coworkers who never say no

  1. How do you deal with coworker nurses who don't say no when inmates attempt to bypass the established practices/rules?--example, an inmate cames to med window asking for a med approximately an hour after designated med pass time. When asked why they didn't come to Med Pass to get them responds with "The officer there at the time made me mad so I didn't wait in line". Myself, I would have told this inmate they should have made the choice to wait in line for the med like everyone else and I would refuse to give the med at the later time. A couple of my coworkers present at the time said "aw, just give the med". It was an antidepressant. The med was given by another nurse. Another example is inmates who request to be seen by a nurse (through the officer who then calls the medical dept) for nonemergent conditions. At my earlier place of work I would tell the officer to tell the IM they need to put in a "kite" to request to be seen at Nurse Sick Call for such a complaint like everyone else does but many of my coworkers let the inmate come to medical to be checked at that time. Usually it's for a complaint such as a stuffy nose. I came from another state's prison system and was conditioned to be tougher than what some of my new coworkers seem to be. Anyone else dealt with such a situation and how did you handle it?
  2. Visit afteralltheseyears profile page

    About afteralltheseyears

    Joined: Sep '07; Posts: 45; Likes: 9

    12 Comments

  3. by   Monica RN,BSN
    This is a very good thread. Personally, I give the med.. even if he is an hour late, we pre -set up our med cups, so it is no big problem what-so-ever to hand the I/M his pill cup and a cup of water. Don't make mountains out of mole hills. I do not think it is a big deal at all. would rather see the I/M be medicated a little late, then not at all. We as nurses are obligated by our state nursing laws to ensure the I/M get proper health care. Refusing to medicate because said inmate was late, could result in a detrimental effect, depending on the drug.. (Motrin, tylenol.. well that is certainly not a life altering issue if missed) but what if it were antipsychotics, antibiotics, hyperglycemic meds, seizure meds.. and the list goes on and on......sometimes it is not the I/M fault if late. I have seen many times that the I/M did not show on time simply because there were no available officers to transport to the infirmary at that time.. there are variables that will most certainly occur. If it is a matter of bad timing.. (ie: inmate has to get and be transported with c/o to medical at 6 or 7 am.. perhaps changing the time to say, 9 am would be more practical.Also take in consideration when your C/O's change shifts. In my facility they work 6a-6p and then next shift is 6p - 6a. This does affect sometimes limitations of transporters, especially when the c/o's are getting their briefing, and doing head counts at the beginning of their shift.
    Just my 0.02 thought for the day
  4. by   JailRN
    I try not to get into a #%@@&^# contest with the IM. I also follow the policy of the institution. If it's a short while, or they have a decent reason, I'll give it.
    What I hear a lot is, "well, the OTHER nurse gives it to me". I smile sweetly and say, "well, then you better hope the 'other' nurse comes back soon, because I can't do that."
    They quickly figure out which nurses they can 'play' and which they can't.
  5. by   nancykday
    I follow the policies and procedures of the institution. Yes I know that not all nurses do, for whatever reason, I am unsure. either ignorance of P&P, complancies, not wanting to be the bad person ect.
    It does make it difficult at time for the nurses that do follow P&P. the rule are the rule in a prison, i enforce them. after all the i/m are there for an inability to follow rules.
    It is an i/m job to try and get around the rules, but that is their choice. They also love to pit staff against each other. When the i/m tells me that all the other nurses do this or that, I usually reply I'm not the other nurses. I'm me.
    If you choose to reopen med line for one, you must be willing to reopen for all, b/c the 1st time you don't that i/m can file a grievance against you, and if you veered off the P&P, you don't have a leg to stand on.
    Also by giving a med not at the prescibed time, you are technially committing a med error.
  6. by   VegRN
    "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.
    Last edit by VegRN on Oct 9, '07
  7. by   Monica RN,BSN
    Thank u for your response for your point of view on this topic. We do have a problem in our jail in which the officers usually are the reason the IM does not show up on time, due to inability for officer to transport for a number of reaoms.
    Goos post and comments ..thanks
  8. by   BSNinTX
    Actually, it is a very big deal. Once you start letting the inmate get away with being an hour late to med line - which is, by the way, a required programming assignment and should receive an incident report for missing - he will start to see what else he can get away with. Maybe tomorrow he'll wander in two hours late, or come to sick call whenever he wants. Over time, you'll find that he comes and goes when he pleases and does what he wants.

    The devil is in the details. When you let small things go, the big things are sure to follow. In addition, the inmate figures out real quick who he can manipulate and subvert.

    If you are having trouble on a regular basis with custody getting inmates to you, the nurse manager or health services administrator needs to sit down with the custody supervisor/warden/etc. to work those issues out. Making accomodations for individual inmates is not the right way to go.

