Content That Monica RN,BSN Likes

Monica RN,BSN 5,925 Views

Joined: Jul 28, '03; Posts: 822 (3% Liked) ; Likes: 31

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  • Feb 17 '08

    "NancyKay" and "afteralltheseyears" , I agree with how you handle things. What does your policy and procedure manual say about this? I bet it backs you up.

    Monica, I disagree with you on this. Bending the rules for one inmate will generally cause an influx of inmates that want to bend rules for other things. Molehills WILL become mountains if the P&P isn't followed. I bet the inmate will get his butt to the med line next time if he wants his med. Yes, we as nurses are obligated to treat the inmates but the inmates are also obligated to follow policy and procedure if they want something from us. The very reason that the inmates are in prison is because they DID NOT follow policy and procedures on the outside. And allowing them to bend the rules is only enabling them to continue to be manipulative and not follow rules. This will not help them change their behavior and become productive members of society if/when they get out. Sorry but being late for med line "because the officer made them mad" is a very poor excuse.
    If I was in this situation I would have said this "I am sorry that you are angry however, you are in charge of your own behavior and you (not the officer) chose not to get in the med line at the set time. the policy states______________. I cannot give you your medication because you chose not to come at the set time. If you would like your medication in the future, you need to be in the med line at ________. If you have questions, I can give you a copy of the policy and if they ask for it, follow your institutions policy for giving an inmate of copy of a policy." And then have the officer take them away when they start whining and getting mad.

    Additionally, it is an antidepressant, the medication doesn't completely exit your system in the span of 24 hours. It takes awhile for it to build up and work and it takes awhile for it to exit your system.

    My response would have been different had it been a VERY important med or the inmate was late because of something verifiable and outside of their control. In this situation though, the excuse is crap and the inmate made their choice when they chose not to get into med line.

  • Oct 3 '07

    Quote from Monica RN,BSN
    wow.. I am a PHS nurse in Fla as well. My base is 21.00 as an RN with 20 yrs exp. I get 21.00 for 7-3, 22.00 for 3-11, and 23.00 for 11-7, and 24.00 for weekends

    where in fla are you? I am in Ocala
    Are you working at Lowell or the men's prison?

    That wage is low, especially considering your experience and the fact that they start off new grads at almost 20 just one county up.

  • Sep 29 '07

    Wow NancyKday, you are good!

    My tips for fake unconsciousness are.....sternal rub followed by nailbed pressure followed by opening eyes and blowing or touching q -tip. If they pass that, try an arm drop over their head. If the hand magically drops anywhere but their face, they are faking. If they are faking unconscious, they will always protect their face.

    Also, be very familiar with what "should" be there in a diagnosis. throw in things that shouldn't be there (for a positive dx) and see what kind of answer you get. Inmates often know what should be there but don't know what shouldn't be there.

    Again, nancykday, I am very impressed with your assessment tips AND also the way you handle the fakers.

  • Sep 28 '07

    Quote from estrogen
    No offense, I guess I have an idea why, but it sure seems like you guys are a pretty callaced (sp?) bunch. I have flirted with the idea to go into correctional nrsg, but reading all this makes me think ...nah, maybe not. I kind of want to keep my sense of compassion.

    I'm a med surg hospital nurse, dealing with my share of DT's druggies, drunks a jail birds, but I still can't help to feel sorry for them... Like taking care o these unwanted souls for some reason... Am I naive?
    In answer to your question, no offense, YES you are naive. I have worked in corrections for three and ahalf years...and I say this all the time...the stories that we correctional nurses could tell would fill volumes, but no one would believe them...except other correctional nurses. It is not that we are calloused, we just have developed an affinity for sorting throught the crap to get to the real problems. We are compassionate and caring when the situation calls for it. The simple truth is that there are fewer situations in corrections that call for it. Corrections is a calling. You either sink or swim. Love it or hate it. For those of us who choose to make it our specialty...we love it. We probably could never work in another setting...or would not want to. It is a very stressful job at times. Ninety percent of the time you are on your're making the decisions. But it is NEVER a dull, boring job! And it requires that a person be able to differentiate between a real medical need and a manipulative ploy by a dishonest inmate. I understand that people make mistakes, but you must keep in mind, these people are there because they broke the law...they are NOT honest, harmeless patients like the ones you see on a Med-Surg unit. It is that keen awareness to these facts that allows us to be good correctional nurses and to survive in such a setting. It is also the understanding of the lengths these inamtes will go to deceive you and being aware of those dangers that keeps us alert and safe and allows us to go home after our shift is over. So, like you, we take care of the unwanted souls, but most of them we do not feel sorry for. Most of them are there for a very good reason. However, we are still patient advocates. And it takes a very special nurse to be the advocate of a criminal.

