Nurses Misbehaving While Caring For Inmates

tbrd450 · May 15, 2010

Wow, great discussion.

Orca, you wrote: "That said, I am not there to find the good in inmates or to walk in anyone's shoes but my own. I am there to provide medical care - period. The reality is that I work around convicted felons, and living an honest, clean life isn't what brought them to where I work."

Unfortunately, I must admit that I see little danger of anyone searching for, let alone seriously attempting to find, the good in these guys. In my humble opinion, there is far too much of the reverse going on -- deliberating identifying the worst. However, I stand by my contention that you don't really know what brought these guys to where you work. To assume, by default, that they are all, everywhere, deceptive, manipulative and playing a game is not only inaccurate in many situations, but also a bit irresponsible if, and that is a big IF, you treat them based on your default preliminary assumption. I don't think you do. However, there is something telling me that maybe you are just a bit quick with the universal characterization of the 2 million incarcerated Americans (95% of whom are in incarcerated for a nonviolent offense). Sure, you may have access to a file, a transcript, some notes and maybe some rumors (regarding these people in your care), but I'm sure you realize that there are many many things you don't know as well. I caution you do be a careful with your presumptions when it comes to humanity -- people come to jail and prison representing the full range of human capacity and experience. In your quest to not know about them, you also don't know the good things these guys have done. I caution you to be careful with the "us" vs. "them" mentality that too often permeates the correctional environment. When such an environment is permitted to foster, research has clearly shown that a slow, consistent chipping away at humanity -- a desensitization -- necessarily follows. The dehuminization of the incarcerated is a very real problem, unfortunately, and one that hinders real efforts to rehabilitate people. An extra knee in the back during take-down when it really isn't necessary; a full can of pepper spray instead of the necessary three-five controlled bursts; An unnecessary shakedown or strip search just to remind everyone who is in charge; a disciplinary report inconsistently applied or for trivial infractions as a retalitory strategy, etc. Unfortunately, this is the environment in far too many facilities -- usually permitted to be cultivated by a minority of staff and yet exist unchecked well under the radar of free society. This is a "Job" for many working in corrections, and, yet, it is the very spirit, soul and lives of those incarcerated that is on the line every day.

Someone asked if I was ever an inmate -- no. I was not. However, if I had been one I would face an uphill in refusing to allow it to define me. I would face an uphill climb in not allowing others to use it against me in defining me. Some people in society use the "us" vs. "them" strategy as a crutch to elevate their own little lives. When you can lower the value of others, they think, you can elevate your own value. They feel better by creating a false "us" vs. "them" psychological platform from which they administer daily pats on the back for keeping society safe.

I am a humanist. I am a strong supporter of equality and human rights -- all humans, everywhere. I was never an inmate, but I can think of no other segment of humanity that is in more need of consideration and oversight in terms of ensuring rights than the people incarcerated.

Anne128 · May 15, 2010

Question to TBRD450-

Several posters have asked if you are new to corrections and I noticed you opted not to answer that question. As a prospective new Corrections Nurse, it would be valuable to me to know if you are in fact new or seasoned in this setting? While your evaluation of the role of a nurse or a self described "humanist" in corrections is interesting, my hinky meter says you may be new to this field. Do you work in a jail or a prison? For how long?

Nurse_Tricia, LPN · May 15, 2010

I think if you are a humanist and looking for a worthy cause, look into foster care.. Stand up for those children who have to live in deplorable conditions and be shoved from one to another home because of NOT the decisions they made, but the decisions made by their parents ( Many of whom you are providing a "caring touch" for while their children go starved for love and in many cases starved for even the necessities of living.) Personally, I still think you are or have been an inmate or are in a romantic relation with an inmate. My :twocents:

tbrd450 · May 15, 2010

Anne128, thank you for your question. Before I answer that I would like to propose a little experiment. I would like to ask you to consider the following two questions, take a little time and think about them in more than just a cursory fashion, and then respond to them. I will then answer your question.

1. If tbrd has had extensive correctional experience, that will impact my interpretation of what he has written in what way?

2. If tbrd has not had extensive correctional experience, that will impact my interpretation of what he has written in what way?

