Problem with Custody Sargents

Orca, ADN, ASN, RN · Oct 24, 2016

In my state, legally nurses must be supervised by nurses. I cannot imagine a system that allows custody officers to give direct orders to medical staff. If California has any sense at all, a complaint like this would go nowhere. We work cooperatively with custody, but they do not dictate what we do.

McNabK9, BSN, RN, APN · Oct 30, 2016

I work for the Department of State Hospitals. We are housed within one of the medical facilities for CDCR so I work around custody, but the boundaries are very defined because DSH and CDCR are two separate entities. I have had this problem when I worked with Psych Techs. What does the RN duty statement say? Does it say RNs will receive work direction from CO's? I think it can broken down three ways: What type of work direction, i.e. clinical? That is a no as RNs have the greatest license on the floor except for the physicians. Are they expecting RNs to do custody work? I would hope not but that would clearly not be ok as custody needs a badge and nurses didn't go to the police academy unless they are a Medical Technical Assistant who only have a PT or LVN license so again the greater license, they work under the RN license. So maybe they are giving administrative requests? If so, it should be able to clarified that in their duty statement. If it is RNs, theu would be a member of SEIU local 1000 Bargaining Unit 17. They can look in the Memorandum of Understanding, y which is posted on the Cal HR website if you need to access it from work. It is not blocked on Cal HR. They could also call their union. I would be very wary of taking work direction from a CO. If it is not in the duty statement and there is a negative consequence, they will be held liable. A CO is only required to have a high school education. Working in these big government entities, lines get blurred and staff gets asked to take shortcuts and work outside boundaries. Most of the workforce has never worked outside of state employment where staff is held accountable. There is pressure to go with the "party line" and sometimes it is hard to set boundaries. As the SRN, I encourage you to get the information you need so that you can share that with a CO or their Seargeant if they ask the RNs to do something they are not supposed to. Do your research, plan ahead and help the RNs have a response figured out so they can feel confident setting boundaries. My answer would be that it is my license, and I am not willing to risk losing it. It may be hard for them to understand because they didn't go to nursing school, but you can make the argument that they would not want to risk their badge.

correctrn · Oct 31, 2016

they can not give ordres that have a clinical aspect to it thay are not clinicians. that was a problem at our facility thanks to a strong nurse manager it changed.

mp1965 · Nov 1, 2016

Hi, I have been working in corrections for 15 years and this practice is quite common. In my area medical is just a commodity. We are not included or considered part of the correctional setting. the security staff especially those with rank can view our actions or decisions as not following orders and yes we get reprimanded as such. So much for nursing judgement.

GoBuckeyez10 · Nov 8, 2016

This is present in The Federal prisons also. I work in a Medical center that houses over 900 Inmates. Custody, mainly Lieutenants and AW's who oversee medical get way too involved all the time. I'll give one classic example I have seen. Inmate John Doe is written for Narcs, over approximately 2-3 months is caught diverting po narcs multiple times, and a fentanyl patch with his name on it is found on another Inmate. His narcs are stopped and he is locked down on administrative detention status. 4-5 week goes by, and all of the sudden He has an order for methadone again. Prescribing MD documents in his order. "Associate Warden asked me to resume Inmate's pain medication" So much for safety and security of the institution. Very frustrating but an impossible fight in the Federal system. If I didn't work there I would never believe how much the Inmates are catered to.

We sentence them to prison, appoint them an attorney because they can't afford one, and then let that attorney who the taxpayers are paying for threaten to sue the prison when they Inmates don't think they are getting the care they deserve. We are now treating Inmates with Heb C.........anywhere from 40-60K for their treatment. Only in America!

B52Bomber · Nov 23, 2016

I'm curious to know what the direct orders would be for them or the inmates? (You don't have to specify) but in the Wayne County jails in Detroit they have health administrators that refer to the medical directors regarding any implementation of treatment or development of guidelines and such. I know specifically in the mental health department that the administrator oversees social workers, other psychologists, general psychiatry residents and clerical staff. Also they report to and collaborate with the lead psychiatrist or medical director. I have not heard of nurses taking orders from custody officers, rather they should be assisting the medical/nursing staff with inmate assessments and implementing care if needed to make sure care is provided when and how it's needed. Most times I've heard of nurses providing education and guidance to the officers regarding safe and effective care.

Kooky Korky, BSN, RN · Nov 27, 2016

Hi, I have been working in corrections for 15 years and this practice is quite common. In my area medical is just a commodity. We are not included or considered part of the correctional setting. the security staff especially those with rank can view our actions or decisions as not following orders and yes we get reprimanded as such. So much for nursing judgement.

