County level nursing...

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Specializes in MICU, ER, SICU, Home Health, Corrections.

A [loooong] question for anyone in small county or regional jails.

I recently took a 5-day ride on a regional jail job. About 400 inmates.

I was the only RN in the building [including the administrator].

The job was contracted, not state, and I'll not mention the contract company.

What I found were a group of LPN's, a couple with experience, but most were

new hires direct out of school with some really odd ideas on how things work.

They asked me to shadow a med pass to learn the job, and avoid sick call, diabetic care or assessments, since the senior nurse took those tasks.

The "senior nurse" was defined as the LPN that's been there the longest.

During the med pass, I noticed that they used pill pack/cards ordered and labeled for each inmate. I also noticed that they didn't seem to care which card they pulled pills from. If the inmate at the cart had no meds, they just pulled from another inmates meds. If no other inmate had a card to pull from, they kept released inmates pills in the cart as "stock meds" and pulled from them. Many got none of their meds, and were told to just wait for the order. I didn't see but a few get meds from a properly labeled pack. Casually taking names during the pass, I found 64 inmates missing 118 meds. That was only one cart, so times those numbers by TWO for the other cart.

Why? Because, as an older LPN noted, no one took the time to order meds and each shift said it was the other shift's responsibility.

I tried to help, but every time I went looking for a med from the MAR, I was told it was D/C'd. I asked how she knew it was D/C'd. She says "You just know... you get to know the IM's and what they're on." I jokingly said... "Hey, maybe if you took a yellow highlighter to the DC's, they would stand out."

Her reply... "That might be a good idea, but changing things might cause confusion. It's easier to just put an X in the last day's dose block if you think of it."

She thought it was just silly, and unnecessary work to take up more time.

So then I sat in on a sick call... inmates came up to medical, waited en masse outside the door in holding, and an LPN stood with a stack of doc forms. It went like this:

LPN - "What's wrong with you?"

IM - "My tooth is rotting out and infected."

LPN - "OK, I put you on a Keflex protocol for 2 weeks. We'll order it and it will be here in a few days. Ask for it in the next med pass and they'll get it for you."

NEXT....

LPN- "What's wrong?"

IM- "My stomach has been hurting all day."

LPN- "OK, I put you on the doctors list and he will see you tomorrow."

.. and it continued that way for 20 minutes with no one looking up from their papers or even turning around to look at the IM. No assessing, no examining, no effort at all.

I sat for 3 days just watching... Folks seemed to believe they were really putting effort into "training" me.

On the 3rd day, I casually asked about emergency procedures, the crash cart and AED in the corner...

"Oh, that's for state requirements. If something happens, just call 911 or do CPR if you feel brave."

On the 4th day, the LPN administrator returned from her sick leave and I spoke with her.

We chatted for about 20 minutes and the only quotes I came out of it with were:

"Oh, it took me a long time to get used to pulling other IM's meds, but it's OK, ordering takes a while and it's just easier to use the ones we have on hand."

and...

"If you call me after 9pm, make sure I'm awake, and if I sound out of it, I'm probably drunk, so be sure to tell me to sit up and get my head together before asking me anything important." The Medial Assistant behind the admin's desk pipes up with "No doubt, and if she's completely gone, just call me and I'll handle it."

They appeared joined at the hip. So also said the staff.

One odd thing stood out... when a person was brought in to booking, they had to be cleared by medical before being accepted. Anytime someone was brought in, I got to walk over and [as instructed] ask "Do you have a medical emergency?" from behind the counter.

This was so the arresting officer was "clear" to remove the cuffs and the jail to accept the IM. There was no paperwork involved in this event and I failed to see the point.

On the 5th day I just followed folks around spectating... out of morbid curiosity.

I then called the contract company who said they'd check into it. They didn't seem

too worried about any of it, made me think they didn't even believe me, so I just didn't go back.

Sorry for the vent, but all that was to ask this:

Is this normal in small [population 400ish] facilities????? Surely not.

Input?

rb

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Specializes in Corrections and Long term care mostly.

NO not a norm..I work at the county level also contracted out and it is NOTHING like that...

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Specializes in LTC, Hospice, corrections, +.

"One odd thing stood out" ?????

I am only an LPN in a small county jail but I assure you we do not operate like that.

....that being said things do tend to operate a little differently on some levels in a correctional facility. I am sorry you had a poor experience in corrections. I hope you will not paint us all with the same brush, and give it another shot if you get a chance.

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Specializes in MICU, ER, SICU, Home Health, Corrections.
"One odd thing stood out" ?????

I am only an LPN in a small county jail but I assure you we do not operate like that.

....that being said things do tend to operate a little differently on some levels in a correctional facility. I am sorry you had a poor experience in corrections. I hope you will not paint us all with the same brush, and give it another shot if you get a chance.

LOL... well, you know.. 'one odd thing' that wasn't included in the "Lose your license in just 10 days" program...

No, not painting anyone, just venting.

Actually I am currently in the end phases of hiring with the federal BOP and thought the county thing a good idea to kill some time for extra bucks.

Little did I know. LOL

Seriously though,

It's obviously a failed leadership problem and as with such, someone [an IM] will have to pay the price before anything is done.

rb

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Specializes in ER,OR, Home Health, Occ. Health, Correct.

I work in a county facility and I am a county employee. I am the only nurse and I am an RN. I do not operate this way! I had to chuckle when you said "one odd thing stood out"...there are WAY more than just ONE ...LOL! Actually kinda scary!

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Specializes in MICU, ER, SICU, Home Health, Corrections.

LOL, yeah.. I guess I mean to say that for everything that I saw wrong, I also saw the glaring problem of *why* things were the way they were. There was no mystery except for those trips over to booking for every new IM.

This is what happens when you hire new grads with no 'basic' experience and just turn them loose. There really should be a "learn to be a nurse first, THEN specialize" approach to learning.

IOW, work in a hospital, nursing home or clinic and get the basics down before being handed autonomy.

I don't blame the employees, I blame management wholly.

rb

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That is not normal at the 327 bed county jail that I work at. I am very lucky though, we are one of the few jails left that does not contract medical out and we are all RN's with experience and county employees with good benefits.:D

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Specializes in nicu/m/s/addictions/beh.health.

i was hired at a county jail as RN charge nurse. the jail capacity was 1200 but the census was 2000. the LPN's did the med passes and when i observed the med carts i saw bowls filled with assorted pills. i questioned what this was and was told "oh, we call this the candy bowl, when the residents refuse their meds we put them in the bowl and use them for someone else". my next question was how do you know what they all are? "oh we just know"

i could relate more horror stories but to sum it up after my second shift i resigned.

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