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Ethical dilemmas of correctional nursing

Correctional   (459 Views | 9 Replies)
by hellokitty98 hellokitty98 (New) New

355 Profile Views; 13 Posts

So I am an LPN with one year of experience in a skilled nursing facility. I am considering corrections nursing. I care about the health and quality of life of the most marginalized and vulnerable members of our society. I believe in the health, quality of life, and rehabilitation of criminals as an alternative to our criminal justice system in a country with the highest incarceration rate and also highest rates of recidivism. I believe our justice system is unsuccessful at rehabilitating criminals and am opposed to the abuse and mistreatment of incarcerated people. I want to work in corrections to provide care for the people our society cares the least about.. people who have committed crimes. My concern is of being put in an ethically compromising situation of having to be quiet about abuse, medical neglect, and lack of power to provide quality care to those incarcerated. And if I speak up about abuse at work will I be punished for it? Will I be working with providers who don't care about the health and safety of my patients? Will I be working with police and COs who want me to keep quiet about abuse and mistreatment especially when it compromises my patients health i.e. questioning use of pepper spray or solitary as a part of advocating for my patients health? I really want to be in a position to help these people and not in a position of fighting the system to try to provide a decent quality of care to people incarcerated. If you have experience in working in this field I would be interested in hearing about your experiences.

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Hoozdo has 15 years experience as a ADN and specializes in ICU, Research, Corrections.

1 Follower; 1,547 Posts; 13,726 Profile Views

**And if I speak up about abuse at work will I be punished for it? Will I be working with providers who don't care about the health and safety of my patients?**

Yes, you will be punished for it in an offhand way. The management might start looking for ways to fire you because you cause too much trouble.

As far as providers, I have spent about 3 years in corrections and I have never met a provider that didn't care about the patients. Most of them bend over backwards to provide excellent care with the resources given.

I know in my jail system, (second largest in the country), as an LPN you won't have much time to be involved in patient care. You will be busy passing out thousands of medications and that is it.

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Trampledunderfoot is a LPN and specializes in Corrections, Dementia/Alzheimer's.

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I have never run into someone wanting to sweep abuse under the rug.  I have actually never run into abuse at "my" prison.  My experience is that patients at nursing homes are treated more disrespectfully, and with less kindness.

Keep your eyes open, though, and learn to discern what is real.  Offenders regularly feel they are/have been abused by medical staff and COs, when they have not been.  They also like to pretend there was abuse for their personal gain.  I'm not saying abuse between staff/offenders is impossible, I'm just saying that my experience has been that if there is abuse, it was between two offenders.  Keep your eyes open and collect all the facts before jumping to conclusions.

At times you do have to fight the system to provide the right care, but this is because of staffing shortages and some unbelief from doctors etc d/t malingering and story telling on the offender's part.  Be ready to display all the evidence to prove your case, make sure your assessments are thorough and your documentation is great.  I have never had to fight the system because abuse was accepted.   There are many laws and policies that go above and beyond to protect the offenders from mistreatment, sometimes to the detriment of the staff.  Sometimes the offenders are given the benefit of the doubt.

A lot of the horrors of prison seem to be glamorized through TV.  Solitary is not very solitary (again, in my experience).  I work in ad seg, and they are catered to more often than not.  It only takes a little whining to get your way.

And I have found that a little pepper spray can do a lot of good, and usually very little harm.🙂

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146 Posts; 675 Profile Views

Is it difficult getting hired o to corrections as a new grad?  Everywhere I read states the eligibility requires a couple years of nursing experience; in particularly in a specialty, plus certain certifications, etc.  

I will be graduating with an ADN from USC/LA County nursing school (LA County Hospital) and then I will have a BSN a year later.  

I would like to get my pension started.  Do I need to wait to apply until I have years experience? 

Did you just apply online as a random person? Did you follow up in person or over the phone? 
How long did it take to hear back once applying online?

I have a 1203.4 on my record, which is a dismissal from an old case decades ago.  County overlooks this.  Would federal?

Thank you!

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ocean.baby has 25 years experience and specializes in corrections and LTC.

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You have been watching too many prison movies.

I have worked in corrections 25 years, and have never seen physical abuse from staff towards the inmates.  I am not saying it hasn't happened, but I have not seen it.  Verbal abuse - yes, but rarely, and not to the point I had to report it.  Most officers are professional.  They want to go to work, do their job, be safe, and go home at the end of the day to their family.  Inmates treat medical staff far different than they do the officers, they want something from us and are usually nice.  That is NOT how they treat security. 

