changing gears at 46 to County Jail?

jailDON · May 12, 2004

update: I did get that job at the county jail. I can definately manage the medical dept. Not to sure about the office politics though.

Office politics....that's where I get trapped sometimes. It seems like whenever security gets in trouble they try to blame a nurse. Probably because we are contracted and are not one of them.

Anyway, I love corrections. I work in a county jail. Are you going to be the manager?

nurseT · May 15, 2004

Well I've had my first week at work at the county jail. Wow, I guess I'm it! It's just me, managing the medical dept. I found out what "The Blue Line" is Friday. The sheriff wants me to protect him from litigation, "after all, it all falls in his lap", the Commander wants me to protect him because "it will all fall on him when it's done" and the Dr. wants me to protect him because "it's his license on the line". Do I think they all forgot one little bitty thing? Ah Yeah! The only reason there is medical at all is because they have to have it, otherwise they could care less, or so it seems. The commander let me know that if someone was fakeing a heart attack I should come in and check them out before sending out. Well I live a long way from the jail. I wanted to ask if he were having CP, would he want to wait until I got there to see if it was real or memorex, but I just sat there absorbing and observing. I'm on call 24/7, and onsite 40hrs/wk, 200 IMs. Well that's the politics that really honk me off. I'm really feeling alone. The nursing will be the easy part. But When I first met the DR., he says "I don't want to work, I want you to be a sponge or a brick wall, I don't want to see more than 5 IM when I'm here. I have signed order blanks. Just fill them out when you need a script,I'll review them if you want me to, but that's the way I prefer it". That's not legal. And there's tons of old meds that the prior nurse just kept in case she wanted to give it to another IM who might need it. I can see there's alot of changes to be made. First thing is send all those meds back to pharmacy to get reimbursed. Then have a talk with the Dr. about getting some actual "standing orders" and on and on. It's a mess, I'm sure they'll all hate me when they find out I'm neat and tidy and not willing to put my own license on the line. My husband said I could quit if I want but I want to give this a chance. What do you all think? Thanks

jailDON · May 15, 2004

Ouch!! Your place of employment sounds like it is totally out in left feild. Your starting place should be NCCHC. Do you have a copy of the standards? Once you understand the standards and begin to follow them everything falls into place. Start with the mandatory standards. Use them as your guidelines, not all those other people. And if the standards are being followed it will protect everybody from being sued. You have your license to protect. We have our doctor seeing 50 patients/day!! not 5, that's a joke. It sounds like you don't have 24/7 nursing coverage. That's a little scary because jail inmates are less stable than prison inmates. I am on call 24/7 also but have nursing coverage around the clock. In the case of chest pain, I would check him out if I were present but if I wasn't I would just tell them to send him to the ER. Medical autonomy is a standard. Don't budge when it comes to doing the right thing. Feel free to ask more questions.

nurseT · May 17, 2004

Thanks for your advice. I don't think I have a copy of any standards. I did ask about a large notebook that stated Correctional Healthcare, but was told " oh we don,t really use that, that's geared more for DOC. We do hold for DOC but medical is more like a bandaid station.What is the specific name of the standards you're referring to. I definatley would like to look at that. I've got alot of reading to do.

jailDON · May 18, 2004

National Commission for Correctional Healthcare (NCCHC)

American Correctional Association (ACA)

ACA encompasses medical standards along with security and the medical section is very similar to the NCCHC standards.

I would get a copy of the NCCHC standards if I were you. There's a different one for jails and prisons so be sure to specify when you order a copy. Try their website.

smk1, LPN · May 18, 2004

hey keep us updated this is a really interesting topic!

nurseT · May 19, 2004

update: I asked the Dr. today if I could type up some standard orders for the routine stuff, he says " sure feel free". I had him on the phone cause he doesn't even come in unless there is an IM to see. I've been treating them on my own, but I did have to call him for a persistant skin infection that has been resistant to keflex x3 repeat therapies that were documented in the record. Sheesh, I'm not a doctor. Thanks for the info on standards. I plan on looking that up soon. What kinds of standard orders do you have? :uhoh3:

jailDON · May 19, 2004

We have nursing assessment protocols so that we can treat simple things without a telephone order. These include: colds, allergies, athlete's foot, withdrawal, rashes, etc. If the person has seen the nurse twice with no improvement, a doctor's appointment is required.

There is a NCCHC standard that addresses how often you hold regularly scheduled sick call depending on the number of inmates you have. I don't have it right in front of me but I can post it later.

Are you getting your intake screenings, physicals (by the 14th day for jails and 7th day for prisons) and chronic care clinics done? If not that would be a place to start as well as holding sick call.

jailDON · May 19, 2004

Another idea: Instead of reinventing the wheel, why not borrow nurse protocols from another facility and have your doctor sign off on them?

