Leaving work at work.

Orca, ADN, ASN, RN · Nov 10, 2009

One of my jobs in corrections was as outpatient psychiatric nurse at a male correctional facility. One day each week the psychiatrist and I rounded on the intake unit, where he would do his initial mental health assessment. We heard stories of some of the most messed-up childhoods imaginable. Abuse, incest, open drug and alcohol use, parental abandonment, you name it. It was little wonder why some of these men wound up where they did. You are right in saying that we cannot fix these things. All we can reasonably do is to let them know that services are available 24 hours per day (in our case, after-hours care started at the infirmary).

To me it appears that you are internalizing too much of what you hear. This kind of suffering goes on in the community all the time. We just don't hear about it. Another thing to remember is that these men were not randomly pulled off the street and stuck into a prison. They had to work at it to get there. Some - perhaps most - were given many chances to avoid prison before finally being sent there.

A big part of the deterrent value of incarceration is that prison is supposed to be an unpleasant place to live. I do not believe that these men "deserve" to be assaulted, but they have made choices that put them in the situation they are in.

Every prison I know of has a protective custody unit, where inmates can ask to be placed if they are in fear of their safety. Inmates have options, even though they are limited.

There are many people who have had childhoods and experiences just as horrifying as those of the men in prison, but it has not caused them to resort to criminal activity.

shell911rn · Nov 16, 2009

Practicing nursing in corrections does not mean you stop practicing the art of caring, an essential component of our practice. We do have to distance ourselves more and probably should do this in other settings as well so that we can be therapeutic and prevent becoming overly involved with the inmate-patient. If we allow our emotions to cloud our thinking, how can we be therapeutic? I actually found it easier to leave work at work when I worked outside the walls, although I have had to learn to leave work at work in corrections, too, by not bringing my work home with me (i.e. memos that need to be written about a problem that I now make time to do while I am on the clock, not my own time). As the previous poster stated, a lot of people have had the same things happen to them in life and worse, and yet they didn't choose to be criminals. Sometimes I think part of the problem with our long-term inmates is they use their past as an excuse for their present behavior. They act as though they are the victims of the system, their own lives, society, etc., instead of accepting responsibility for the role they played in where they are at in their life. Instead of dwelling on where they came from, we should be helping them make a better life for themselves. That's being therapeutic, empathetic, as opposed to being sympathetic and enabling.

We can make a difference in the lives of an inmate by encouraging them to be better people and setting boundaries with them on what is and is not acceptable behavior so that they can go back in to society with new ways of behaving and coping. I joke that I am helping to "rehabilitate" them as I work for the "Department of Corrections and Rehabilitation," that I'm not just a nurse. We will reach some, but not all. A lot of our repeat offenders of suicide attempts have issues of attention-seeking, hence why they make repeated threats of suicide and/or attempts. The help they need is beyond our scope of practice. All we can do is refer them to the appropriate disciplines and practice therapeutic communication. It is not riding on your shoulders to change them or their way of thinking anymore than it was riding on our shoulders to change our patients' ways of thinking outside the walls. It can be harder in this setting, especially since we work with the same patients every day. But you have to maintain a professional distance in order to survive nursing and to be therapeutic. This does not mean you stop caring, though, about your patients, just because they are inmates.

jschut, BSN, RN · Nov 23, 2009

You are not the only one.

I hate working OP. When I see the emergencies tht come up, the young boys who are battered and bloody, and even though you know what has happened, they won't say. And putting them in Seg isn't an option. Overnight, maybe, but what happens when they are put back out in GenPop?

I prefer my Infirmary. I generally have the MI, the infections, the whacked out lab values.....

But no..... you aren't the only one.

RNonRun · Nov 23, 2009

No, Eirene, you are not alone. But you do seem to be internalizing it a bit (in my own reading and interpretation.) I too have a big heart. I try to just deal with what is in front of me. I do not work with your degree of mental health but while working in Corrections we all deal in Mental Health one way or another.

