Basic Jail Nurse Questions

[OfficerRNBSN]

Hi. A little background: I am both a RN and a police officer with experience in both capacities albeit separately, lol. I've been hired recently to help rebuild a jail's infirmary after previous staff undertook in both illegal and unethical acts. I have hospital nursing experience, EMS experience, and more police experience than either of those put together. I am being hired with a desire by the agency to carry both my law enforcement and RN credentials into the jail (in this state jailers cannot charge inmates with crimes, are not trained to use or carry weapons of any type, etc. and relegated mostly to security but certified police officers have no restrictions).

So broad, detailed questions with anecdotes if I may...

I have been reading the ANA Correctional Nurse scope of practice statement, fyi.

1. In corrections, settings has anyone become intimately familiar with being both an officer and a nurse? For example, I may be called upon to transport specifically to healthcare settings outside the jail, help quell riots, and function in other aspects where armed officers are traditionally used. At times, I may have to use force against an inmate, that may or not be a "patient," or any other conceivable scenario a deputy might find himself in. So with this I ask about personal experiences and how that "goes" with state boards of nursing. As an aside, I will be carrying both nursing malpractice insurance as well as police officer's Liability Insurance so as not to rely solely on agency/county legal assistance and qualified immunity.

2. Where does HIPAA come into play in the corrections setting? In general law enforcement, personal health information is not private if entered into an incident or arrest report because LE reports are public record. In the corrections setting, how is (or is it) this information shareable with other jail officials? For example, telling jailers what disease/condition an inmate is in could be critical to security and safety as could be medication usage, etc.

3. Can anyone point me toward educational materials to both train myself and "modernize" our infirmary?

Thank you for the support.

[cchezem15]

Are you coming to work in our infirmary?!? Haha :) We are undergoing a transition to privatization (we were controlled by the county, now we are run by CHC).

[nurse2033, MSN, RN]

I am a Certified Forensic Nurse and corrections is part of that curriculum, although I have never worked corrections. I have learned a lot from "Essentials of Correctional Nursing" by Schoenly and Knox, I recommend it. The write that to be an effective nurse you must operate and be viewed by the inmates in the nursing role only. Correctional nurses should not be touching the inmates operationally, (except in self defense of course). If you are operating in both roles the inmates will never trust you fully as a nurse. They write that the nurse relationship must be therapeutic.

As for HIPAA they write that health information may be shared if it is in the patient's interest but can't be shared for other purposes. It's the basic "need to know" foundation of HIPAA. For example, for guards to know an inmate is diabetic would be for the inmate's health and safety. If an inmate had TB this would be another time that information could be shared, for the safety of all.

I think if you are operating in a dual role it may be problematic at times. I have had students who work corrections and they love the challenge, but by leaving enforcement to the officers, they have told me they can build a professional rapport with the inmates. Best of luck.

[tom7044]

As a Registered Nurse with over 20 years working in urban jail settings; mostly as an Intake Nurse or Intake Supervising Nurse with CCHP-RN certification you present a challenging and perplexing situation. The facilities I am familiar with and the law enforcement agencies operating then would hire you in one capacity or the other. I have worked with several nurses that were former police officers often times having more skill and experience than the custody staff we worked along side of and found it difficult not to intervene when they observed bad technique of poor compliance with acceptable standards and practices by sworn staff but had to adhere strictly to their job descriptions as Registered Nurses. I would suggest that you contact your State Board of Nursing and inquire of that agency about your dual role. Make sure that you have a specific job description that you , your medical director ad the ranking officer that is in charge of medical services all are in agreement and understand exactly what your role is. The National Commission on Correctional Health Care would be an excellent resource. Best of luck

[GrannyLpn2005, BSN, RN]

I agree you need to get with your State Board of Nursing. On the other hand I would think that if you are being hired as a nurse then that would you would be doing. You will have to separate your self from the Police Officer and remember that you are a nurse. I know in our jail when it comes to the HIPAA we are not allowed to give any information to anybody unless we have permission from the inmate. Now on the other hand when we have someone in our medical department cells and they have something going on that is contagious we have to put up a sign that says, "Universal Precautions" So that way the Officers know how to handle the inmate in our Medical Cells. Usually the inmates themselves open their mouths and tell on themselves.......so we don't have too! You will see things in the jail/prison that you won't like, especially when you think that person should be placed somewhere else in the jail or something goes down, like a fight or something gets said to you, you have to learn to keep quiet and let the Officer's handle it and not you! You have a challenge on your hands......Good Luck!

[OfficerRNBSN]

I agree you need to get with your State Board of Nursing. On the other hand I would think that if you are being hired as a nurse then that would you would be doing. You will have to separate your self from the Police Officer and remember that you are a nurse. I know in our jail when it comes to the HIPAA we are not allowed to give any information to anybody unless we have permission from the inmate. Now on the other hand when we have someone in our medical department cells and they have something going on that is contagious we have to put up a sign that says, "Universal Precautions" So that way the Officers know how to handle the inmate in our Medical Cells. Usually the inmates themselves open their mouths and tell on themselves.......so we don't have too! You will see things in the jail/prison that you won't like, especially when you think that person should be placed somewhere else in the jail or something goes down, like a fight or something gets said to you, you have to learn to keep quiet and let the Officer's handle it and not you! You have a challenge on your hands......Good Luck!

Thank you. I have an administrative, office job more than anything, and other than triaging inmates for doctor call my RN work is more akin to case management/follow up. My law enforcement role is about to evolve, and I'm already provided the same uniforms as the jail and patrol deputies so yeah it's a gray area, lol. The administration seems to embrace my wearing both hats, and because I am well versed in searching and restraint and am qualified with weapons I can transport inmates to specialty and dental appointments when the need arises. That really lets me clear my "to do" list, lol.

[xikan07]

As a Registered Nurse with over 20 years working in urban jail settings; mostly as an Intake Nurse or Intake Supervising Nurse with CCHP-RN certification you present a challenging and perplexing situation. The facilities I am familiar with and the law enforcement agencies operating then would hire you in one capacity or the other. I have worked with several nurses that were former police officers often times having more skill and experience than the custody staff we worked along side of and found it difficult not to intervene when they observed bad technique of poor compliance with acceptable standards and practices by sworn staff but had to adhere strictly to their job descriptions as Registered Nurses. I would suggest that you contact your State Board of Nursing and inquire of that agency about your dual role. Make sure that you have a specific job description that you , your medical director ad the ranking officer that is in charge of medical services all are in agreement and understand exactly what your role is. The National Commission on Correctional Health Care would be an excellent resource. Best of luck

Would you happen to have any advice for a new grad who is interviewing for a p103 rn position at the SF county jail?