How frustrating does correctional nursing get if you want to do it right?

texascowgirl · Aug 10, 2007

just realize that the offenders have access and rights to BASIC health care..you will see things are done a little different than in the free world. just practice within the guidelines of the Nurse Practice Act and your facility SOP's and you will be fine. if you dont already have the skills of dealing with manipulative behavior, and malingering, get them quick, or you will learn the hard way.

what facilities in Texas are you considering? i am going back to correctional health here in Texas.......in the next few months. (currently working ER, but have worked prisons for years)

Sheri257 · Aug 11, 2007

Again, not trying to be offensive, but nobody can tell me that the careless, neglectfull or downright abusive type of prison personell doesn/t exist.

It does ... although I haven't seen too much of it, mostly because I work in California where state facilities are under federal court order to provide care. While there certainly is some staff who are neglectful and abusive, overall ... I've found the medical staff and custody is, for the most part, trying to do what they're supposed to do.

Staff abuse was the major problem in the past, but the real problem now is that the court order has created a situation where the malingers can take advantage and flood the system with bogus medical requests .... to the point that there isn't enough time and resources for the really sick inmates.

Case in point: inmate doesn't like his new housing assignment and isn't getting along with his cellie so, he cuts himself and claims he's going to commit suicide. Eventually he admits that he isn't really suicidal and that he really just wants his housing changed but ...

Because the inmate used the word "suicide" and he knows the court order requires us to drop everything and address the situation as soon as he utters that word, my entire day was wasted on this one inmate's bogus claim.

We did write the inmate up for staff manipulation but ... it doesn't change the fact that my entire day was wasted on this bogus case when I really should be spending more time on the inmate who was recently hospitalized for a heart attack, making sure he's getting his medication, is scheduled to see the MD for follow up care, etc. But, unfortunately, I don't have much of a choice because I have to follow the court order.

Meanwhile, the inmate with the legitimate heart condition is also concerned because he knows that too many inmates are taking advantage and faking so, what happens if he has a heart attack again? He knows that we wouldn't intentionally deny him care but, he's worried that custody will be tied up with too many bogus cases and there won't be enough officers to take him to the hospital in a real emergency ... and I can't say that I blame him because it's a real possibility.

To me, at least, this is the really frustrating part of trying to do your job right in corrections. It wouldn't be so bad if the malingerers weren't taking up all your time but, the fact is ... they can and do take advantage with this court order. So, in many ways, your hands are tied.

Whether it's staff abuse or inmate abuse ... either way, the abuse creates a situation where the inmates who are really sick don't always get the care they need.

saraltx · Aug 11, 2007

Thank you to both of you for bothering to reply. You both give some valid point to consider. I found it very interesting to get some first-hand insight in the challenges of correctional nursing. Some more things to take into consideration before I make up my mind.

TrudyRN · Aug 12, 2007

It does ... although I haven't seen too much of it, mostly because I work in California where state facilities are under federal court order to provide care. While there certainly is some staff who are neglectful and abusive, overall ... I've found the medical staff and custody is, for the most part, trying to do what they're supposed to do.
Staff abuse was the major problem in the past, but the real problem now is that the court order has created a situation where the malingers can take advantage and flood the system with bogus medical requests .... to the point that there isn't enough time and resources for the really sick inmates.
Case in point: inmate doesn't like his new housing assignment and isn't getting along with his cellie so, he cuts himself and claims he's going to commit suicide. Eventually he admits that he isn't really suicidal and that he really just wants his housing changed but ...
Because the inmate used the word "suicide" and he knows the court order requires us to drop everything and address the situation as soon as he utters that word, my entire day was wasted on this one inmate's bogus claim.
We did write the inmate up for staff manipulation but ... it doesn't change the fact that my entire day was wasted on this bogus case when I really should be spending more time on the inmate who was recently hospitalized for a heart attack, making sure he's getting his medication, is scheduled to see the MD for follow up care, etc. But, unfortunately, I don't have much of a choice because I have to follow the court order.
Meanwhile, the inmate with the legitimate heart condition is also concerned because he knows that too many inmates are taking advantage and faking so, what happens if he has a heart attack again? He knows that we wouldn't intentionally deny him care but, he's worried that custody will be tied up with too many bogus cases and there won't be enough officers to take him to the hospital in a real emergency ... and I can't say that I blame him because it's a real possibility.
To me, at least, this is the really frustrating part of trying to do your job right in corrections. It wouldn't be so bad if the malingerers weren't taking up all your time but, the fact is ... they can and do take advantage with this court order. So, in many ways, your hands are tied.
Whether it's staff abuse or inmate abuse ... either way, the abuse creates a situation where the inmates who are really sick don't always get the care they need.