I don't know how much nursing experience you have or how old you are. I was "In Jail" for four years and I now have about two years of "Prison time" LOL.

Maybe its the area you work in. I prefer Jail in someways because it was hopping and more drama and lots of fun really. I also think there is more hope because even tho it too is a revolving door and they WILL be back, there is HOPE that they won't. Prison is much more final.

I try to be clinical like I would suppose an ER is like. Just do the job. You can show compassion but don't show weakness. I can get on a soap box about all the injustices in the world there are so many of many different kinds in the correctional setting.

Personally I couldn't work with youth because I wanted to slap them and hug them all at the same time and it was WAY too Heartbreaking for me. Too personal brought it home every night.

I have WAY more drama with my staff than I do with the inmates. I take some of THAT home with me at times. But I LOVE this line of work maybe you just need to find the right area of corrections to work in. I can't say I would do any better in your area until I tried it.

But no you don't have to be a hug-a-thug just because you have compassion in your heart.

Sorry, just rambling a bit. Don't give up. Lots of nurses have our perspective.

I just try to remember in all things.... It Is What It Is.

A little fact a Shot Caller told me one time. I am a nurse he is the inmate. I take care of his medical needs and do not judge (as much as possible)

--leslie

tbrd450 · Apr 21, 2010

Eirene, THANK YOU! THANK YOU!... finally, a true voice of compassion, reason and humanity. While everyone acknowledges that brutality leaves men broken, demoralized, raped and destroyed behind bars... as you said "I've tried to talk to my nursing friends about this. 99% of them think that they deserve this. After all, they are criminals."

As I read through the posts within this nursing specialty -- correctional nursing -- this is rarely spoken of (the injustices meted out on the people who arrive as patients). The only things I seem to read about is how these inmates are less than human, manipulative, game-players, untrustworthy, masturbating deviants, and things like how it is nice to be in the environment because correctional officers are close at hand to squelch any back talk, how it is nice that nurses don't have to deal with "inmate" (not "patient") families, how the inmates know not to get out of line, how nobody ever actually sees abuse despite seeing the obvious after effects of clear abuse, how correctional officers are willing to put a man in restraints because he insulted a nurse, etc... Finally! a truely compassionate nurse that has the internal fortitude, courage and integrity to stand up and point at the true and legitimate outrage of this "work environment." Young, nonviolent men, old men and weak men, are preyed upon in a truly barbaric environment -- that is where you work. That is your workplace. I would certainly think it would be the most commonly spoke of concern ... but nope... the main issues discussed are trivial in comparison. And, it is one thing to hear the BS from correctional officers...I kind of expect it from them,... but nurses!?!

Eirene, do not fool yourself into thinking that just because rape and assaults occur in free society it is okay that it occurs in locked up environments. They are totally different. There is no escape inside. These men were sentenced to incarceration -- that is it. They were not sentenced to being raped and brutalized every other day for the lenght of their stay. Nobody "deserve what they get." If one can't buy into that concept, then she/he has no business being a nurse. Actually, I wouldn't even think she/he should be permitted to be a dog catcher with that mentality. Don't ever allow yourself to slip into that mindset. You will regret how it changes you. Hold on to your compassion and scream about the outrages, file complaints, tell the media, speak to the prosecutors, and demand the basic human rights for all humans, yes, even convicts. Do everything you can to prevent a man from having to return to a general population of further abuse, where you know his mind, spirit, body and soul is one more assault away from total collapse. He will try to act tough, but he needs you. These men are not worth less than that by virture of their crimes. Believe it or not, it is mathematical fact that some of them are truly innocent. There are reports coming out all the time how DNA has proven that incarcerated men could not have possibly been involved in the crimes for which they spent half their life behind bars (in some cases a lifetime of brutalizations, rape and psychological torture). Look down the hall and ask yourself, which one(s) of these men are truly innocent. Some are.

