Originally Posted by elkpark
The MMPI has to be scored and interpreted by qualified, licensed psychologists, so it's not really a "screening" tool that a nurse could use. I'm a psych CNS and I've never worked in corrections, but I'm not aware of any "screening tool" for malingering and, as a staff RN, I would not be willing to take responsibility for making those kind of decisions ('way outside scope of practice). If it were me, I would just refer all those people to the mental health clinicians and let them make the call -- that's their job, not yours.
It seems like this would be much easier said than done, as there is usually a long wait to see Psych, at least where I have worked. And even Psych can't really read their minds. They can only form an impression, just like nurses or anyone else can. Just my
. I know it's their job and they are trained for it, I guess I just am cynical. I do agree that every inmate probably needs to see Psych to figure out how to make the remainder of their lives better than whatever brought them to jail.
For OP: You are not really having to be concerned with the behavior so much as with protecting your license, as someone stated. I know a lot of guards and nurses seem to think everyone is malingering unless they are bleeding, not breathing, febrile, seizing, or otherwise overtly ill. Some staff, including nurses, are very suspicious of every medical complaint and this makes me very angry and frustrated. Not everyone is faking it.
You are not a lab, you do not have x ray eyes. Yet, you are probably called upon to make decisions that not even an ER doc makes without labs, consults, imaging, and old records. It is not your job to decide if someone is faking illness. You should only do a good objective assessment - VS, bowel sounds, breath sounds, pulses, edema, PERRL or not, MAE or not, whatever is appropriate to the inmate's c/o. After that, treat by protocol is you have these at your disposal or refer to the appropriate place - MD, DDS, Psych, ER, wherever you deem appropriate after your righteous assessment.
Never compromise your license, never compromise your safety. I know it requires a lot of courage to not go along with the guards or your peers if they are urging you to say someone is malingering. Do not argue with them and make a bad name for yourself. Just express fear of losing your license if you were to wrongly brush aside a complaint and the patient suffers harm.
The ones urging you to brush someone aside are not going down with you when you face lawyers, judges, and the Board. They will not be paying your bills when you lose your job. You are a nurse, not a punishment tool of the guards.
Just don't ever say all of this to them. Just quietly, without condemning them, do your job. Does that make sense? I hope you don't run into this too often.
I know how hard it is to feel like you're an oddball, standing alone against a bunch of people wanting you to side with them. The truth will come out soon enough if all the labs, exams, etc. come back negative and then the inmate will be at their mercy and they can be about their business with him, without
you being compromised.
One tool you can use is to let them "ride the pine" for a good long while if you do suspect they are not being truthful. For anyone who doesn't know, that means they should sit on the bench in the hall and wait. And wait and wait and wait. It's not necessarily definitive but I have seen staff use this technique to invite those who are not inclined to wait change their minds about seeing the nurse that day. Maybe they have to get to work or will miss their meal, exercise, Canteen, the movie, clothing exchange, visitors, whatever if they wait too long. Sort of like Triage, the waiting room, and leaving AMA. Just check on the person often enough and thoroughly enough to be CERTAIN he is ok. Don't be cruel.
Once in a while, you might even ask someone directly if they are really having "10" level pain in their RLQ or are they needing to achieve some other goal. It probably won't get you anywhere but the inmate knows you're not a complete pushover. Try humor, too, gently.
Just treat them like the human beings they are, made in God's image, no matter what demonic stuff they are accused or convicted of having done.
The trick is to never argue with them. You don't want to make an accusation unnecessarily. Where would it get you if you did? Don't make enemies inside. You might need the inmates' help if something bad goes down.
Treat them kindly, as you would want to be treated and you will earn their respect, I think. Don't be mushy or improper in any way, keep that professional distance.
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