And where are your DON, CNO, or whatever the boss nurse is called, and other Nursing bosses?

Has Custody ever wanted you to do something you knew was wrong from a Nursing standpoint? What came of it?

Kooky Korky, BSN, RN · Nov 27, 2016

This is present in The Federal prisons also. I work in a Medical center that houses over 900 Inmates. Custody, mainly Lieutenants and AW's who oversee medical get way too involved all the time. I'll give one classic example I have seen. Inmate John Doe is written for Narcs, over approximately 2-3 months is caught diverting po narcs multiple times, and a fentanyl patch with his name on it is found on another Inmate. His narcs are stopped and he is locked down on administrative detention status. 4-5 week goes by, and all of the sudden He has an order for methadone again. Prescribing MD documents in his order. "Associate Warden asked me to resume Inmate's pain medication" So much for safety and security of the institution. Very frustrating but an impossible fight in the Federal system. If I didn't work there I would never believe how much the Inmates are catered to.
We sentence them to prison, appoint them an attorney because they can't afford one, and then let that attorney who the taxpayers are paying for threaten to sue the prison when they Inmates don't think they are getting the care they deserve. We are now treating Inmates with Heb C.........anywhere from 40-60K for their treatment. Only in America!

They also get to continue, at taxpayer expense, hormones to keep them whatever gender they say they are - if they have been taking hormones before being locked up. Maybe these aren't as costly as Hep C treatment, but it certainly costs something.

What I've come to realize is that this is a business. Custody personnel look at visitors' kids and say, "Job Security". And there are numerous other examples I've heard that tell me that certain populations are viewed as guilty until proven innocent and worthy only of jail and prison.

I also have experienced a Captain who wanted me to ship a certain inmate out for a medical reason to what I knew was the wrong facility. I thought he could wait to be seen by our Doc in the jail next morning. Cap was gunning for me after that. My blasted bosses, two of whom I spoke with for

advice, should have just told me to do what the Cap wanted. Instead, the B^%$#+ told me it was my decision, knowing I'd be on the Cap's list for death or worse after that. He at least assigned me

to a different jail after that.

Another time, a couple of guards wanted me to say an inmate was fine after they'd "chatted" with him. I said I would like to help them but couldn't risk my license by not truthfully charting and treating what I saw. I feared for my safety after this event, the above incident, and another incident.

That's the trouble if you don't go along with Custody - they might not be there for you in an emergency. They might let you get seriously hurt or killed.

NottaSpringChik, BSN, RN · Nov 27, 2016

Oh my gosh, your post is timely for me today. I practice in a jail which is not in CA but this exact same expectation has caused me problems throughout my time working in jails, most particularly this past week. Something happened on Wednesday which is going to cause me to probably give my resignation. I was told by CLassifications personnel (totally unlicensed ) and a custody deputy to do something. When the scenario played out without me doing what they ordered me to do with no questions asked they bullied me and ultimately went to management with such an embellished account of the incident that it did not resemble the truth. It is important to note that no patient was compromised by me not doing what they told me to do right away, in fact, what they wanted me to do right then was contraindicated to the patient at that moment. After a proper assessment and consent the patient received the an injection of the psychoactive medications I was ordered to give him "because it is on the MAR and he needs it right now." I didn't have some components of the injection in stock and wanted to wait to give the injection until I had the ingredients because giving the medication without both components wasn't effective. I told them the delivery was expected any moment. Also, the injection required consent which they never told me the patient had expressed a wish for. When I approached the patient he said he did not want the injection. I planned to approach the patient later in the day and offer the IM medication (also when I had all the ingredients) and had full expectation he would accept it later, which was the normal course of things. The patient actually did consent and receive the injection with all the medications in it that day! But because I didn't just jump up like a roboton with no questions asked and give the patient the injection (with ingredients I did not presently have in stock) and without even talking to him I was subjected to bullying and ultimately severely chewed out by my (temporarily acting) supervisor based on false information that didn't even resemble the truth. I am pretty sure I am going to quit this job now, which the day before this happened I was absolutely loving. So this is something I plan to confront this week and came here to seek the counsel of my colleagues. I think this cultural expectation(do what you're told with no questions - subjected to bullying if you're recommendations are not what anyone wants to hear) is unsafe for the professionals and patients. If I leave this jail I absolutely will never return to corrections nursing.