Eirene, the easy road is to simply fall in line and accept that "it is what it is, what can I do?." Many of the soldiers, nurses, and doctors in Irag, Abu Ghraib, did just that. They now live with that knowledge. It took one lone soul of courage to stand up and say enough is enough. He released the photos and the world was shocked. It was identified for what it was -- clear, sadistic abuse and torture.

Trust your instincts. This stuff is not right, you know it, the incarcerated patients know it, and even the correctional officers and nurses that argue othewise know it. Don't be silent. Yes, think about it. You are a human being. That means your are mentally healthy. The inmates don't have the freedom to remove themselves from dangers -- sure, some can go into ad seg for a few weeks, but that just makes the brualizers more angry.

Eirene, continue to acknowlege, think and speak about it because that means you are moral and ethical. Do it for them and do for yourself. Based on what you have written, you appear to be the real deal. And, as such, you are worth a thousand other nurses who have allowed themselves to think detachment is okay, and "they get what they deserve". To them I say, if you want to be detached, then go be a car mechanic.

A broken, battered, bloodied rape victim with a prolapsed rectum needs your humanity. He is somebody's son. He played ball as a kid. He giggled as a toddler. He opened up presents on Christmas morning one year. He learned his ABCs. He is a human being.

He needs a real nurse -- he needs you.

Thank you, Eirene, for stating the obvious. Thank you for putting the real issues in correctional nursing in the proper perspective.

deyo321 · Apr 21, 2010

Wow just wow. That you could read this nursing specialty blog and come to that conclusion is beyond me. Reread what you bolded; the word correctional is not in front of nursing.

I have never read where a nurse in corrections wrote that inmates are less than human.

I have never read where a nurse in corrections wrote that they get what they deserve.

I have never read where a nurse who actually works in corrections stated it was a truly barbaric environment.

I have never read where a nurse who works in corrections meted out injustices on inmates.

I believe you are the first to use the term masturbating deviant.

Let me enlighten you: inmates are manipulative, untrust-worthy game players. And God help you if you forget that because you will be in no way effective in your role.

They are inmates that is the correct term. Just because you put it in quotes does not make it an aspersion.

It is nice to work in an environment where you don't have to deal with family members, surveys or abuse. Why is that a bad thing?

This is not some free for all jungle. Rules and structure exsist for safety. Why would you denigrate an officer not allowing a nurse to be disrespected? That makes no sense to me.

You use words like sadistic and toture is that to inflame? We work very hard to keep the inmates safe. Yes bad things can happen. You seem to argue on both sides without clear insight, and then you lump us together as incompassionate. You feel that weaker inmates are preyed upon, but you don't want the officers use what force is neccessary to keep a nurse safe? You can't have it both ways. Maybe it is not the most commonly spoken concern as you would have it because it truly is not that common. Trust me no one in my facility is being raped and brutalized every other day.

tbrd450 · Apr 25, 2010

I certainly had no intention of lumping everyone together -- all correctional nurses and officers -- as incompassionate. I was simply thanking Eireen for stating and exploring the real issues that should be on the forefront of correctional dialogue. If one simply explores the various threads throughout the correctional speciality, one finds an uncanny consistency of message. That being, as I previously stated, the second class consideration of the human dignity of inmates. And, that they all, everywhere, have it too good. When I write of "injustices," I am not referring exclusively, or even mainly, of those situations when the injustice is meted out by a staff (nurse, officer, etc.). That bad stuff does happen, we all know that. No, I was mainly referring to the environment in which we place these convicts. Society is at fault. We all are.

For many, their sentence is not just incarceration -- you know that. For many, some degree of other injustices are realized -- extortion, pressure, brutalization, assault, rape and even murder. You may only know about the official complaints. But every correctional nurse knows that many go unreported, unprosecuted and otherwise ignored. In most situations, I suspect, it is because the victim is smart enough to realize that revealing the truth may get him killed. For those protecting him, it is an 8 hour a day job. For him, it is his 24/7 life.

