lassieSR

Can anyone give me their opinion of what inmates are entitled to at county jails in CA? I've been at a county jail for past few years, getting feedback that I was doing an exceptional job. I have a new manager who has very little clinical (or management) experience. My manager is requiring an HR meeting now after he told me I was being too detailed in my assessments and charting. He says the jail inmates are to receive the minimum amount of care. He said mine wasn't a job to "go above and beyond". I do all the scheduled nurse sick calls on one day of the week, Saturday, and our on-site provider does NP sick call one other day. There are no nurse sick calls on other days because the manager doesn't allow for this. He is now telling me I am doing too much for the patients, and I feel like I am being gaslighted. I am really confused and I have no one to ask because the regional manager is not interested. Anyone out there who can give me an opinion?

As an RN for 45 years in acute care and last 3 years in corrections, it would not be acceptable to "triage" meds in anything less than a disaster or emergency situation. Lack of custody staffing is not enough of a reason, in any normal situation and should include escalation to your nursing supervisor. Jails and prisons are supposed to be controlled environments. Medical care does not fall as a lesser priority than visits or inmates getting laundry, commissary or tablets. Privatized medical contractors cannot dictate custody buy in to provide staff for medical encounters, but government provided medical care have common administration as the custody side and may better communicate deficiencies.

I'm an RN in a local county jail. Inmates are mater manipulators. You are very correct when you are seeing incongruent reporting by the inmate/patient. Often arrestees are under the influence of drugs/alcohol, or really mad they were arrested, and may not participate in the intake process. When they are withdrawing they will say anything and often not able to think rationally. The inmates often lie about health conditions, and for many, more than they tell the truth. It is the hardest part of my job in daily encounters that they fake seizures, chest pain, intentionally have another inmate break a bone, seriously cut themselves, and just last week one of the inmates swallowed a plastic fork, apparently for the 3rd time just to be able to go the hospital. Sometimes we don't have an officer to take someone to ER and stand guard for long periods of time, and so the inmate may be released instead. They all know this and take advantage of which sergeant is on duty, who is more likely to cut hem loose. Drug seeking is very common, AND diversion of drugs, including ones you would never think would be abused, are commonly abused. You have to be very observant and do mouth inspection after every dose of medication because they "cheek" or "palm" them and save up of the pills. Even ones they really need like antibiotics, but especially psyche meds because they can get high if they take several at a time, They will report conditions they think will gain sympathy or be prescribed a specific med for the condition. We require verification of acute or chronic conditions and prescribed medications before ordering, unless there is a clear indication. They usually have some medical records, even if from other jails, and are frequent users of ER, and some have primary care doctors.

As an RN I know it's pretty hard to go through and check all VS that have been charted. RN is reviewing orders, doing their own assessments, passing medications, and may be busy doing some of the CNA duties, because CNA's are busy as hell too and patients often have immediate needs. The RN shouldn't be angry at you, especially if the patient's condition was not compromised. Maybe someone blamed her, and it filtered down to you? Anyone can get busy and not get around to reporting abnormal VS or other findings. No nursing or other staff should "hide out" or act bothered by getting a report from on their patient. If they do this, you must ignore their bad behavior and approach them anyway in a matter of fact way, and if staff are hiding out to avoid work or even perceived to be doing so, go to the supervisor and if they are a good leader, the problem can be rectified in a professional way without anyone getting butt hurt.

California nurse patient ratios are regulated by state law. No other states, nor federal govt, have ratio laws yet. Acuity system is also a state mandate and hospitals must follow or answer to CA Dept of Public Health if complaints filed. Federal and state laws determine break pay, penalty pay for missed breaks, and overtime pay as well. CA has higher levels of protection for the worker. States with unions have higher pay and benefits due to unions, even for jobs that are non-union in order to compete and retain staff. The downside is the animosity that results from the conflict with managers against unions, and vice versa. Management often tries to intimidate nurses who speak up for union contract rules and the regulations.

Unions don't just have political views, and also work hard to enact legislation that protects patients and healthcare workers. I have worked in both represented and non-represented. The jobs I had that were non-union fortunately were with the best managers ever, and were on our side all the time. Things have changed over the decades and now corporations are seeking the almighty dollar instead of providing patient care in a healthy work environment. Union nurses have better pay and benefits, and get rest and meal breaks for the most part. Non-union employers can change your benefits at the drop of a hat and fire you in a minute if they don't like you.

Seems the insurance paying for an RN is not intended to pay for unskilled labor. Unless the parents are overwhelmed with tasks or working and cannot maintain basic needs like laundry or patient's dishes, you are not be the housekeeper. If they are self pay, and you agree to that, you may decide it's appropriate. An agency who is paid by insurance for skilled nursing tells you to do unskilled care, they may be violating insurance regulations. But if a family is self-pay, the agreement may be through the nurse?

Pyxis should not allow override for Vecuronium outside of area staffed by critical care staff. Nurse should not administer a drug she has no knowledge of. You cannot trust that a drug obtained from Pyxis is even the drug that should be in a labelled "cubie", it could be anything. Must always check drug against the order, and all other "rights". Hospitals push nurses to rush, but no one can be forced to do things faster. RN must deliberately take all actions to practice safely. This sounds like "Holier than Thou" statement, but his nurse will forever regret that she made this mistake. Hospitals are responsible too, but WE are the end of the line, and are the direct link to the patient. I've been told I am not fast enough, not keeping up with the pace employer expects and on and on. But I am not making "ERRORS".