Advice on conducting nursing sick call

crjnursewarrior · Mar 31, 2006

ninjanurse,

Basically you are going to conduct your assessment on an inmate in the same manner you would on any pt. You will have a few variations on this theme, however. For example, you will most likely have a correctional officer present at all times. Occasionally, (not usually during nurse sick call) your pt. may be in hand cuffs (hard restraints) or a restraint chair(4-point restraints with soft restraints to ankles/wrists). So, you must always make sure your officer is the same gender as your pt. if you need them to undress for the assessment. You must never take anything the inmate says at face value. Always remember to do a thorough assessment and look for symptoms of a particular complaint. 95% of what these inmates tell you is untrue and as for the 5% that is legitimate--that's your job to weed through the bologna and find the pts. who really are sick. Remember that these people are not there for medical treatment(unless,of course, it is a correctional medical facility). They are there for punishment, therefore, look at the odds. Think about how many people in the outside population get sick with the ailment they are claiming they have (example: c/o CP "I think I'm havin' a heart attack"). Sometimes you get 10 or 15 c/o CP a week...how many actual MIs do you see in an ER in a week? But, as I said, there are sick people there, and it is your job to treat, so you must hone your assessment skills. Don't ASK them about their symptoms...LOOK for them first, then ask questions if you think there might really be something there. Don't give them ideas of what to tell you. They are quite manipulative in this way. You always have an obligation to examine, assess, treat as necessary. You don't want to ever not check something out because that inmate that cries wolf all the time could actually need treatment at some time. Some people feel like correctional nurses are not skilled or they are not challenged in their job. This is not true. Correctional nursing takes excellent assessment skills and knowledge of disease processes. You will see alot of Hepatitis, HIV, drug abuse related symptoms and diseases. Then you get your typical colds,flus, allergies, need to see the dentist...again, alot of it is run-of-the mill. Then you get trauma, responding to emergencies like fights, attempted suicides. It is never dull, never the same thing from one day to the next.

Best wishes in your endeavor...if you have any other questions feel free to ask! Hope this helps!:wink2:

Shell3 · Apr 4, 2006

I couldn't have said it better. Although, in our sick call we have one officer in the building, and he stands by only if called. (Medium security facility) It may differ from state to state and the type of facility you work in. Everything else is right on the money.

1ninjanurse · Apr 5, 2006

Thanks so much for the advice. I feel so much better knowing there is someone out there who really care & takes the time and effort to validate my efforts & feelings! Again, thanks to both of you!

HEDNURSE · Apr 5, 2006

Our Counterpart Has Pretty Much Covered The Bases. But, The Most Important Thing Is Consistancy. If You Are Going To " Give Up The House" To One Then You Must Do For All. If You Are Going To Be Shrewder Be Shrewder Throughout Your "bid". These Guys Have Nothing Better To Do Than To Attempt To Get Over On You. All Day All Night How Can "i",they, Get Something Out Of You, Over You, And On You. Assessment Skills Are Extremely Important!!! The Ability To Weed Out Is A Skill Of Your Fine Tuned Assessment Skills. The Three Most Common Problems Other Than Psyche Are Back, Chest Pains, Fungus. These Are Also The Three Things That The Inmate Can Take Care Of Himself, Most Times. Thre Are The Occasional Mva Gsw That Impair The Quality Of Life Issues. But Develop A Consistant Regiman In Your Delivery And Do Not Be Wishy Washy Or Else You Will End Up Burning Out! And Most Of All Don't Get Sucked In By Some Drama Story !! Seen To Many Of Our Counterparts Walked For Dumb Crap That You Would Not Do For A Patient In The Real World Let Alone In Bizarro Land! Good Luck And Be Consistant!

Aurora · Apr 9, 2006

It's all very well to advise "be consistent"; however inmates generally have limited intelligence, despite their manipulative prowess. Therefore, many times, do not understand why one patient is treated/medicated differently than another. Specifically, they don't always get it that a nurse knows one is genuinely ill and the other is trying to mimic symptoms. Then they think they have been treated unequally and unfairly. So consistency yes, but apply with professional integrity.