:rolleyes:

nurseT · May 22, 2004

No, when the nurse who was leaving oriented me she said the inmates are entitled to a physicial from the doctor after 14 days if they want one. All they have to do is ask. It is written in the inmate handbook that way. Most of the inmates aren't there long enough for that. The initial bookin process has select medical questions incorporated into it that is labeled medical screen. If the inmate denies having any health problems then there is no reason to seek out the inmate for medical. Every am when I go in I take all the previous evenings medical screens from new arrests and review them. If the inmate indicates a health problem or need for medications, I first see when they go to court.If they are going to court that day then I set the screen aside and wait for the outcome of court. The inmate may get released. If they will be staying I go from there. If there is a pressing need such as a serious medical condition then I put them on my list of inmates to see that day. I then review all the medical request forms, most of which are repeat drug seekers " I'm nervous and can't sleep, get me something to help me with my nerves before something dumb happens". I write back, "It's normal to be nervous and unable to sleep in a stressful situation such as being in jail, and our Dr. says he will not prescribe meds for a normal condition". Then I show it to the commander who writes," If something dumb happens" we can take care of that". I put the legitimate requests on the list to see them and then prioritize.I conduct sick call daily. Some days there is nothing so no sick call. If I can't take care of the problem I will place them on sick call for the Dr. We do not have a chronic care anything. If we have a pregnant female that looks high risk the county tries to get the female released or transferred to another agency (DOC) who can provide the medical tx needed. We are really a bandaid station. Probably 90% of the population is young and healthy and never turn in a medical request before they are released. If they are on hold for DOC they will first be transported to RDC which holds the inmate for 2wks and does a thorough medical assessment befor going to DOC. I will call some of the surrounding co jail nurses and ask if they have a nursing protocols I can borrow, that's a good idea. Thanks

cindyrn1 · May 22, 2004

First of all let me tell you, you have a great job with much potential. Second of all, you seem to be doing a terrific job making this job work for you. I have been a psych nurse for 14 years and have done every area of psych to include Forensics but Correctional nursing is so different. I am new to the field like you and YES there is political issues as well as your own nursing issues that you run into everyday. I learned a few valuable lessons the first few weeks I was at my job in the prison and these lessons helped me know what I need to do versus what they tell me to do. We are nurses FIRST. Our license is on the line no matter what we do. We are responsible for the assessments and directing those that need it to the doctor, hospital or whatever. It's hard having an officer tell you that a particular IM doesn't need any help when you know they do. My psychiatrist told me one day that no matter what other people tell you to do or ask you to do, always know that YOUR assessment of the situation is what counts. When you get those orders for that IM, it's your name on the order along with your physicians. I learned really quick that just because a social worker tells me that an IM's meds need to be changed doesn't mean that is what I do. I do all my own assessments and go from there. We have another big job and that is determining who is actually needing our services versus just pulling our leg. You will learn that part of correctional nursing as you go along. I work soley with women in a Women's Maximum Security Prison. Women are so notorious for trying to get what they want when they want it. You can do this job, just tell yourself that you are the nurse and what you do is based on your excellent judgement, insight and knowledge. One thing to remember, we can't change the system all the time but we can sure try to make it better. I do know that YOUR assessment of that IM makes a huge impact on what we do with them when they get to prison. I will leave you with this one scenerio we ran into with a county jail: an IM was having severe headaches etc. Tylenol was given in jail. This helped a little but IM was still very sick. It was time to ship to prison system and IM still was having some severe complaints. We get the IM and after a few days, symptoms she was having in the jail worsened. There was very little information regarding the problems i the jail and she ended up in ICU at a hospital for a very serious life threatening illness. Your job is very important for the prison system. You are the first step in making sure that our prisoners receive the medical attention they need before coming to the BIG house. This particular prisoner should have never come to the Prison system as she needed to be hospitalized first. She could have infected hundreds of other IM's and we would have had a real epidemic on our hands. You have an important job and just know that if you ever need to talk about what you are doing or have any questions you can always write me and I will try to help you out. I love what I do and hope to stay in this area of nursing until I retire. Congratulations on getting your new job and hang in there. They need you and you can make things happen around there. Correctional nursing is not like hospital nursing. You are your own boss and you have a lot of responsibility that goes with that. Take advantage of your new career field, learn all that you can and do what you know best.......take care of those that need your help. Good luck to you!

:balloons:

nurseT · May 22, 2004

to cindyrn1: Thank you for the information and encouragement. I really appreciate any advice I can get. I know what an inmate needs are after assessment and what needs to be done. It's looking like I won't be able to do everything I would like to do for an inmates healthcare do to the politics. If I am notified that an inmate is going to DOC I gather all the information I can and the medications and send with transport officer. I will even call the nurse and give some report so they've got something to start with. However, the CO's could care less about medical. I was aware of an inmate scheduled transfer on the weekend and left all his medical and meds in a bag for the officers. When I came in the next morning, there it sat on the table in the exam room where I left it. They just go " oh, oops". I'm not sure about the headache story details. But all of our new inmates C/O HA unrelieved by tylenol and insist they get oxycontin or TYL#3. Unless they start showing neuro S/S, nothing more is done. We had an inmate who fell on the floor clutching his chest, drooling out the side of his mouth, the whole ball of wax on a holliday with no nurse present. Co's sent inmate to ER. Inmate must have done the same thing to the ER staff too cause they ran all sorts of tests including a cardiac cath and all tests came back negative. His bill was around 7,000.00. The county has a fit over that kind of stuff and the inmate was given MSO4 at ER, the standard for CP, which is exactly what he wanted, IV to boot! So what can ya do? :uhoh3: