Inmate patients- keeping the guard happy too

[angiebelle440]

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.

[Racer15, BSN, RN]

I'm ER, so it's not as much of an issue buuut, if the doc orders it, I give the treatment, as long as there is no contraindications like drug court or whatever. Warm blankets, coffee, soda...I'm going to give it to them as long as they are not NPO. They are under hospital policy while I am taking care of them(aside from the restraint policy!).

[ruby_jane, BSN, RN]

The guard is approaching this perhaps from the standpoint that less attention paid is best. I mean...I don't think you can fake DKA....but if you consider that sometimes inmates (or high schoolers, or middle schoolers, or anyone really) may exaggerate symptoms to get out of something (class, prison)...it makes sense.

The patch was a doctor's order - I'd do it. You don't have to agree with the guard. You don't have to disagree. Just nurse on.

[JKL33]

I would not entertain these questions/comments at all. I wouldn't discuss anything patient-care related with the officer that didn't directly involve him/her. I would've said, "Your supervisor is welcome to contact the physician." Case closed.

[registerednutrn, BSN, RN]

Depends on your facility policy but if dr ordered nicotine patch I would give. As far as extras like soda jucce and coffee the agreement the facility where i work would not allow those. Some of the prisoners we get are pretty hard core so the will have a guard at bedside a second guard in the room and one outside the room as well as one of the hospital security guards at the nurses station. The guards don't allow the prisoners to ask for extras.

[Sour Lemon]

I wouldn't give a prisoner hot coffee or anything else that could potentially be used to attack me. The nicotine patch is appropriate, though.

[Castiela]

Ultimately it comes down to that despite the patient being a prisoner, they are still entitled to the same care and respect that every patient is entitled to. It isn't our job to judge or withhold care

Nurses tend to look at patients in a humanistic, phenomenological lens, were it sounds like this guard is looking through a justice lens. That being said, I would alert my supervisor that the guard is trying to interfere with the patients care plan and your concerns about her comments and then continue caring for the patient as you would any other.

[NurseSpeedy, ADN, LPN, RN]

I've never had a guard get THAT into an inmate patient's care. Most have no problem with beverages/snacks and many know not to ask for them in excess (probably because the guard may then have an issue with it). I also try to keep the guard in mind too. They're sitting in the room for 12 hours and have to eat their meals at the bedside. I offer water/coffee/ice to them as well. Maybe treating them well has made them back off a bit when it comes to the way I treat my patients.

[RotorRunner]

I treat all my patients with kindness and respect, and if I tick off a guard for giving an inmate a warm blanket and a nicotine patch, so be it.

[macawake, MSN]

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.

I guess it's possible that there's a more benign interpretation of the guard's behavior and since I don't know all the details of the situation, I'll have to give her the benefit of doubt. However I wouldn't be very surprised if it was just a power struggle, I've witnessed that more than once. Both from LEOs and nurses. I detested that attitude back in my law enforcement days, and it still annoys me. Some people just enjoy having someone under their thumb.

Unless it's medically counter-indicated I will administer the medications that are ordered and I will serve coffee. Of course I wouldn't serve it scalding hot as I don't want it thrown in the guard's or my own face but apart from that, I'd give any patient coffee as long as they're allowed fluids by mouth. I might serve it in a paper cup if there was a risk that the hospitalized inmate would use a "real" coffee mug to injure themselves or someone else, but I see no point in withholding the coffee.

While it makes sense to hear the guards out since they might have knowledge of safety risks regarding a specific inmate, I wouldn't let them dictate how I carry out my nursing duties in areas that do not pertain directly to security. If something did, we'd have to come up with a solution that works for both parties, bearing in mind that the patient is hospitalized for a reason. They need medical care and should receive it just like any other patient.

[traumaRUs, MSN, APRN]

I take care of prisoners on dialysis. In IL, there is no smoking in any public building and no smoking in prisons/jails since at least 2012 so nicotine patches are not an issue.

However, these are MY patients, not the guards' patients - I do for them exactly what I would do for any patient to the extent reasonable.

[angiebelle440]

Thank you, everyone. I feel like we're on the same nursing page. Every guard I've worked with has been different, but as someone said, they are there for the safety aspect, and I would depend on them to handle the safety part of care. Usually the guards don't let the patient hold the call light, and I don't question it, because that's their dept. This is a first time though I've had a guard so involved with what I was doing as well as have issues with it. And no, the guard did not want any coffee either :)