    Quote from Monica RN,BSN
    This is a very good thread. Personally, I give the med.. even if he is an hour late, we pre -set up our med cups, so it is no big problem what-so-ever to hand the I/M his pill cup and a cup of water. Don't make mountains out of mole hills. I do not think it is a big deal at all. would rather see the I/M be medicated a little late, then not at all. We as nurses are obligated by our state nursing laws to ensure the I/M get proper health care. Refusing to medicate because said inmate was late, could result in a detrimental effect, depending on the drug.. (Motrin, tylenol.. well that is certainly not a life altering issue if missed) but what if it were antipsychotics, antibiotics, hyperglycemic meds, seizure meds.. and the list goes on and on......sometimes it is not the I/M fault if late. I have seen many times that the I/M did not show on time simply because there were no available officers to transport to the infirmary at that time.. there are variables that will most certainly occur. If it is a matter of bad timing.. (ie: inmate has to get and be transported with c/o to medical at 6 or 7 am.. perhaps changing the time to say, 9 am would be more practical.Also take in consideration when your C/O's change shifts. In my facility they work 6a-6p and then next shift is 6p - 6a. This does affect sometimes limitations of transporters, especially when the c/o's are getting their briefing, and doing head counts at the beginning of their shift.
    Just my 0.02 thought for the day
  9. by   Aethon
    I once had a problem with an inmate who was taking seizure meds and on occasion he did not show up for medline. After medline was completed I called his block and had him come for his medication. Well over the next week he did not show up for medline and so was called down. After the third time I informed him nicely but firmly, if I have to call you down to medical again I will write you an informal ticket. He left medical after apologizing and I have not had to call him down since (6 months ago).
    Inmates having nothing but time on there hands and yet will find ways to save time and act cool by saying to their fellow compadres, :"Hey, look at me, I do not have to wait in line like you guys do, I get called down. I am the bomb." What these guys are are annoying knuckle heads who need to be put in there place when they are observed trying to circumvent the system.
    The same goes for the ones that ask for a motrin or an "aspirin" while at the medline. IF they have a current order for the medicine but have not yet received it from the pharmacy in the form of bulk medication, then I will give them two doses, one for now and one for later. But half
    of them do not have an order and I tell them sick call or commissary and commissary is cheaper. Unfortonatley I have seen nurses who either give motrin out like it was M&Ms or those that will not give anything and tell them until the pharmacy sends their meds they will not give it. I personally think this is not right so I will give it but if an Inmate tries to see me after being told no by another nurse then I simply tell them that you have already asked and you have received your answer. Can not allow inmates to pit one nurse against another unless the result truly would impact the inmates health for the worse. Motrin,however, does not.
  10. by   bollweevil
    Quote from Monica RN,BSN
    This is a very good thread. Personally, I give the med.. even if he is an hour late, we pre -set up our med cups, so it is no big problem what-so-ever to hand the I/M his pill cup and a cup of water. Don't make mountains out of mole hills. I do not think it is a big deal at all. would rather see the I/M be medicated a little late, then not at all. We as nurses are obligated by our state nursing laws to ensure the I/M get proper health care. Refusing to medicate because said inmate was late, could result in a detrimental effect, depending on the drug.. (Motrin, tylenol.. well that is certainly not a life altering issue if missed) but what if it were antipsychotics, antibiotics, hyperglycemic meds, seizure meds.. and the list goes on and on......sometimes it is not the I/M fault if late. I have seen many times that the I/M did not show on time simply because there were no available officers to transport to the infirmary at that time.. there are variables that will most certainly occur. If it is a matter of bad timing.. (ie: inmate has to get and be transported with c/o to medical at 6 or 7 am.. perhaps changing the time to say, 9 am would be more practical.Also take in consideration when your C/O's change shifts. In my facility they work 6a-6p and then next shift is 6p - 6a. This does affect sometimes limitations of transporters, especially when the c/o's are getting their briefing, and doing head counts at the beginning of their shift.
    Just my 0.02 thought for the day
    I happen to agree with this approach. Some of her coworkers, though, might find it wishy washy to look at mitigating factors and could make her life at work unhappy. They might set her up, get her in trouble, try to get her to quit or get fired. Something to think about.
  11. by   bollweevil
    Quote from VegRN
    "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.
    If the CO was giving the inmate an unreasonably hard time and leaving the line avoided a fight or write-up, maybe it was wise of the IM to leave. Don't we on the outs avoid trouble if we can? So should the IM. I think it's not our role to have to check out every instance of possible CO maltreatment of IM's but we should keep in mind that some CO's do pick on some IM's. I know we have to have solidarity with our coworkers but not if the coworker is wrong, abusive, illegal.
  12. by   rgcirn
    At the mens medium security prison that I work at, we have officers hand out the controlled medications at pill line 4 x day. If the I/M doesn't show up, they get called up to get their medication and a warning to show up on time. If they fail to show up again, they get a ticket. They even have to show up to refuse their medication.
    As far as the I/Ms who have officers call the health services unit because they want to be seen for a health related complaint, I personally think you have to use your nursing judgement. We ask to talk to the inmate on the phone (officers hate this, but too bad). That way we can telephone triage their complaint. We have found that this works very well, and the RN gets a better idea of what is going on. The officers tend to embellish what the inmate complains of because they don't understand or are afraid of getting in trouble if there is something wrong.
    We have one nurse who tells the officer to have the inmate submit a health service request about 99% of the time they call. He never talks to the inmate on the phone. He gets mad at us when we talk to the inmate or tell the officer to have the guy come up (this we do for known asthmatics or cardiac patients who are having problems). I told him, it's my license and if in my nursing judgement I feel this I/M needs to be seen, I am going to see him. He still doesn't like it, but he accepts it.
    I agree that consistency is very important, the population we work with is extremely manipulative and they have nothing better to do that try to pull one over on us. But, I believe in using my common sense and nursing judgement. I've been fooled several times, but would rather that than overlook a potentially serious illness.
  13. by   Ms Mischief
    Quote from rgcirn
    At the mens medium security prison that I work at, we have officers hand out the controlled medications at pill line 4 x day.
    Is this even legal? They are technically administering medication and they don't have the license to do this.
  14. by   rgcirn
    Yes it is legal. They aren't administering, they are dispensing. Technicality, but it is legal. The medications are prepackaged and we set up the medication administration record. It is the same as having a med tech.

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