Attention Prison Nurses!!!

smurfynursey · Mar 18, 2011

I worked one night at a prison (that was enough...long story) and the guards brought IMs to me for FSBS and insulin. Not sure if that helps, but good luck.

NPvampire, MSN, RN, APRN · Mar 18, 2011

I've worked psych forensics before and although we weren't "separated" from the inmates as a law-run prison is, we checked their blood glucose anywhere from once per day to ac/hs/3am depending on the type of diabetes and the severity. We would do the accucheck and administer the insulin, never let them self-administer. We typically don't line them up at all because it causes problems...the techs have a list and call them one at a time in the same order every pass.

~Transplant Nurse~ · Mar 18, 2011

Interesting. The assignment was to come up with a proposal that would outline a program that incorporated telemedicine in diabetic prisoners. I just don't see how this would work without giving inmates access to needles or lancets. :confused:

reddellrn · Mar 18, 2011

I worked in a prison for 2 whole months. Yes the diabetics come to the infirmary before supper time and they check their own bs. We draw up the insulin and the inmate administers it theirselves. We also gave their po meds at this time.

~Transplant Nurse~ · Mar 18, 2011

Sounds like nobody likes the prison nurse job! Thanks for the responses. One more question, and this may be a dumb one. Is there always a physician present in prisons? I'm guessing not. Also, would you have to write the BG's down, or did you have a glucometer that uploaded them to some computer system?

Silverdragon102, BSN · Mar 18, 2011

Moved to the Correctional Nursing forum

psysn · Mar 18, 2011

I work at a medium security prison, and the diabetes line runs about as you said. Sometime between 4 and 5am they call the line to come to healthcare, and again around 5pm. Those who need more frequent checks get passes to come over. They do their own check, most of them give themselves their own insulin (we draw it up and make sure the needles go in the sharps box, every needle is accounted for). No computerized charting, so everything is hand written, often in more than one place.

We have a physician there four days a week and he's always on call. We also have a nurse practitioner and dentist there four days a week. There is a provider on site every weekday except major holidays.

This is my first job as a nurse, and except for the commute, I absolutely love it. There are frustrating moments but you'll get those anywhere. You might try checking with the American Correctional Association to see if they have guidelines; we use a lot of state directives that might not be available online but your state department of corrections might have something you can reference.

everthesame, LPN, LVN · Mar 19, 2011

We check BGs BID for inmates on 70/30 insulin and TID for inmates on Lantus. Our insulin lines are at 5:30AM and 4PM...approx 30-60 minutes before breakfast or dinner. The IMs who are on Lantus come to the infirmary on their way to lunch at approx 11AM. The IM's do their own fingersticks, but the nurse draws up and gives the insulin. There have been instances where IMs have shot part or all of their insulin out onto the floor before sticking themselves. The nurse giving the insulin ensures the IM gets the entire dose.

If a diabetic IM does not take insulin but is on oral hypoglycemics, they only have their BGs checked BID one or two days per week.

We have protocols which allow us to check BGs prn and how to manage high or low BGs. Our doc is on site M-F 7a-3p and is always on call for emergencies. In case of an emergency and the MD does not call back within 15 minutes (rarely happens) the RN can make the decision to send out to the hospital.

We document BGs in the EMR. The IMs are not allowed to keep lancets or insulin syringes and we constantly monitor our "sharps" during insulin lines.

We also oversee a work release program connected to our prison. We issue a week's worth of lancets and insulin syringes to the work release offenders. They are also given a glucometer and test strips. The diabetic supplies are kept locked up at the officer's desk and the offender must ask the officer to get the supplies when they need them. A work release site might benefit from a telehealth set up. They do not usually have 24/7 medical on site.

I like my job but I don't really love it. The job itself is okay but I am looking to get back to my roots in OB nursing. In this job market, openings are few and far between. I have the luxury of having a good job that I do like and not have to go to a job I hate every day while I try to find another job. So far, my worst day working in corrections is still better than an average day on a certain med surg unit where I used to work.

~Transplant Nurse~ · Mar 19, 2011

Thank you for taking the time to respond :loveya: The posts were VERY helpful!!!

Multicollinearity, BSN, RN · Mar 19, 2011

This sounds like an assignment created by a nursing instructor who has never worked in a prison, maybe? Inmate patients receive FSBG checks and insulin in person, and under observation/performed by the on-site prison nurse. They cannot have access to lancets/needles on their own due to security concerns.

Each prison has an MD or other healthcare provider who is there daily, or at a minimum, weekly. These MDs or other healthcare providers are on-call for emergencies such as high blood glucose emergencies. Also, correctional RNs have set protocols/standing orders to follow automatically, such as when to give D50 or glucagon, under their own discretion.

The only telemedicine application I can see with inmates who are diabetic is endocrinologist consults done via telemedicine - if an inmate cannot be managed or is too complex for the MD on site at the prison. This would be an unusual instance, and good luck finding an endocrinologist who will agree to see an inmate patient and tx without performing a physical exam.

porthos · Mar 21, 2011

I have worked as a nurse for the Department of Corrections for 4 years. I can honestly say I absolutely love my job. I work at a level 5 institution and we currently have 27 insulin dependant diabetics. They come to medical bid @ 0500 and 1600. The nurse runs the diabetic line pretty much they way she wants. I prefer alphabetical order so no inmate is overlooked. Frequently u may have to go on the compound to get on that didn't show up due to their sugar being low and being disoriented. The inmate does his own finger stick but the nurse always draws and injects insulin with a retractable safety syringe. Yes inmates will squirt out some of the insulin and not get appropriate dose. Although the. Issue is more a security rick. These are rapists, child molesters, and murders some of which are HIV+. It wouldn't be wise to hand them a deadly weapon! Staff safety first always!! Being a prison nurse is always exciting and u never know what's coming through ur door . The best is when u get that call on the radio" We need medical now!".