Medical staff give inmates what they need, not what they want.  You want an extra mattress because yours is too thin?  That is a security issue, they assign mattresses.  You need an extra mattress because the thin one makes your back hurt, and security told you to get a medical release?  Well, we are not in the mattress business.  There are strict guidelines as to who gets a second mattress and they are few and far between.  You do not qualify. 

You need 5 packets of antibiotic ointment because you have cuts on your hands?  Hmmmm, or do you really want it to masturbate with? 

You have a cut on your finger and need some bandaids?  Well, bandaids can be used to make shanks, the cut isn't bad, just wash it with soap and water then keep it clean and dry. 

An inmate comes to pill call and looks like hell - pale, diaphoretic, weak.  When questioned he says he isn't feeling good, his stomach really hurts.  You have never heard him complain before in the 6 months you have seen him daily.  You have the officer take him to the infirmary, or the nursing office on that unit, get his vitals and assess him.  BP is low, pulse is high, can't get an O2 sat.  You call the doctor and get orders to start an IV, put oxygen on him, and ship him to the ER.  You might have saved his life. 

The best nurses only focus on medical care and issues.  You need to have a good working relationship with security and develop mutual respect.  When they tell you something, listen, they know what they are talking about.  They will keep you from getting killed if you pay attention to them and do not take offense when they tell you that you did something stupid or out of line. 

Inmates do not receive the standard of care that a congressman with great insurance does.  They have to receive the same as the community standard of care.  If you are a single mom working at McDonalds, no insurance, and have a bad tooth - you can afford to get it pulled but not a crown.  Same with inmates.  You have a scar across your face from a car accident 5 years ago - but you can't afford to have plastic surgery.  Same with inmates.  You have cancer, you have a heart attack - you get the treatment you need.  Same with inmates.

Go into the facility wanting to give good care, not looking for any perceived problems.  Please keep your mouth shut until you learn the system unless it is a life threatening situation.  Watch and learn,  you will do fine. 

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Orca has 25 years experience as a ASN, RN and specializes in Corrections, psychiatry, rehab, LTC.

1 Follower; 1,812 Posts; 26,398 Profile Views

Your opening statements sound like someone ripe for compromise. You talk about caring about "the health and quality of life of the most marginalized and vulnerable members of our society", then you act as if you expect to find abuse and neglect before you even walk through the door. Not to say that it never happens, but I have not seen either in 19 years of working behind the fences in the medical area. What I have seen is inmates who go to great lengths selling their stories of such to the people who they believe to be the most gullible and naïve members of the staff.

There is an article tacked to the main bulletin board in our nurse station that is entitled, "You Will Be Sued for Doing the Right Thing". If you are in this business long enough, you will learn that inmates will make repeated allegations against you and your coworkers, and that 98 percent of the time, the stories are exaggerated or fabricated.

Edited by Orca

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24 Posts; 333 Profile Views

As a Correctional nurse, I am providing care for a unique population of folks who have violated our society's social or legal contract. Some of them have violated it many times. If someone has been a heroin addict and stealing cars since 1997, only that person can decide, "OK I am tired of this lifestyle, I dont want to go to jail anymore, Im going to treatment, and make a change in my life". Its not easy, its a lot of hard work, some mental illnesses are not recoverable, and there are not enough resources for mental illness in society. Corrections to a large extent sees a lot of patients whose lives have been destroyed by these factors.

Reality is, my opinion, our justice system is not for rehabilitation. Our justice system currently exists 1. for punishment 2. to separate dangerous offenders away from the rest of society. Its primary goal is not to rehabilitate people. I think it would be difficult to go to work every day inside a punishment/public safety holding facility if I fundamentally disagreed with that reality. And the justice system itself (legal system, courts, etc) which sentences people to the punishment facility is technically a legislative arrangement. Jail and prison are just the holding tank and the end result. The business end of all of this is the legal system, not the building where the individuals are kept. Legislation drives all of these policies. But I digress.