Nurse_Tricia, thanks for the advice. A while back, I did some work in Foster Care. It is definintely one of many worthy causes out there. I managed caseloads of teenagers who had some of the most horrible childhoods behind them. It was heart-breaking to watch many of these kids self-destruct emotionally, psychologically and even, in some cases, physically. You are absolutely right about "choices." Children don't get to pick their parents and, unfortunately, for some of these kids I encountered it appeared as those life-long pathways toward self-destruction were seemingly pre-programmed from early childhood. It is vey sad. I can truly say that for some of these precious little souls I had the privlege to get to know, they never really had a chance. Some of those same kids now sport mohawks, too many tattooes, and cold-hearted, piercing stares through hardened adult eyes. Unfortunately, a disproportionate number of them now refernce the County and State correctional facility when prompted for a home address. In many ways, when I do see them now from time to time I still see them as those "kids" they used to be.

People are more than an event. People are not defined by a mistake. People are made up of millions of brief moments, lasting experiences, psychological break-throughs, good deeds, bad deeds, hate, love, and relationships that are strung together in a cosmic network of humanity. We are all linked -- there is no "us" vs. "them." We do not have to choose sides.

tbrd450 · May 15, 2010

Orca wrote: The continued use of the word "empathy" was another red flag, because no nurse needs to completely identify with his/her patient to be effective.

From: PubMD: "Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and © to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting."

Nurse_Tricia, LPN · May 15, 2010

I could be wrong, but I believe when they speak about empathy, they are speaking about the medical situation, and not in life in general. I perceived it to be used as in ex: A patient has just come to you after falling off a ladder, he is screaming in pain. Empathy would be identifying with his experience of pain. Therefore, stabilizing him and if ordered by the doctor providing pain relief. Not showing empathy would be not to identify with his/her pain and not to provide relief. I wouldn't ask about his life, nor would I give any information about my life in which a different communication or bond may be started. You know my Mom was a terrific ER nurse for 30 yrs. As a kid my brother put his hand in a snowblower and cut off his finger. I don't think I have ever seen my mom become so unraveled in her life as those moments. I am sure my Mom has seen many of fingers, arms and legs severed from her patients before and had only the thoughts of performing her duties as a nurse should for the best outcome of the patient. However, when it was someone whom she loved and was on that emotional level..well, she was a hot mess and not in the good way either.

My mom finished her years working in psych/correctional for kids. On her last day of her nursing career (not by plan) she had a 12 yr old girl knee tackle her and another aide to the floor and pound on them. Neither have been able to return to work after 11 yrs. She states she would have never have guessed out of all those there (and there were some tough kids, gang members from other states) that girl to have been the one to do it. So, I believe what Orca says about using Universal Precautions and just being aware of your surroundings. there is nothing wrong with NOT sharing life information with your patients. If they need an ear, I am sure there is a chaplain. Nurses are there to provide medical attention.

tbrd450 · May 15, 2010

Nurse_Tricia wrote: "I could be wrong, but I believe when they speak about empathy, they are speaking about the medical situation, and not in life in general."

Nurse_Tricia, exactly. This is certainly addressed within the context of the medical situation. As nurses (I am not one), I would certainly want to believe they (nurses) bring empathy to the proverbial table, regardless of where that table may be. I am starting to think maybe we are all thinking about "empathy" differently. When I reference that word, I am not implying one has to/should engage the incarcerated patient on a life-altering universal journey toward personal ephphany or social rehabilitation. No, that would not be practical in any medical setting, and it certainly would not be advisable for anyone without at least a Master's Degree in a Psychologoy related field. I am talking about viewing the "inmate" as a "patient" when he comes for help. I am talking about delivering quality care without automatically presuming he is necessarily always lying. I am talking about extending the benefit of doubt to a person based on his position, or temporary role in your clinic, as a "patient." To do this, I happen to believe, one has to at least momentarily imagine what the patient is experiencing, feeling (at the moment), and likely facing with his injury or illness. One has to care enough to engage the human in need, as a human worthy of your best. One has to empathize with the patient, however slightly and briefly, if for no other reason than to avoid delivering rote, mechanical care based on a standardized medical algorithm -- something best left to those repairing robots at NASA. I sense that all too often some of those working in corrections begin to learn to face each new correctional day based primarily on their experiences (usually negative) from the previous day, in terms of viewing the unique individuals under their watch and care. It is very challenging to face nine manipulative patients ("inmates") in a day, for example, only to guard steadfastly against automatically presuming the tenth is necessarily lying about something for alterior motives. The longer one stays in corrections, the slippier that slope can become -- a slope toward potential complacency, emotional disconnect and desensitization. While the ramifications of, say for example, a prison correctional officer or a prison administrator sliding that dangergous slope are certainly serious, the ramifications of an actual care giver (a correctional nurse, or doctor, for example) are for more detrimental and far reaching -- not only to/for his/her patients, but also to/for him/hersef.