Sounds like you guys need to do some diesel therapy with your malingerers. :devil:

TrudyRN · Aug 12, 2007

Well, OP, you are aware, I see, of the realities you might encounter. I guess my reply is to just do the best you can without making anyone hate you and try to set you up for being different or an inmate lover.

Don't carry in a purse or other personal items, check your coat pocket and lining before you leave - just be totally heads up so no one can get over on you.

Don't be verbal about how great you are or complain about how bad other staff are. Just quietly do what you think is right.

njbikernurse · Aug 14, 2007

What's diesel therapy?

suecdnp2b · Aug 16, 2007

...waiting to see if bikernurse gets a reply...Van Diesel?!

Sheri257 · Aug 16, 2007

As much as the malingerers drive us crazy, I don't think Diesel Therapy is the solution. In my state, it would probably be considered cruel and unusual punishment.

Diesel Therapy: the continuous or unnecessary transport of a prisoner from place to place, especially as a form of reprimand or punishment, but also as a result of bureaucratic mistakes.

http://www.doubletongued.org/index.php/dictionary/diesel_therapy/

During his incarceration Rep. Hansen was subjected to what federal inmates refer to as "Diesel Therapy," so named because of the continuous transport by diesel-powered vehicles. This takes place in transit to or from whatever detention facility to which the prisoner is ultimately assigned.

"When they chain you up, legs and wrists, they put a thing called a stiffener on those they don't like. That's a small black box slightly larger than a pack of cigarettes. This is placed on the chains between the handcuffs and makes them rigid so your arms can't move. Then they run a chain from your arms and fasten it to your waist. When they do that it pulls your arms from a normal 180-degree angle to 90 degrees, putting your arms in a bind which cuts into the nerves of your wrists so badly that, the result is, after an extended period of time like that, it requires weeks and sometimes months to get feeling and circulation back to your hands--and pretty much the same for your feet."

After placing these manacles on hands and feet, "they strap you into a seat and you're so bound up with chains that if you have to go to the bathroom, you can't do anything about it. You can't pull your pants down or do anything to relieve yourself."

According to Hansen, the vehicles he was transported in reeked of urine and feces because the prisoners were chained in that position for twenty hours a day, forcing them to accommodate their bodily functions without access to sanitation facilities.

http://www.constitution.org/ghansen/hansen9-97.html

texascowgirl · Aug 20, 2007

to the poster who talked about malingerers taking time away from those who have serious health concerrns........i have worked in correctional health and ER. let me tell ya, the situation is WAY WAY worse in free world ER. the reason being, OVERALL, unless you work in a "MEDICAL" prison, the patient population is generally healthy, with some chronic illness, nothing real acute. think about free world Emergency Medicine, TOTALLY OVERLOADED with malingerers, those who use ER's as their primary health care providers because they cant afford the PCP copay...and they take up EMS time and ER beds for those who come in with acute MI's, traumas etc..........

give me correctional health and its malingerers over free world ER any day

p.s. and in correctional health, unlike free world ED, you can actually tell the malingerers "where to go".........and litigation risk is much lower...........and there is NO PRESS GANEY!!!!!!!!!!!!!!!!!!!

Sheri257 · Aug 21, 2007

Yeah ... I see your point. The only reason I think it may be worse than a regular ER is that in California we're under court order to see every inmate, for every complaint within 24 hours ... no matter how bogus it is. So, it does give the malingerers an advantage, so to speak.

And, since these guys literally have nothing else better to do ... all they pretty much do all day long is sit around and think of new medical complaints.

But, for us nurses in California, the litigation risk is not lower. These guys have a law firm in San Francisco (among others) that does nothing but file lawsuits on their behalf ... and they've been quite successful with big court ordered damage awards. Afterall ... the state is an easy target with deep pockets.

So, we can't just tell the inmate where to shove it .... we really have to be careful to protect our licenses.

texascowgirl · Aug 21, 2007

well, then, glad i aint in Texas. here in Texas we truly operate under the mentality of the slogan "Dont Mess With Texas"..........

Yeah ... I see your point. The only reason I think it may be worse than a regular ER is that in California we're under court order to see every inmate, for every complaint within 24 hours ... no matter how bogus it is. So, it does give the malingerers an advantage, so to speak.
And, since these guys literally have nothing else better to do ... all they pretty much do all day long is sit around and think of new medical complaints.
But, for us nurses in California, the litigation risk is not lower. These guys have a law firm in San Francisco (among others) that does nothing but file lawsuits on their behalf ... and they've been quite successful with big court ordered damage awards. Afterall ... the state is an easy target with deep pockets.
So, we can't just tell the inmate where to shove it .... we really have to be careful to protect our licenses.