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.
We get patients in the ER that are accompanied by guards. I treat them like I would any patient but I keep the guards security in mind. They get blankets, coffe, food, and soft drinks as appropriate. I also give the guard things too. They are after all protecting me too. I don't give scalding coffee (but I wouldn't to a regular patient either), cans (sharp edges they can have styrofoam cups), or sharp utensils. I don't leave sharp objects within reach. I've never had an issue. If I did, well my patient is under my care. If it doesn't impact security, it's not the guards concern.
I've never had an issue with COs, and we do get a good number of pts who are either incarcerated or newly under arrest. Never been less than 100% respectful; they even step in immediately if the pt is less than 100% respectful...e.g. stood up in front of the pt and in their CO voice "You will not speak to the nurse that way. Apologize to her," for addressing me as "hey, woman!"
If they did try to dictate treatment, I would calmly explain that if an MD order is medically indicated (i.e. safe), I don't have the legal right to withhold it... nor am I obligated to discuss the medical/nursing plan of care outside their need-to-know. Some examples of need-to-know: q2 hrs, they need to move the shackle to the other ankle so that we can reposition the pt..... the pt is on strict T&L precautions, so the bed must stay flat or reverse Tberg.... pt tested + for MDRO, so contact precautions in place. Don't need to know: nicotine withdrawal shouldn't be an issue bc the pt is wearing a patch. (Any corrections nurses, please correct me if I'm wrong.)
Non-harmful DOC policies like inmates not allowed coffee outside of mealtimes I have no issue enforcing. If we break the law, we do lose certain rights -- including the right to liberty, if offense warrants incarceration. I'm not going to get all sanctimonious and declare they have the exact same rights as every other pt -- because they don't. They have the right to their needs being met, competent nursing/medical care (including any necessary comfort measures as prescribed), and respect due to every human being. Coffee and Jell-o are not human rights.
When I worked postpartum our hospital had an exclusive contract with the DOC so all the pregnant inmates came to us to deliver. If they had pregnancy issues they were with us during their antepartum stay as well, either until they delivered or were discharged back to the prison.
There was a wide variation in COs. Some were kind and respectful to both the patient and me, others were more abrupt. A very few were downright rude but thankfully they were few and far between. Occasionally I had runins with them over the prisoner being shackled to the bed, one hand and one foot. We are a mother/baby unit and it made it real hard for these moms to take care of their babies with one hand chained to the bed. Or we'd get the c/section moms whose lower extremities got pretty edematous POD 2ish and the shackles would get too tight. Unless I got an order for it, the cuffs would stay on, so I had no problems at all getting MDs to order that the pt be cuffed to the bed with one hand only (if LE edema) or one foot (so she could care for her baby). The MDs would give me that order in a heartbeat.
I realize that's a bit of a special situation and not most units in the hospital. Even if they were prisoners it always broke my heart when they had to go back to prison and leave their babies in the hospital. Most of our patients were not a danger to society, not even many of the ones in for murder (most of the time it was an abusive spouse they'd killed), and I never had an issue with any of the inmates. I always treated them exactly the same - same food, drink, amenities - as any other patient. If the COs had a problem with that I offered to let them speak to my charge or manager, but I was never asked to change my practice.
Would you be OK with them referring to you as caregivers instead of nurses?
Its not really reasonable to ask them to respect your profession if you don't respect theirs.
Actually they are guards. That is not a derogatory term. A guard is defined as "one assigned to protect or oversee another." They are also not all officers. Some of the guards that we see are Sheriff Deputies.
I personally would not be offended if I was referred to in a general term as a caregiver which is defined as "a person who provides direct care." Since I do provide direct care in my role as a registered nurse, along with techs, MAs, CNAs, and LPNs. We are all caregivers.
I hope you are not so easily offended in real life, because if you are getting so worked up over the use of a general term that is not even derogatory I think you must not lead a very happy life.
Cat365
570 Posts
We get patients in the ER that are accompanied by guards. I treat them like I would any patient but I keep the guards security in mind. They get blankets, coffe, food, and soft drinks as appropriate. I also give the guard things too. They are after all protecting me too. I don't give scalding coffee (but I wouldn't to a regular patient either), cans (sharp edges they can have styrofoam cups), or sharp utensils. I don't leave sharp objects within reach. I've never had an issue. If I did, well my patient is under my care. If it doesn't impact security, it's not the guards concern.