  • Sep 24 '07

    I find the comments that a correctional nurse is found in such an environment or maybe LTC because they cannot find work anywhere else rather offensive. I've worked in both. I am not a bad nurse.

  • Sep 24 '07

    I agree with Texascowgirl regarding presenting yourself as a role model ect. And, although it may be an unpopular choice, a chat with your direct supervisor could be what's needed. From the information you have provided, this worker is creating a hostile work environment for you. I work in a state facility that treats the criminally mentally ill as well as individual's who are brought in (civil) as a danger to themselves or others. The job is rewarding and I love what I do, but if I were exposed to this work environment I would burn out quickly. These patients need nurses like you, not loose nurses like you. Good Luck and welcome to the field!

  • Sep 23 '07

    OUR booking fee is $122.00 Trustees, earn $2.00/$3.00 a day.

    We don't charge for medical, psych, and the dental is only extractions, no dentures, hearing aids, sex changes, heart transplants, etc.

    Good luck with you coworker...maybe her attitude is WHY there was a charge nurse postition open. I don't understand how she can collect welfare or any government benefits (other than social security benefits for the child, IF the child's father is deceased) if she is a RN.

    I don't think confrontation of her inappropriate comments would work, usually these people are too agressive--how about becoming busy when she starts talking? A change of offices?, hours? days off? requesting a transfer?

    Come to Los Angeles, we don't have that problem, (unless someone is complaining about me and I haven't picked up on it yet?)

    Let us know what happens!!

  • Sep 20 '07

    welcome to the world of correctional health, where, as much as i hate to admit it, you are likely to find, in any correctional facility, some unprofessional nurses....and it's one of the few areas where they can get away with being unprofessional.
    i am willing to bet that she feels insecure around you-she probably doesnt have a strong background in acute care facilities as you might.
    that has always been the problem with me-i have worked correctional health on and off, and have a strong ER and critical care background-i can get hired on at any Level I Trauma Center with my curriculum vitae.
    the reality is, that there are some nurses in correctional health that work there, not by choice, but because they cant work anywhere else, except maybe LTC facilities........
    i dont have any advice for you. i doubt you will be able to change things-if she's been there for a while, don't expect her to leave.
    just do your thing. continue working as the professional that you are, and set an example, be a role the long run, you will develop respect in the facility-respect from officers and inmates

  • Sep 20 '07

    I am not sure how to address your concerns re: your co worker. As far as her insistance that she is in charge when she is working, she is the more senior and experience correctional nurse. I not familiar with Fl DOC, but in my state, we are unionized and seniority takes precidents. Have you tried addressing your concerns to your supervisor. Maybe he/she can mediate a more functional work environment.
    As far as the copay, once again I cannot speak for Florida, but in our DOC this is a state legislative mandate that the i/m are to pay a co pay for access to certain health care services. There are more
    exclusions, that inclusions, but requests for urgent and/or nonemergent healthcare access does require a minimal health care charge. These were instituted by the legislature to attempt to decrease abuse of medical services. Although on the surface, it may appear that will deter i/m with minimal financial resorces from accessing healthcare; but in reality the i/m must decide between healthcare or commissary. I hate to sound cynical, but they already have 3 hots and a cot and are not financially responsible for anything else.
    I hope this experience will not sour your correctional career. You sound like a caring and compassionate individual and can be an asset to corrections.
    If you have any further questions, please do not hesitate to PM me.

  • Aug 30 '07

    Hello Tonya,

    Well congratulations on your prison nursing position! Correctional nursing does offer some unique challenges, but can also be somewhat frustrating at times. Here are a few tips that might help you through this.

