Is 1 nurse to 500 patients acceptable?

Specialties Correctional

Published

I am an LPN at a local correctional facility. We have an extremely bad turnover rate for nurses. We are supposed to have a Head Nurse in the AM and the PM (AM works 8A-4:30P and PM works 3P-11:30P, both M-F). The "regular" nurses work one week on Mon, Tue, Fri, Sat (AM 6A-4:30P, PM 4P-2:30A), and the alternate week you work Sun, Wed, Thur, Fri (AM 6A-6:30P, Fri 7A-11A. PM 6P-6:30A, Fri 7P-11P) So 2 nurses on each shift M-F (1 head nurse and 1 regular nurse per shift). Oh and we are ALL LPNs.

You now see how the shifts are set up but the real problem is we have at this time 550 inmates/patients. Even if we have a full set of nurses we usually have 275 inmates/patients to 1 nurse. I work nights and we are short a nurse on days so they have pulled our head nurse on nights to cover day shift. So 90% of the time I am working it is 1 nurse to 550 inmates/patients. I have to do diabetics, pill pass, order medications, check in medications, daily weights/VS, Sick calls, Blood work, see EVERY person in booking, PPDs, wound care, tend to every emergency, oh and last but not least PILL PASS! I give anywere from 500-600 medications a night which takes around 4-5 hours.

My main question is how legal is it to have that type of inmate/patient ratio to nurse? Also it is impossible to get all the tasks I have mentioned above and some BP, weights, Sick calls, etc. are not completed because there is not enough time to complete everything. Can I be held accountable for everything not being completed since it is not humanly possible for me to complete everything? I will be finishing my RN school May 2014, and I am worried about the liability of the workload that I currently have. Should I suck it up? Find anothed job? Or quit and focus on school? Any help would be greatly appreciated and if you are in a similar situation let me know what you do.

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That's insane! I worked in a jail for 2 shifts before I quit for that same reason. WAY too many inmates to the number of nurses & guards. I'm not risking my life/assault for a few extra bucks.

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I agree, insane.

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I work four, ten hour days (Mon. - Thur), and there are half that number of inmates here. They are not patients and, in times other than an emergency, must submit a written request to be seen by me or another level of provider. Additionally, unless the written request demonstrates something emergent I am not required to even address the issue. Right now 31% of the inmates are on some type of medication. I have been with the facility for one month and we have mutually adopted the policy of providing healthcare services relating to emergencies and basic needs. For example, we do not address difficulty sleeping, dental problems, or rhinitis. I think one nurse for 500 is sufficient. Most of my job relates to supply, billing, case management, and I issue medications during two of our four scheduled times. A lot of my "menial" work consists of ordering refills, finding prescriptions for basic need meds such as BP meds, and getting meds doled out for issue by other jail staff. I also triage inmates to be seen by the visiting doctor each week and make rounds in the jail getting the inmates out of their pods when needed, etc. I have a dual credential as I am a fully qualified and equipped deputy as well so I can also take care of the medical transports as well as security issues that I see requiring immediate attention. I try to refrain from doing anything else with or for inmates that they often request of jailers.

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

I worked night shift as one of two RNs in a facility with approximately 1,700 inmates. We did everything you listed and managed to accomplish it all. The problem with nursing ratios in prisons and jails is that not all of the inmates are patients, just potential patients. That is a big and very important difference.

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I worked night shift as one of two RNs in a facility with approximately 1,700 inmates. We did everything you listed and managed to accomplish it all. The problem with nursing ratios in prisons and jails is that not all of the inmates are patients, just potential patients. That is a big and very important difference.

Frankly, I don't even infer the inmates getting meds as being patients. They're inmates...getting meds.

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Frankly, I don't even infer the inmates getting meds as being patients. They're inmates...getting meds.

And I always make a point to refer to them as "patients." I am their nurse.

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Specializes in Rehab corrections med-surg.

In some prisons you are required to refer to them as inmates not patients

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Specializes in Correctional, QA, Geriatrics.

Try 1 nurse to 2500 inmates. They were not patients unless they were in our infirmary. It is not an inpatient acute care setting nor is it a LTC setting with patients requiring continuous nursing oversight. You have to use a triage system and there are other methods than the nurse administering all meds to help get med delivery accomplished. Depending on the state regs one can use Keep on Person (KOP) meds, certain corrections officers can receive additional training for pre packaged med distribution, staggered med/pill call times and not dispensing OTCs daily without parameters for assessment. When an inmate has to have money deducted from his canteen account to pay for sick call visit so he can scarf down his daily antihistamine and tylenol "fix" it is amazing how the numbers of requests for a "cold buster boss" go away.

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I worked in a federal prison with 3,000 inmates roughly and three nurses on PMs. We had to do all of the same things. The thing to remember is that they are inmates. Period. Secondly, not all of them get meds or need insulin, sick call, lab draws, etc. Ours also had to submit a written request for sick call. On day shift, we had more nurses and on NOCs, we usually only had 2. On NOCs, we had to do phlebotomy in addition to getting sick call started along with AM med pass and insulin call. We also had to go to the SHU (lock down unit) to do sick calls as needed and med pass three times a day.

We were also a "new" federal prison, so in the beginning, we were doing all of the above duties (and more) along with conducting intake assessments and in processing on several hundred inmates a week. We were working 12 hr shifts 5 to 6 days a week... not fun, but BIG $$$!!

You have to remember that not all of those 500 inmates are going to need things from you all at the same time. You can't really use a "standard" nurse/patient ratio in that situation.

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In some prisons you are required to refer to them as inmates not patients

Of course, when talking about them to custody staff or writing in the custody log (I usually avoid saying inmate and refer to them by name - Mr. XXXx), but I make a point of referring to them as patients in the medical documentation. Many of my fellow colleagues also refer to inmate, "Inmate complained of ..." "Inmate observed to be ...." That is their personal and appropriate choice. But I prefer to think of them not just as inmates but also as a patient needing my expertise as a nurse. I just like to keep the custody part and the nursing part separate. However, that does not mean I do not understand that their version of truth and others version may differ significantly; or that they may be very manipulative. But that may be true of any patient anywhere, yes? They are the same patients who were in the ER and hospital last week. (I work in jail, not prison though, so ALL of my patients aren't convicts:).

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Custody and medical serve 2 different jobs in a jail/ prison. My job as a nurse is to provide medical care, what or why theybare incarcerated is not for me to worry about. We as nurses should strive to provide the best possible care, whether to an inmate or patient.

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