Ion · May 22, 2006

Boundaries, Boundaries and Boundaries.

Be empathetic, not sympathetic.

Trust your assessment and your objective data.

HOOSIERNW · May 24, 2006

Bizarro land......excelltent definition of correctional nursing.

nurseT · May 26, 2006

Assessment skills need to be top notch. This is one of those nursing jobs where you will be using your brain more than your hands. You are on your own and need to know what your talking about. The inmates will insult you everytime they don't get their way with you. If they like you, you may have broken a rule. I had one inmate complain his contacts hurt his eyes and he thought he might even have an eye infection from them. When i said " So take them out of your eyes" he threw the biggest fit you've ever seen, got real loud and says "what kind of stupid nurse are you". The officers present planted the guys face in the floor. I just walked away. He didn't really need me. At the other end of the spectrum. I had a young hispanic who was having repetative seizures. I sent him to the ER. Turns out he had a parasite in his brain. It was caused by eating raw pork. I can't remember what it's called, but I had to set him up with an infectious disease doctor for treatment. He was non english speaking, an illegal alien. Sad case. I did get a hispanic trustee to interpret for me. Most of the time the complaints are easy stuf, like common colds, common rashes etc. Most of these inmates haven't got a clue about normal body functions. The women always think they have an infection or "must be having a miscarriage cause this period is really bad". Be safe.

Orca, ADN, ASN, RN · Jun 6, 2006

Look for inconsistencies between what you observe and what the inmate tells you. Inmates will seldom admit to being assaulted, instead saying things like, "I fell off my bunk", "I ran into a door". etc. Two black eyes is inconsistent with running into a door, as are scrapes and even a shoeprint on the back (which I have seen twice). You generally don't fracture both collarbones falling off a lower bunk either (although I did witness an inmate snapping an ankle jumping down off a top bunk once). Knowing whether an inmate has a psychiatric history helps as well, as a psych inmate may totally fabricate symptoms just to get attention or to get out of the cell (non-psych inmates do this as well).

Some inmates believe that they will get narcotics if they make the symptoms convincing and severe enough, or maybe even an ambulance ride to the hospital. One of the most important things is to be able to tell when you are being suckered, and this comes with experience. Probably the most overused phrase in prison is "chest pains", used for everything from an MI to gas bubbles. Some even mistake muscular pain in the rib cage from overexertion for chest pain. If it goes away with Maalox, it ain't a heart attack. I have even had inmates insist that they were having an MI, with normal vitals, sats and EKGs.

Some inmates become very practiced as to what symptoms to claim that they have, but if they're breathing normally, talking and smiling, it isn't crushing chest pain. If an inmate claims that he "can't breathe" (probably the second most overused phrase in prison) and his 02 sat is 99%, he isn't exactly suffocating. Faking seizures is another jailhouse favorite.

If you are in a facility where there isn't a lot of transient movement, you will get to know who the game players are and who you had better listen to if they complain. One night on my pill call rounds in the housing units, an inmate who never complained of anything came to me and said that he was having trouble breathing. I cut off my pill call and took him back to the infirmary on the medical cart. His O2 sat was 62%. We shipped him out to the hospital within 30 minutes. Had I told him to fill out a kite (request for treatment) and to see the doctor in the morning (as some of my colleagues might have done), he would likely have died during the night. Trust your instincts. If you get had, you get had, but at least no one can accuse you of doing too little.

nurse1972 · Jun 7, 2006

Some of our Correctional Officers have adopted a policy of telling the inmates in the bullpen before they come in the dispencery that if anyone is having "chest pain" or "trouble breathing" they automatically will get a 7 days bedrest order from the nurse. They don't like that idea because they can't go to the recreation hall or out to the courtyard. That usually weeds out some of the fakers.