It is precisely a "jungle" like atmosophere that permeates many of this country's correctional facilities. In fact, it is that very "jungle" like environment that the main unions for the correctional officers describe and present as support for wage increases, at every negotiation.

Of all the people in the setting, I want to believe it is the nurses that hold on to the ideals and values that lead them into the nursing field to begin with. No nurse, no place, under no situations, should permit herself to become detached from those very ideals. No nurse, in my opinion, should ever view the person she is helping as anything other than a patient. If she can't do that, I don't think she should be a nurse in the correctional setting.

Every one of the "I never read" are, in fact, precisely supported by statements I found throughout the threads in this speciality. If you want, I can point you precisely to them -- just a sampling. Here is a good one: Post: Correctional Nursing Humor by Kb23503 - Post: BsninTX March 5, 2007 12:07 Pm: "I often suggest my inmates stand very close to the wire at 3 am. That way, the perimeter patrol officer can deliver their medication most effectively ... in the 12 gauge dosage."

You don't even have to search far and wide for more. It is absolutely amazing the consistency, and standardization of the apparent tone, attitude and outlook that seems to surround the correctional environment -- the culture of silence. The view that inmates are something short of human, something less than, all manipulative, and deserving of whatever comes their way.

I mentioned the Abu Ghraib situation to illuminate this correctional culture of silence. It is a psychological given that people with power over other people will, eventually, find that very power intoxicating and difficult to resist. Look up the Stanford prison experiment. Doctors, medics, soldiers and nurses pretended that the stuff going on over there was not abuse and torture. I'm sure many claimed to have "never seen anything." Then the photos came out. Nude prisoners, in the hundreds, were being paraded around, piled in pyramids, and well, tortured. That is the only reason I mention that here -- the culture of silence. It is interesting, don't you agree, that the main ringleader in that disgusting display of inhumane treatment was, in fact, a Pennsylvania correctinal officer before shipping off to Iraq ??

Eirene, you are truly not alone. To you, I now say, most people are followers. Most people, even if they themselves are internally disturbed by what is going on around them, will say nothing and avoid the difficult path at all cost. One need only look back to 1938 Berlin, Germany. Eirene, you are not alone, but you are outnumbered. Your path may present you with a fork -- a choice to make. When you have to make that choice, I only ask that you follow your instincts and do the right thing.

Please, I mean not to offend any particular individual working in corrections. It really must be difficult work. It is the system that needs to be fixed. It is the environment that is in need of examination. In an ideal world, every correctional officer would get twice the salary he/she now makes, but would have at a minimum a PhD in Psychology. In an ideal world, the Eirene's would be in charge of medical services, and they will would be well compensated.

tbrd450 · Apr 26, 2010

With regard to not allowing an inmate to "disrespect" a nurse,... restraint chairs, stun guns, pepper spray, cell extractions and all other forms of "security compliance" endeavors are not meant, ever, to be used as punishment. They are only to be used to secure the safety of everyone. However, everyone from the school nurse to the surgeon general knows all too well that in this nation's prisons and jails (many of them) they are used precisely for punitive, punishment, and "disciplinary" reasons.

That is why correctional lawsuits are as common as Nascar shirts at a tractor pull.

Verbal assaults do not warrant beat-downs, pepper spray, cell extractions and whatever other indignities can be couched under the guise of "security."

Hopefully, as surveillance becomes more and more widespread, these sort of abuses will necessarily reduce in frequency. The irony regarding the rising proliferation of surveillance cameras in the last decade, is that they are often more beneficial to the abused detainee, inmate, or aresstee. The original intent -- to protect officers from charges and lawsuits --has seemed to backfire to some extent.

As our society evolves, and becomes more humane in how we treat those in custody, our standing in the world will improve. And, across the globe, I suspect there will come a day many years from now -- maybe a thousand -- when we all look back on our treatment of those in custody during this period of human history with amazement and disbelief.

Somebody pretty important once said something to the effect of: That which you do to the least of us, you do to me.

