Inmate patients- keeping the guard happy too

Nurses General Nursing

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We occasionally get patients that are inmates from the jail or prison, and of course a guard is present at all times. I had a patient the last 2 shifts with DKA, and I'd been treating him. This morning, someone mentioned (not sure who- maybe patient) that the patient had a nicotine patch on. Granted, this isn't a common thing for the doctor to order, but the admitting doctor did. I entered the room as the guard was getting very upset, stating that at the jail they don't provide nicotine patches, so the patient should not have one. The guard asked me if the patch was important in the patient's treatment plan. I replied there was a doctor's order for it, and as long as it was safe to give to the patient, then yes, it's part of his treatment plan. (OK, we all know he could live without a nicotine patch, and he'd probably be better off without it in the long run, but I had never had an issue with something like this, with the guard questioning a doctor's order.) The guard had a real problem with this- she called her supervisor, talked to our supervisor- ugh. Our supervisor said we don't have a policy in place for something like this, so we would basically treat the patient with what the doctor ordered. The guard started having an issue with the patient having coffee too, and that was the last I heard of it, as I am NOC and I was leaving all that daytime drama (shift over).

This sounds like a power struggle to me, like the guard is annoyed this patient is getting all of these benefits instead of serving time under her roof. But really, how much power does she have over the patient/prisoner's treatment in the hospital? She kept repeating that the prisoner should only receive what is important in his medical treatment. At the same time, though, shouldn't we treat prisoners like our other patients? If they ask for coffee or other comforts like that, whose policy are we operating under- the jail's or the hospital's? I'm curious about your input- does anyone else have a policy regarding this? We have a policy when an inmate is under surgery, but that's all I could find. This situation might bring about a policy of its own.

Specializes in orthopedic/trauma, Informatics, diabetes.

We get a lot of prisoners. They are under the watch of the guards. The guards can decide what they eat. (not in a DKA type thing-but they usually aren't allowed to order-they get a standard tray).

Depending on the smoking policy at the prison, they may not be allowed the patch. That is something for administration, or start with your charge nurse. It all depends on if they are local, Federal, etc. I'm polite and don't get in the middle of it. We did have a para that had issues with the shackles on his legs causing skin issues. I usually talk to the guard to the side.

It is tricky sometimes.

Specializes in Neuro, Telemetry.

We get prisoners a lot at one of my jobs. Facility policy was is an agreement between the prisons we contract with and the hospital. The prisoners get the standard tray and a standard afternoon and evening snack offered. They get no choice in the food and cannot ask for extra juice,soda, coffee, whatever. Just water and ice refills. They get teas and juice or whatever with dinner. But outside of that, it's water only. We don't apply nicotine patches. There's a whole lot of other stuff. But that's the basics.

Your facility really should have a policy for all of this if they are going to serve prisoners. Something to fall back on when things get questioned.

Specializes in ER.

Just as an FYI, please don't call them guards!

They are officers, and you will all get long much better if you use their correct title.

We get 10-20 prisoners a night in this ER, and mostly the same officers, so we know them by name, but still refer to them simply as 'Officer' in the presence of a patient.

I wonder if your officer was more concerned that the prisoner had acquired something from another inmate? Its not unusual for them to trade meds and do crazy things with them!

Specializes in Medical-Surgical/Float Pool/Stepdown.

The correctional officer was most likely trying to follow the rules of their warden. In the hospital I'm at, the warden makes surprise visits on his officers just making sure they are walking the line as well. Not knocking it but it is a control thing!

Specializes in Oncology.

Our guards just sit there and watch TV with the patient and seem happy for their easy shift.

Specializes in Oncology.
Just as an FYI, please don't call them guards!

They are officers, and you will all get long much better if you use their correct title.

We get 10-20 prisoners a night in this ER, and mostly the same officers, so we know them by name, but still refer to them simply as 'Officer' in the presence of a patient.

I wonder if your officer was more concerned that the prisoner had acquired something from another inmate? Its not unusual for them to trade meds and do crazy things with them!

What med are you thinking he could have taken to inflict dka? Are inmates usually allowed to inject their own insulin?

My first thought was "When did the guard finish Med School?" .

After reading the other replies, I guess I understand that it's more an issue of the guard fearing the prisoner is getting spoiled or is acquiring something that could be used as a weapon or to trade with another prisoner when he returns to prison.

At least this guard was being attentive, not just sleeping or reading or goofing off on her phone.

I say let the supervisors figure it out and they can then make a policy so the nurses don't have to deal with this type of thing.

Specializes in Hospice, corrections, psychiatry, rehab, LTC.

I am a correctional DON. I once found myself in the middle of a dispute between officials from my agency and hospital personnel over an inmate treatment issue. A floor nurse called me at the office, and she wasn't sure what to do because she was unclear about the legal standing of inmate patients, and how much authority that corrections officials have over treatment. My response to her was simple: You have a valid order from a physician, and you carry it out. Nobody in the Department of Corrections has the authority to override or question a physician order, or to dictate the course of treatment.

I have also encountered issues when an officer will overhear a conversation and either focus on a fragment of it taken out of context, or completely misinterpret what was said, then report back to his/her superiors, and then it gets reported to the warden. Those can be fun to sort out as well.

Call the prison and report it. I worked as one and we were not to question the doctors order. You should let them know that she interfered in your job duties and so forth. Let the warden know because they have been trained to not do this.

We had alot of inmate/under arrest patients on our unit, never had a guard have an issue with anything we did or attempt to interfere in care of the patient?

Aren't prisoners allowed to smoke in prison? I believe they sell cigarettes in the commissary (I know people who would have to leave money so they could buy them). So if the patient is allowed to smoke in jail what is the harm of a nicotine patch, its not a fentanyl patch?

I do think though, that if memory serves when someone is incarcerated the jail has a lot of say, but my experience in my facility is that the guards tend to not get involved in treatment, they're there for safety and to prevent the patient from escaping custody.

Specializes in Psych, IV antibiotic therapy med-surg/addictions.

Just because there is a law about not smoking on the law books concerning prisoners doesn't mean that it doesn't happen. It's called contraband and some prisoners can get whatever they want-for a price. Who smuggles contraband in...guards. Including suboxone if they want.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

Nicotine withdrawal can exacerbate other symptoms. Your patient should have a patch if he is a smoker.

But that's none of the guard's business anyway. The guard is showing a lack of respect for your profession. It is not his job to make decisions about your nursing interventions. It's his job to make sure the prisoner doesn't hurt anyone or escape.

I deal with the same crap in inpatient child psych, which some people think is little more than a prison for children. For example, techs will tell me I can't give a child their meds in pudding because it isn't snack time and they shouldn't be getting extra pudding. They have told me that I should just dissolve it in water. No respect whatsoever for what I know and they don't. I have had to go to management about this problem and I have gotten a little support, but not enough.

Hopefully management supports you and takes your side on this. You need the authority to care for your patient under your license and scope. If management didn't support me in this case I would ask to be replaced as this patient's nurse and not to be put on assignments for prisoners as it would cause an ethical dilemma for me.

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