Many of your patients will be awaiting legal proceedings or already convicted of some very abhorrent behavior. Keep in mind that (in my facility) fully 10% of the inmate population are in PC (protective custody) meaning they are awaiting trial for sex offenses or have prior sex offenses which make them a target for violence from other inmates.  I have taken care of many, many, many patients whose face I just saw on the news for charges/& or convicted of molesting children. Personal feelings and judgements good or bad cannot come into patient interactions. The "I think this patient is innocent/guilty" thing drives me crazy...its so unprofessional. I do not care if that person is guilty or innocent, I dont care if they are a sex offender, it has nothing to do with my job as a nurse.! I work with one nurse who gets all tangled up in her feelings about the innocence of inmates and the injustice blah blah. It is beyond aggravating. I want to tell her every time I talk to her: if you want to work in Justice, please go to law school. There is a profession for persons who are practicing the field of justice and judgement, and it is not nursing. 

The Corrections officers do not want to pepper spray or tase people...any use of force means they have to do lots of paperwork, on top of it puts them at risk for injury or death. If you think Corrections was unneccessarily violent with their use of force, you could file a complaint. Its all on video and chances are there were 10 other CO's there when it happened as witnesses. All their uses of force are investigated. I have never witnessed abuse by our Corrections staff. They are professional safety officers, like I am a professional nurse, but their role is to maintain safety and order and inmates who obey the rules have no problems. They want everything to run smoothly and safely. Lots of them have been there for like 20 years + and I work hard to cultivate their respect. 

A key point in Corrections health its not you vs. the system....you are the system. Its not about being in a position to be "fighting the system" for mistreated persons who "the system" has failed to properly rehabilitate. Corrections health staff are *part of* the system. When my schizophrenic patient gets sent to segregation, it is my expected job to create a whole care plan for that person to ensure their safety and proper care...and there is a whole protocol in place for it.  There is plenty of room for providing nursing care with respect and compassion with the appropriate boundaries. 

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KCMnurse has 36 years experience as a BSN, MSN, RN and specializes in Educator.

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On 1/2/2020 at 4:42 AM, Overcast said:

 

I would like to get my pension started.  Do I need to wait to apply until I have years experience? 
 

This does not seem like the appropriate reason to enter this field of nursing...

 

 

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"nursy" has 40 years experience as a RN and specializes in ICU, ER, Home Health, Corrections, School Nurse.

198 Posts; 809 Profile Views

I have worked in corrections and agree completely with all the above posters.    Rehab and recidivism are huge issues in the U.S. but your job as a corrections nurse are not going to magically revolutionize the system.  If you want to change the system, go back to school and become a lawyer or an activist.  

All the providers I worked with were genuinely compassionate and caring.  Unfortunately, some of the worst issues I encountered were from my fellow nurses.  It was almost impossible to get fired from my prison, so there was drug diversion, malingering, back stabbing, and a host of other issues that eventually drove me out.  But the actual job of corrections nursing, I very much enjoyed, and felt like what I did, really mattered. 

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Orca has 25 years experience as a ASN, RN and specializes in Corrections, psychiatry, rehab, LTC.

1 Follower; 1,812 Posts; 26,398 Profile Views

Inmates will also insist that they have all kinds of undiagnosed conditions, and that their rights are being violated because they aren't being treated. I was once sued by an inmate (I'm a DON, so I get sued every time that the medical department is named) because we weren't treating an obscure neurological condition that she claimed to have that was not diagnosed by anyone who we obtained medical records from. Our contract neurologist didn't find it either. I looked it up, and the main treatment for this condition is opioids. She is an opioid addict. She found a condition that few people knew about or understood that would feed her addiction, she claimed to have it, and she was hoping that we would treat it without verifying it. When we didn't, she sued us. She lost.

Inmates will try to convince you that they aren't getting what they need, when in fact the issue is that they are not getting what they want. I was sued by another inmate over a different medication issue. He was insistent that two medications that we removed from our formulary because they have trade value on the yard and had created an underground economy were the only medications that worked for him. Neither drug was listed by any source that I could find as a treatment for his condition. We replaced the drugs with drugs in the same classes as the ones that he was on, but he was still insistent that they "don't work". Most likely we took away his income, and he was hoping that the court would force us to give it back to him. The court didn't bite.

This is a work environment unlike any other. We have to consider issues that would never come up in a hospital setting. Our clientele is almost without exception manipulators. They weren't put here for their honesty. Behind that backdrop, we have to separate the legitimate issues from the fabricated ones, and it isn't for everyone. If you come in with the attitude that all inmates are neglected, they will eat you alive. They will have you twisted in so many different directions that you won't know which end is up.

Welcome to my world.

Edited by Orca

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