Orca, ADN, ASN, RN · Apr 26, 2010

No nurse, in my opinion, should ever view the person she is helping as anything other than a patient.

I completely agree. This is one reason I never ask what an inmate is serving time for, because I don't want my personal feelings about what the person has done to affect the care I deliver.

In terms of punishment, I am not here to deliver it. The courts have already done that by taking away the freedom of those in my care.

That said, there is a distinct difference between caring and empathizing so much that it affects your personal life. If you can't have some degree of detachment, prison is not the place you should be working.

mikethemurse, BSN, RN · Apr 28, 2010

Well, this has really generated a great deal of discussion, so first let me thank the original poster for that. I work in a county jail, so my perspective comes from my experiences there. I love my job! I sort of fell into corrections, and am so glad that I did. I work over night at my facility, and am the head medical professional at night, which includes mental health. So I have had to deal with self mutilation, suicide attempts, and Pt coming off of "wet" who are hallucinating, and violent. And to answer the first part of the discussion, jail is not an easy place to work, and yes the inmates are subject to dangers that most of us have never even thought about, being afraid to sleep for fear of rape from your cell mates, entire blocks beating you down because you "snitched" on another IM. These are horrible and brutal situations that we see/hear about, and ultimately try to treat medically, and report to the approp. authorities in order to prevent in the future. The system is not perfect, I agree. And we (as nurses in this field) all know that. Now to the question about taking the work home with you. No I don't. Now that does not mean that I do not care for my patients, because I do. I do my job, and I support, care for, and treat all of my patients in any situation. I am a Nurse. I take that title very seriously as everyone who has worked so hard to become a nurse does. A patient comes to the infirmary, I see my patient, not a violent criminal who deserves whatever has brought him in front of me be it a cold, or a fight. But when I go home, I don't let the horrors of the night consume my thoughts. Yes, if you feel that a patient is being brutalized DO SOMETHING ABOUT IT!!! That is your job, be the patients advocate. That is something that in corrections you need to be even more than on the "outside" because these patients can't or won't advocate for themselves. That being said, I don't care if you are a nurse in a jail, an ER, or on a L and D unit, you have to be able to displace your emotions from your professional responsablities, in order to deal with the trauma of the job, and to be effective as a nurse. I have had some hellish nights at work, but when the dust has cleared, I know that I have done everything in my power to care for my patients. Now because I displace myself does not mean I am an uncaring jerk!, It means I am a professional.

Now as to some of the stuff that I have read in this thread...

1. Nurses like to complain about their jobs, it is an outlet...if you read any of the specialties blogs, I am sure you will be able to find nurses complaining about what ever kind of patients they have to deal with everyday. The peds nurse saying, "if I have to deal with another parent that thinks they know more than me..." We deal with inmates who do manipulate given a chance, and this is forum is meant for nurses, who may not want to deal with "major issues" all the time and may want to just vent.

2. Now as to the "off-color" kind of humor that was noted by another post, I know that some of the jokes that nurses, and other health professionals (especially those who work in high stress areas such as corrections) use can be looked at by others as being cruel, but that is just a defence mech. A way of dealing with a stressfull situation. Does it mean that the nurse is cruel and uncaring, no it is just a joke, an outlet used in this a safe situation where nurses are speaking to others who understand the stress, and the taxing situations we all have to go through.

A final thought in this already long rant that I have gone on...

This is a difficult and rewarding specialty in nursing, one that not many nurses could or even would do if given a chance. We have to be understanding of one another, and try not to judge, anymore than we judge our patients. I don't think that anyone who does this type of nursing is anything less than an extraordinary nurse, and find it hard to believe that if given half a chance would not go above and beyond in order to help a patient in need. If this is not the case in the institution that you work in, by all means endevor to change it. I am sure you will find like minded nurses where you work. There are many terrible things that can happen to our patients in prison/jail, we need to do our job in attempting to keep all of our patients safe. Be an advocate. If someone closes their door and won't listen to your concerns keep going up the chain until you are heard. But leave work at work. The ER nurse who goes home with the tragedy of the shift occuping their mind, won't last long. It is the same in our specialty.

