A large part of needle sticks are due to people not activating the safety device. I am sure that rushing plays a role in it too. I would think you would be at higher risk giving the insulin injections to the inmates. Being up close to an inmate with a needle, I don't think you would be safer.

Again, I don't mean to minimize your concerns, just wanted to clarify the needle stick issue.

Yes, inmates could use the dirty needle as a weapon but, how often does an inmate use a dirty needle to harm a nurse? If an inmate really wanted to harm you, their inventive minds could make a weapon out of anything...parts from a door, sharpened end of toothbrush and the most common....writing pens (from staff, not the inmate pens). I do not trust the inmates either but their anger is generally not directed at medical staff. I have seen some of the most violent offenders be consistently cooperative with the medical.

I think the scenario you are concerned about has a very low level of being played out. However, if you are concerned about it, I would keep pushing until you get an answer as to why it is done this way.

[MadisonsMomRN]

Vegrn,

Yes... the "one stick and I am toast" is exaggerating it... but you get what I mean I hope. Its just scary. I do realize that the chances of an inmate sticking a nurse is low but there is always a chance. I have talked to other nurses there and they say they have never had anyone get hurt by an inmate like that which does make me feel better.

Yes I do know that disease can be contracted anywhere. I am new to corrections and would just like to know if this is considered common practice.

As far as the hep B vaccine... I have had two series of these vaccinations and my titers are negative. I am getting ready to have a 3rd series done and hopefully it will take. So, I am just praying this last time works because after this I don't believe I can get it again.

I have been told its all in how you approach the inmate. I know that some of the inmates will be really nasty to some nurses but nice to others. So far I haven't had any problems at all.

Where I am new to the insulin line I need to get a little faster because they get impatient. But they are understanding for the most part.

Thanks so much for your info... it did really help!

[Monica RN,BSN]

In our facility it is standard practice, that in the diabetic line the nurse hands one alcohol prep, one guauze square, one lancet to each I/M and they do their own finger stick and we watch that they dispose of the lancet in the sharps box. the nurse then draws up dosage of insulin ,and hands syringe to inmate.. they inject themselves, and dispose in sharps box. They also are required to remove their own strip from the meter after use. every syringe is then counted and recorded on every shift.

[akwesook]

I have only worked at county jail but it was the policy there that the inmate stick himself, dispose of the sharps into container and inject self. I for one feel safer that way because of the distance between me and them. I have experienced that the guards are (at times overly) protective of us and willing to use whatever force they feel appropriate