    1. First and foremost, SAFETY is the most important aspect of your
    job. You need to be ever-vigilant of the population you are dealing with. No sweet elderly grandmothers here. You are dealing with drug addicts, rapists, and molesters now. The vast majority of the inmates you deal with will be very nice, charming and friendly, but you have to be careful. They teach us to treat each inmate as if they were someone waiting to stab you in the back the minute they got the chance. This is of course, not true, but it helps keep you aware of any potential danger.

    2. Try (and this can be difficult) to maintain a non-judgmental
    attitude about your patients. Look at them as human beings, deserving of dignity and respect. If you label them according to the crime they committed, it will make it much harder for you to provide quality care.

    3. Be careful not to disclose personal information about yourself.
    When inmates see a new face, they will try to find out things about you. "Are you married? Are you from here?" Only share with them things they need to know. Your personal life is none of their concern.

    4. USE YOUR NURSING SKILLS when assessing a patient. An inmate may
    come down saying he's (I'm assuming this is a men's facility) having a lot of pain and wants something for it. Don't trust him at his word. He could be a drug seeker. Use your skills as a nurse to see if he's really in pain. Is he pale, diaphoretic? Are his BP, respirations and heart rate elevated? Many times I've run into patients who have complained of pain, only to get a lay-in from work, or some extra medication. Rely on the inmates non-verbal skills to tell you if he is in pain. They'll tell you more than his words.

    5. Don't fall into the "giving trap" as we call it. You will find
    that inmates will test you in terms of what they can get from you. If a medication is scheduled for 0600 and they come down at 0630 wanting their medications because they slept in, refuse them and tell them to be at Medline on time. It seems harsh but they will know that they can't get away with things. If you give in easily, they may come down at 0640, then 0650, just to see how far they can push you. You need to maintain a "fair but tough" attitude with inmates. Don't worry, if you don't have this, you will learn to be. :-)

    6. Remember those silly little safety and precaution techniques you
    learned in nursing school? Well they can literally save your life here. Remember to glove up at all times, and WASH YOUR HANDS!!! Blood borne diseases are rampant in the prison population. Within our facility, 30% of the population has hepatitis. Many have STD's and many more are being treated for exposure to TB. The sad fact is that some inmates are willing to use bodily fluids as a weapon.

    7. If you do a Medline, you'll have to do a mouth check to make sure
    inmates don't cheek their meds. If they are on psychotropic medications
    like Seroquel, Paxil or Wellbutrin, they may try to cheek their medications so they can either crush and snort it, or sell it to another inmate. Don't be afraid to have an inmate lift up his tongue and pull his cheeks apart so you can check in between his cheeks and gums for medications. It's a lot less work than having to respond to an emergency if he tries to kill himself by overdosing on stocked up medications.

    8. When men are housed together, whether it be an army camp, summer
    camp or in a prison, levels of cortisol and testosterone will rise. This is a natural response and many men's bodies will revert to a pubescent stage, so expect to see a lot of acne, rashes, and a number of other skin conditions.

    I hope these pointers are helpful to you. You will find that Correctional nursing is never dull, never the same, and you will see things behind those walls that you've never seen before! Please keep me updated on your
    experiences. I'd love to hear how well it works out for you. Best of
    luck, Tonya and if I can be of any more help, please don't hesitate to ask!


    George a.k.a. PrisonrNurs

  • Aug 28 '07

    About six years ago we did care plans at my facility before going to COI charting. Not that difficult. Just remember your ADPIE and you'll be great. When they first come in on intake (e.g.), "knowledge deficit r/t new facility" then list interventions: "oral and written orientation provided to (name of facility) medical department. verbal understanding noted. continue to monitor per policy and as needed." Say they get a superficial abrasion from fighting another inmate. This gives you too great nsg dg. First "anxiety r/t altercation with another inmate" interventions "offer comfort measures, monitor vital signs, refer to mental health, follow up as needed" Then reassess for your evaluation of care. Second "risk for infection secondary to skin breakdown" interventions "instructed on keeping area as clean as possible using soap and water to area and will provide triple antibiotic ointment twice daily times three days per nursing guidelines for increase infection control, healing. Inmate verbalizes understanding of self care. To return to medical with and futher problem." All this seems basic and straight to the point, but that's the style you need to have in correctional nursing. It's actually harder than critical care because you have to learn to be basic with your approach which goes against what a lot of us are used to doing in the "customer care" approach at hospitals. Also, your facility may be advanced in it's practice and have handy little worksheets already mapped out for you to use during assessments instead of having to do narrative charting. May not hurt to suggest this to your supervisor if it will help you all in the medical department. Hope this helps!

