One thing that makes correctional nursing a bit tricky for some is the nature of the environment. You have to unlearn many of the things you have accepted as gospel in other specialties. For instance, in most specialties, most everything is done for the patient, and we get things and do things for patients as soon as possible. Inmates, on the other hand, are expected to accept some responsibility, and to abide by set rules and regulations. Run and fetch for them, and they will expect it all the time. Word will get around the yard quickly that you are someone who can be manipulated, and can be used to get around the rules (such as waiting lists for appointments, waits for prescription refills and so forth). Before you know it, you are running all the time for no good reason.
An RN I worked with one night literally broke into a sprint because an inmate was tapping on the holding cell window. I had to remind her that this was not ICU, no one was dying, and the inmate was simply waiting for an escort back to his unit after his clinic visit (he was wanting a drink of water, which he could have gotten inside the holding cell).
This is a specialty in which, contrary to the custom in many others, responding too quickly can be detrimental to your effectiveness. Inmates are master manipulators, and many will try their best to see how much they can get you to do (especially if you are a new face). Don't create unnecessary work for yourself, and don't let yourself get put in the position of "bending the rules".
This is not to say that you ignore legitimate emergencies, or that you assume that everyone who comes through the door is lying. Just realize that you are much less likely to get honest responses from inmates than most patient groups. Many will fake symptoms just to get out of their cells. Some even try to con you into shipping them to the hospital so they can get out of the prison setting altogether. The attitude you must develop might be considered uncaring in some settings, but sometimes doing the right thing means saying "no", and firmly standing your ground.
Aug 22, '02
My commander once said, "Kindness is mistaken for weakness, and they (the inmates) will chew you up and spit you out"
We nurses say, "no good deed goes unpunished, the better you are to someone, the worse they treat you"
They are inmates, not patients and we really have to get the new nurses to understand this. If they don't get it. they usually don't last long
Aug 22, '02
One of the "kind hearted" LVNs took an inmate a requested extra sandwich "because he said he was still hungry" and was promptly fired--as she should have been. If you bend the rules in any way, the inmates will then use this as 1) a sign that you are weak, want to "please" and can be easily manipulated and, 2) a way to blackmail you in the future if you don't do what they want (like bring them cigarettes or a ball point pen, for example). THEY know you will lose your jail clearance, and thus your job, by doing the things they ask, even if you, as a new person, do not. So you can be blackmailed, just as they use threats to try to get what they want when they are, all too briefly, on the "outside."
They talk amongst themselves to come up with ways to test you for this stuff, having nothing else to do all day long. Most particularly they like to play "let's you and him fight," by getting you into a conflict with custody staff or with other health care providers. To them it is entertaining, and YOU are the comedian.
These people are criminals with criminal minds, most of them, with very limited personal and social skills (except for a lot of the sex offenders and forgers) and usually very limited educations. A good thing to remember when you expect them to "understand your position and role."
A great many of them have never held a job nor conformed to a schedule of any kind--except that of incarceration--nor do they ever wish to (unless it is a temporary step towards getting out of jail for a while). They honestly do not have any idea of what "deferred gratification" or "self-discipline" mean. They see jobs and these other things as evidence that people are weak and in chains. It's a different way of thinking. They don't have your brand of common sense, for sure, for the most part. IMHO.
And again I say, the officers/custody staff/deputies/guards are YOUR FRIENDS. They will save your butt many times, most of which you don't even know about.
Last edit by sjoe on Aug 22, '02
Oct 2, '02
As an 18 year veteran RN in Correctional Nursing I whole-heartedly agree!!!!!!!! We must still be advocates for the healthcare of our "charges" but must do so consistently and without being taken advantage of by them. I have learned to be firm, fair and consistent and though many of the inmates don't always like my answers....they still respect me for who I am in my role as a helath care provider. Once again...3 cheers from Wisconsin
Oct 5, '02
Thanks for your advice!! I am a newby to corrections and I will certainly abide by it!
Oct 5, '02
I am an lpn in LTC, and my husband is a correctional oficer. He is always telling me how manipulative the inmates can be. He tells me if they ask for anything, even something simple like a piece of paper, the inmate will build on that and try to see what else they can obtain.
Oct 6, '02
The facility which I am employed with offers each employee a 40 hour (off the unit) orientation which is conducted by a seasoned lieutinent. She echos exactly what you all have mentioned in this section. She repeatedly has told us that the offenders are very manipulative!!! I will keep my eyes open.
Oct 10, '02
I wish that this was done in the Nevada Department of Corrections. Nurses need to be aware of the differences between prison and any other area of nursing they have worked in. I got a week of orientation (with medical staff only) before functioning on my own.
Unlike my coworkers, I had the advantage of having been a correctional officer (Oklahoma DOC) before going to nursing school, and I already knew about security concerns and the games inmates play. It gave me a decided advantage. It would be nice if the people who work with me were given some background in security, if only a brief overview, before they start.
Oct 10, '02
Correctional nursing is a completely different animal than any other type of nursing in the game. You need to know that inmates want to see what they can get from you and somtimes they lie. I wish that they instructed the new staff more on that cause I have seen too many new nurses lose thier jobs cause they got involved with inmates. And this is more than just giving them a piece of paper mind you. We have a class that we have to take yearly called "Professional Boundaries" and it helps me remember my role. It is hard when you first start as a correctional nurse cause you have been taught all these years to be a caring person and you have to be a little more on your guard at this job. I have been a correctional nurse for 13 years and I have seen lots of things and believe me I have heard a lot of stories from the inmates. Just remember, they are not worth losing a very good job over.
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