Like I said...good thread! Thanks for generating the discussion!

tbrd450 · Apr 29, 2010

The caring nurses (I suspect probably most, but certainly not all) whom do their job professionally within the correction setting, as nurses treating patients, are absolutely invaluable to the system. The inmates, the officers, and the law-abiding, tax-paying citizens definitely rely on them; and we all want them to want to come back to work tomorrow morning. It probably is really not much different than what is needed in any other nursing setting. The things the typical ER nurse must see, for example, would probably burn images into one's brain that are forever life altering if there wasn't some way to psychologically move past it at the end of the day.

However, I happen to think that a correctional setting often is different in some unique ways. I think it necessarily desensitizes the nurses and officers to some things they probably should really try hard to avoid becoming desensitized to -- mainly, the perception that the inmate is somehow less deserving, however slight, of care, compassion and protection in time of crisis and need. The correctional system is a very unique platform for human activity and interaction in any civilized society. In no other setting of human society are the patients more vulnerable, trapped and scared.

Some scientifically devised surveys have shown that correctional officers often change -- their personalities change -- after a period of time in the line of work. They often display PTS symptoms -- aggressive with wives and family, detached from children, etc..

"the inmates are subject to dangers that most of us have never even thought about, being afraid to sleep for fear of rape from your cell mates, entire blocks beating you down because you "snitched" on another IM. These are horrible and brutal situations that we see/hear about, and ultimately try to treat medically, and report to the approp. authorities in order to prevent in the future."

"When I see the emergencies tht come up, the young boys who are battered and bloody, and even though you know what has happened, they won't say. And putting them in Seg isn't an option. Overnight, maybe, but what happens when they are put back out in GenPop?"

This is a story! This is worth discussing. This is a problem and clearly not the correctional environment that should be allowed to exist in a civilized society.

I completely disagree with the statement: "A big part of the deterrent value of incarceration is that prison is supposed to be an unpleasant place to live. I do not believe that these men "deserve" to be assaulted, but they have made choices that put them in the situation they are in."

This sort of statement is one that resides on very slippery slope. It sort of serves to lay a foundation for justification. I say it is much clearer than that. If they don't deserve this treatment, they shouldn't be getting it. If they don't deserve this punishment, they shouldn't be getting it. They made choices that put them in incarceration -- that was their punishment. The judge didn't say to the convict at time of sentencing: "3-5 years with whatever beat-downs and brutalizations that come your way!."

The brutality of the environment is the story,... it is the crisis!. It is the real outrage!

I often hear officers talk about how the general public really doesn't understand what they have to put up with. I often hear an interviewed officer pose the standard, rhetorical question: "What would society do if every correctional officer went on strike tomorrow?!?" The clear implication being that society would then have to deal with the monsters themselves. I would like to pose a rhetorical, thought-provoking question back at them and society: What would happen if every correctional officer and correctional nurse went on strike tomorrow demanding that enough resources, training, staff and services were made available such that no inmate would ever again have to live in fear of beat-downs, assaults, rapes, coerricive extortion, etc. ? What if the focus of the dialogue shifted to the those whose very lives, souls and spirits are on the line -- the inmates ?? Or, at least the dialogues was at least mentioning them from time to time ??

I know the good nurses and officers have an uphill climb. But, sometimes the issues just have to be put in their proper perspective. Nurses who want to let off steam...of course...tell some jokes, call the inmates whatever.... but, please, when you enter the iron gate tomorrow morning, please just behave as if you find that sort of thing offensive. You never know whose life you may indirectly impact. Let the patient feel like a human being for the 15 or so minutes you see him. Let the CO know that you will not be a part of any jail-house justice. Let the inmate know that you understand his fear of retribution for speaking up... And, then, speak up on his behalf. You will like yourself at the end of the day. Trust me on that one.