Inside the correctional facility, the wards (inmates, charges, whaterever you wish to call them) are people first and foremost. They never relinguished their humanity. One may think/feel they don't deserve that status (based on one's own politics and emotions around their crimes), but that has to be checked at the gate. Every imaginable rule, policy and guideline within the correctional facility is based on and centered around keeping free society and facility staff safe first and foremost from these inmates (even the 95% of incarcerated Americans that never committed a violent offense). And, clearly, listening to other correctional nurses it is clear they often never felt safer than they did once they began working in corrections. It must be working in that sense.

However, unless one is diligent, daily, about facing his/her own biases and prejudices against this mass of PEOPLE walking around in organge jumpsuits, one risks losing his/her own humanity, not to mention engaging in very damaging dehumanizing interaction with, and care for, his/her inmates ("patients").

Anne128 · May 15, 2010

TBRD-

In response to your questions- YES. It would absolutely make a difference to me as to whether you have worked in corrections or not, and whether you are a newbie or seasoned in the correctional setting. I am not so sure your "bleeding heart" (as you self-described in another post), humanistic approach is being validated as a sensible or appropriate foundation of practice in correctional nursing by other seasoned correctional nurses here. Being a seasoned hospital nurse without any corrections experience, knowing your background as well would be an essential key for me to weigh and balance the value of your ideology vs. the ideology of those with stated experience. You sound much more sympathetic than empathetic, which is a danger zone. I also agree that correctional nurses focus on medical issues and assess for needed referrals out to other professionals. (ie: psyche, social workers, clergy etc.) Perhaps your wholistic, emotional approach (which is valuable in other settings) would not be truly an asset in corrections. Just a guess, but is your background in public health or hospital admin? Both?

Any responses?

tlc365 · May 15, 2010

I work as a "pill pass" nurse at a state facility in AZ. I am employed through an agency and started at the end of March. I have learned so much in the past 6wks. I could start writing a book. Several nurses have been walked out of the facility d/t issues with giving things, including themselves, to inmates. I do treat my patients with respect but still look at them as criminals..because that is what they are. They know how to play "the game" they all want special treatment and feel the need to be at the head of the line for anything. They try to circumvent the system and will use YOU to do it. The key is to remember the facts of the situation and use critical thinking skills. Relay on medical records to paint the picture. You will find interesting info about previous complaints and it helps you to decide what is B.S. I am an LPN and only doing this through the summer until I grad RN school this fall. I primarily pass pills to inmates but often when I am on the "yard" I am called to assess situations and often times inmates who don't need meds come in line to have me address issues they have with ANY medical issue, pharmacy, dietary, dental, and vision issues. So knowing how to sort out what is important is a major part of the job as well. Like I said most of them want "the front of the line" and try to get me to meet their issue NOW. But the system is so slow that all I can tell them is it is out of my handsand inform them to put in a Health Needs Request(HNR) and that is sometimes frustrating for the legit issues 5% of them have. As for the staff also Trust No One. I hate to say it but sometimes you have to be as superficial as they are. I go in with a smile go with the flow and do not get involved with gossip and drama I stay so neutral it HURTS!! LOL but anyway that is the key to my survival and I am actually less stressed out at this job then I have been anywhere I have worked in the past 6 yrs!!