  • Aug 27 '07

    It's great you have lots of experience as a floor nurse because you need excellent assessment skills. The nurses I have seen have trouble in corrections, are those with limited physical assessment experience such as those coming out of an exclusively psych background. Your assessment skills are essential to walk the fine line between providing quality health care (very important, since you are the only access to health care these people have), and not being taken advantage of. I have seen nurses get fooled too much by fakers, and the prison staff lose respect for them and become uncooperative, which can make the job impossible. I have also seen nurses assume 'every' inmate is faking without the assessment to back it up, which leads to poor health care and liability. The faking can be pretty amazing: I've had a patient before who would sharpen a fingernail and pick his nose deeply with it, swallow the blood down the back of his throat until he had a belly full, and then make a big show of vomitting blood in front of the staff (all for the amusement of a ride to the hospital). More common stuff, especially in the booking area, is hyperventilating until unconscious or simply going limp and unresponsive (that's what ammonia inhalants are for). So, you have to have enough assessment confidence separate fact from fiction accurately.
    Do not trust but respect: the USA incarcerates a relatively large percentage of their population for a variety of reasons. They are not all scum and should not be condescended to or treated badly. If you cannot maintain you 'unconditional positive regard' for patients in this setting, do them a favor and get a job elsewhere. It would certainly be scary to be required to entrust your healthcare exclusively to a prison healthcare outfit, so some of the attitude you might get at 1st is understandable. If you show yourself to be competent (NOT generous, just competent), you will wind up having a good rep with the inmates and hence a good working relationship. Get too generous or friendly, and the requests will never end.
    Call the custody staff 'Officer', not 'Guard'. Same as inmates, you need to walk a line with them between cooperating with them but not allowing yourself to get pushed around. Appear to defer to them and respect them, be friendly when appropriate, and don't get a rep with them for being too soft on inmates. But certain ones won't want to be bothered to do their job when it comes to the nurses, and will try to intimidate you out of seeing patients. Be assertive, never passive or nasty/aggressive.
    In other words, Officers or Inmates: you won't be able to do your job if you are too nice OR to rude to either group. And if you ever catch yourself thinking romantically about anyone from either group, hit yourself over the head with a two-by-four a few times.

  • Aug 27 '07

    that was the shift i was on. was head nurse (RN) of a 1200 male offender prison. it was just me and the LVN. the LVN spent the whole nite setting up morning med pass.

    i did chart reviews, did all post altercation physicals, did all seg physicals (offenders who bought themselves a administrative segregation cell e.g. solitary confinement), responded to medical codes, did seg rounds, picked up sick call slips in all cell blocks for the day shift, reviewed them, sorted them, pulled charts and set them up for the day shift. i did diabetic clinic in the morning-accuchecks and insulin administration for diabetic inmates (small portion of inmates, so it wasnt bad), and did post-exposure cell checks...e.g. after gassings, to ensure inmates werent in respiratory distress after the OC/CS was fired. (yes had my own gas mask lol), and i did some paperwork e.g. working on my chronic disease clinic that i was assigned to.
    i know it sounds like alot but it was pretty laid back and boring and slow, unless there was a riot and/or gassing involving a whole house, or cell extraction etc.....
    congrats on your job! i know you will love it!

  • Aug 24 '07

    I believe this is one I took free a few years nursing spectrum charges for it but it would be worth it.....really, really good stuff. Like why correctional nursing is the only specialty specifically governed by an ammendment to the constitution of the US and why.

    Here ya go......

  • Aug 23 '07

    I just finished taking the correctional certification program. I enjoyed it very much. Dr. Dutcher is quick on replying to e-mails, and is also good about phoning if you need him to. There is a research paper due at the end, but that was fun to write. It was suppose to be 1800 words, but I had almost 3000. Probably could have written a book once I got started! The only draw back, and it's minor, is that it takes the college a long time to send the certificate so that I can get reembursed from my prison. I finished the course the middle of July, and I'm still waiting. The college states that they send a very professional certificate so that's the hold up. Would definitely recommend this course!