Inmates, Career Criminals, thugs.....& nurses

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(Could be a book title, huh?) I had a frustrating day yesterday.

One of the hardest (& thankfully very infrequent) roles is when the nurse has to be the "police" to a prisoner. Since I am usually in a "healer" role and have been for all 23 of my years in nursing, I absolutely hate it when somebody I've been trying to help starts acting out, being a "thug" and causes me to have to write them up......which resulted in a particular inmate being taken to SHU yesterday.

It all started when I wrote him a shot (Incident Report) for missing a call out for wound care--about 2 mos. ago. With all the MRSA we have these days, proper wound care is serious business (no matter where you are, but especially in a crowded environment). Accountability is an even bigger issue. The only escapee we ever had from our institution had missed a call out and was not reported by the department where he was scheduled. So accountability also becomes a security issue.

After I wrote this inmate a shot, he began refusing wound care...JUST FROM ME. Of course I counseled him each time & had him sign refusals. Since I am the only nurse available on many days and he could not do his own care because he has paraplegia, the care went undone. He is mentally competent and has a complex wound.......and I have reported this many times to Medical Administrative staff. This all culminated in a hostile situation when I counseled him that he had refused 24 times and his wound has gotten much larger since. This inmate has a history of assaults on staff--yes, even though he's in a wheelchair. I work alone on weekends and holidays in my area, but of course I have a body alarm. I'm not afraid, but I'm not stupid either. He began shouting, angrily waving his arms at me (in front of other inmates) saying I was denying him care (can you believe the absurdity?). I told him that wasn't true, that's enough and ordered him to be quiet. Of course he didn't. I radioed control that I was having an issue with an inmate and the stampede of help immediately arrived as he continued to hurl verbal accusations against me. He's in the hole because he was behaving like a thug. This morning he is in "timeout" wearing an orange jumpsuit and I am still wondering what can be done. I can't FORCE him to have wound care, but our institution cannot let inmates pick and choice who their caregivers will be. Please let me hear your thoughts on this. (I work in a Federal Prison.)

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I swear I have taken care of the same inmate before....except the inmate I took care of was a State inmate, had serious mental problems and has since died....I think. They were both non compliant para's that attacked staff while in a wheel chair though. I always wondered why an order to treat wasn't pursued in the inmates case.

If that wound doesn't get taken care of, you are going to be footing the bill for super expensive treatments that probably won't work anyway because his wound would be too advanced and he's non compliant.

The inmate I mentioned earlier had a a specialty bed (which cost 50K to buy, we just paid the pricey rental fee) for his stage IV coccyx wound while he was in the hospital. It was a special zero pressure, silicon bead bed. He also had a wound vac on which is also very costly. And then add on the long term abx, the hospital bill and you have got yourself one fat bill.

This inmate is clearly trying to manipulate staff, cause problems and play the victim. Then when his would starts advancing, of course he will blame medical. I know state and federal are different but what about an order to treat??

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I appreciate your reply so much! I wonder who inmates like this think they are hurting. I confess that although I wish I could blow it off and think nothing more of this situation, it does irritate me and I really wish it didn't. However, there has been only one other person I've ever had to "write off" my conscience and "turn them over to themselves" (like I really ever had any control of the situation in the first place!!). In the other case, it was a person who had had a wound for 9 yrs. that was the size of a grapefruit (so help me!) on the calf of her leg. I got it down to pea-sized and she began sabotaging every thing I did. The day she referred to her wound as "my friend," the light finally came on for me and I realized how much attention and control she had gotten of other people during the course of time she had "her friend." So my next move for THIS inmate is to ask his doctor to refer him to psychology and ask that they allow me to sign off his case completely.

Your response lets me know I'm not alone in this experience. Thank you so much!

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In the other case, it was a person who had had a wound for 9 yrs. that was the size of a grapefruit (so help me!) on the calf of her leg. I got it down to pea-sized and she began sabotaging every thing I did.

Amazing that you got a wound down to that small of a size! You deserve an award!

I know how you feel, sometimes I have inmates that get under my skin so much and I have trouble shaking the irritation.

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Specializes in Step Down/ Rehab, Psych & Correctional.

I have to laugh...Boy...no matter what prison you work in:jester:...inmate behavior is the same...

I think we've all had these inmates ....what is it with them? :argue:

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Time for a psych consult maybe?

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Specializes in LTC.
Time for a psych consult maybe?

Yeah, sounds like classic borderline behavior...it's funny, I've never worked in prison but have worked in plenty of NH's where there are half a dozen or so paras/quads who behave exactly the same. And the policy is clear in public populations..they have the right to refuse tx (read: let their skin rot off, stink up the room, and put other residents at risk), and the state apparently has the right to tag us for not taking care of them. :banghead:

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Specializes in ER- Correctional.

We have Medical Segregation cells,for inmates who refuse a treatment or medication, that could affect the facility as a whole(ie: MRSA or TB TX) Luckily most are compliant,as no one wants to be Seg. in Medical.It's a totally "No Frills" Place. Usually it takes one day, of the Seg cell ,with patient teaching about the well-being of the facility..& they come around & comply with tx. They really don't want to miss their baseball, basketball & other activities, over a medical issue, that take a few minutes out of their busy days. :)

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Specializes in med- surg home health corrections.

i feel your pain ive been a nurse 34 yrs and in corrections for 11. i hate it when u r trying to heal them and they refuse care even though we have them sign a release of responsibilty, i feel that i have failed to provide care i had a thug come in the other night with 34 stitches from a dog bite he got on the streetwhich they were like 3 weeks passed from having them removed once i started talking about the super bug his attitude changed real quick and it took me about 45 min ro get them out. i told him give respect /get respect but i love correctional nursing. its a passion with me

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