katkonk, BSN, RN · May 15, 2010

I am guessing that this posting is by someone in the psych/social work field. But, WOW...did you pick the wrong group of people to lecture about...hmmmm...what was it...oh yeah, humanity! You are going to LECTURE a bunch of nurses about humanity ??! (as per your post -"I caution you do be a careful with your presumptions when it comes to humanity") As nurses working in the correctional setting, we know what it is like to care for the disenfranchised, AND those that would slit your throat or rape you if given the chance-anyone that has not "walked in our shoes" as you put it, does not know what it is like. And many, if not most, come from other backgrounds in nursing where we watch and help people die or as they are dying. We get the full "big picture" of the good and the evil in people. Lectures and verbosity is not needed in these chats. Exchanges of ideas and discussions are great, but lectures do not belong here, especially by non-healthcare workers. Seek a social worker site. Or perhaps a site for corrections psychologists or counselors. And yes, there are good nurses and bad nurses and everything in between in corrections. But, in corrections, regardless of your viewpoint, there is too much to do in just trying to triage and treat or refer every complaint that comes in. There are too few staff, too many inmate health complaints, too many medications to give, and too many emergencies to respond to, to keep chatting with offenders (as we call them) and drill down to the core of the poor suffering human beings behind the label "offender". That is WHY the mantra for corrections health care is FIRM, FAIR, and CONSISTENT. For me, this thread is now done!

tbrd450 · May 16, 2010

KatKonk wrote: ["There are too few staff, too many inmate health complaints, too many medications to give, and too many emergencies to respond to, to keep chatting with offenders (as we call them) and drill down to the core of the poor suffering human beings behind the label "offender".]

Wow, when did I ever advocate such an approach ??

Could it be, possibly, that maybe you have read a few sentences of mine and then launched prematurely over to some standardized, preconceived, canned conclusion(s) about who I am and what I advocate. Please help me here, when did I ever advocate: ["to keep chatting with offenders (as we call them) and drill down to the core of the poor suffering human beings behind the label "offender".] The very fact that you appear to be implying that was ever my intent sort of reinforces one of my main points -- let's just try to remain clear and objective about my message (anybody's message, including the inmates'), let's try to remain clear and objective about what I contend (what anybody contends, including the inmates'). In fact, in my last post I basically said that [for example: drill down to the core of the poor suffering human beings behind the label "offender".] is certainly not what I advocate nurses (anywhere) do on behalf of their patients. Heck, that's certainly true of nurses in the hospital, doctor's offices, medical clinics or any other free society institution. Not only is it impractical but it is also not the role of a nurse. Granted, correctional nurses are more likely than other nurses in other settings to see their same patients day after day and thus be tempted to go beyond basic clinical empathy. But, I certainly don't think the typical nurse is qualified, nor availabe, for such endeavors.

I fear that you may have presumed I meant that simply because I associated the word "empathy" with correctional nurses???

re:["the poor suffering human beings behind the label "offender".]

I detect a bit of anger and frustration behind these words. Maybe you feel/believe that is overdone in society? ... the reliance on past experiences for explaining present behavior? Maybe you believe/feel inmates over-do the "poor suffering human" excuse?

Honestly folks, um ... why such a defensive posture? Have I touched a nerve here?

KatKonk, you described a failing system: "too many inmate health complaints, too many medications to give, and too many emergencies to respond to" ... as I read that, I could almost visualize someone angry, frustrated and on edge standing at the head of a long line of inmates trying to keep everyone's meds in order over the noise and chaos of a mid-day correctional med-line?? You should not have too many of anything to manage. There should be, in every correctional institution residing in one of the wealthiest nations on the planet, enough high calibar, well-trained, well-paid, staff to deliver the care and service in such a manner that nothing, including the very cornerstones of nursing standards and ethics, is ever remotely in danger of compromise. This is exactly one of my main points I have been trying to make.

Often when institutions begin to fail, when staff melt downs lead to abuses and "inappropriate" behavior, when patients (inmates) are generalized in to oblivion, when the us vs. them culture is cultivated and permitted to foster under the veil of security, it does so far too often with basically decent, law-abiding participants and bystanders. I see that it is often referred to as "turning" from those posting on the inside. Curious about someting, once "turned," do you perceive these past co-workers of yours you do all convicts you encountered prior to the day he/she got walked out of the institution? Do they now become the "them?" in your mind? How do you reconcile that?

As I posted before, the correctional environment is very unique in a civilized society -- it is a stage on which the actors' integrity and genuiness is difficult to hide or fake.

I certainly never intended to offend anyone here, and I really can't admit I ever wrote anything that was offensive to any individual. I do suspect I have touched a raw correctional nerve. I offered advice to someone starting out, I put my opinion out there for readers, and I advocated for those without a voice in a forum I thought would be most conducive to that.

Anne128 · May 16, 2010

KatKonk wrote: ["There are too few staff, too many inmate health complaints, too many medications to give, and too many emergencies to respond to, to keep chatting with offenders (as we call them) and drill down to the core of the poor suffering human beings behind the label "offender".]
Wow, when did I ever advocate such an approach ??
Could it be, possibly, that maybe you have read a few sentences of mine and then launched prematurely over to some standardized, preconceived, canned conclusion(s) about who I am and what I advocate. Please help me here, when did I ever advocate: ["to keep chatting with offenders (as we call them) and drill down to the core of the poor suffering human beings behind the label "offender".] The very fact that you appear to be implying that was ever my intent sort of reinforces one of my main points -- let's just try to remain clear and objective about my message (anybody's message, including the inmates'), let's try to remain clear and objective about what I contend (what anybody contends, including the inmates'). In fact, in my last post I basically said that [for example: drill down to the core of the poor suffering human beings behind the label "offender".] is certainly not what I advocate nurses (anywhere) do on behalf of their patients. Heck, that's certainly true of nurses in the hospital, doctor's offices, medical clinics or any other free society institution. Not only is it impractical but it is also not the role of a nurse. Granted, correctional nurses are more likely than other nurses in other settings to see their same patients day after day and thus be tempted to go beyond basic clinical empathy. But, I certainly don't think the typical nurse is qualified, nor availabe, for such endeavors.
I fear that you may have presumed I meant that simply because I associated the word "empathy" with correctional nurses???
re:["the poor suffering human beings behind the label "offender".]
I detect a bit of anger and frustration behind these words. Maybe you feel/believe that is overdone in society? ... the reliance on past experiences for explaining present behavior? Maybe you believe/feel inmates over-do the "poor suffering human" excuse?
Honestly folks, um ... why such a defensive posture? Have I touched a nerve here?
KatKonk, you described a failing system: "too many inmate health complaints, too many medications to give, and too many emergencies to respond to" ... as I read that, I could almost visualize someone angry, frustrated and on edge standing at the head of a long line of inmates trying to keep everyone's meds in order over the noise and chaos of a mid-day correctional med-line?? You should not have too many of anything to manage. There should be, in every correctional institution residing in one of the wealthiest nations on the planet, enough high calibar, well-trained, well-paid, staff to deliver the care and service in such a manner that nothing, including the very cornerstones of nursing standards and ethics, is ever remotely in danger of compromise. This is exactly one of my main points I have been trying to make.
Often when institutions begin to fail, when staff melt downs lead to abuses and "inappropriate" behavior, when patients (inmates) are generalized in to oblivion, when the us vs. them culture is cultivated and permitted to foster under the veil of security, it does so far too often with basically decent, law-abiding participants and bystanders. I see that it is often referred to as "turning" from those posting on the inside. Curious about someting, once "turned," do you perceive these past co-workers of yours you do all convicts you encountered prior to the day he/she got walked out of the institution? Do they now become the "them?" in your mind? How do you reconcile that?
As I posted before, the correctional environment is very unique in a civilized society -- it is a stage on which the actors' integrity and genuiness is difficult to hide or fake.
I certainly never intended to offend anyone here, and I really can't admit I ever wrote anything that was offensive to any individual. I do suspect I have touched a raw correctional nerve. I offered advice to someone starting out, I put my opinion out there for readers, and I advocated for those without a voice in a forum I thought would be most conducive to that.

And..you still have not answered the most frequently asked question.. Have you worked in corrections, if so, in what capacity and for how long? Thanks in advance.