**nurse**

17 chairs, 4 techs, 1 or 2 nurses. Getting to be 1 nurse more and more often. I told them I'd leave if this became the norm, I was told on hire that 6-8 patients would be the usual. 12 is ok. 17 is not good. So I'm starting a new job on wednesday!

99% behind you. I have to hold off for that 1% because I know that there have been times when it is appropriate for a nurse to be asked for by name, although I don't think that's what you are talking about. If one nurse orders all of the keep on person meds for the institution and an IM wants to know if something that has been waited for, a non formulary or maybe a med they don't want to name in an area where people can hear, that's reasonable. Likewise maybe one nurse does all of the HIV testing and results. Usually you know when someone is asking because of something like that. If your alarms are going off because you know a nurse is crossing boundries that shouldn't be crossed, you can talk to that nurse yourself, talk to your supervisor, or, as I've done on more than one occasion, tell the IM sorry, you've got me. How can I help you today? If the boundries get crossed too often the nurse doesn't usually last in corrections anyway. We've all seen that.

The times it most affected my home life was when I was in dysfunctional relationships (2). Controlling men do not like "thier" women working in an environment that is mostly men. Getting rid of them solved that problem. My kids loved it....one son in particular. He got in trouble at school once and the teacher asked for a number to call me. He told her, she couldn't, his mom was in prison. She totally changed from anger to sympathy and worked hard to give him loving support. Little manipulator. I don't know how she felt when she found out the truth, but he managed to graduate and is doing fine on his own now. Working in an environment where a whole group of people are defined to have less rights can be damaging. It wasn't good for a lot of slave holders, Nazi's, etc, etc. I went through development of wanting to save them (briefly!) from bad medical care of some of the staff, to becoming cynical, a fair period of being the junkyard dog and CATCHING them manipulating, ROOTING OUT the malingerers, making them SORRY. Then thankfully beyond to just giving good care. Understanding that the correctional part belongs to DOC, and the health care part mine. That I need to always have my safety and my coworker's safety in the highest priority, but not be so worried about someone getting over on me. I guess a few hundred or thousand times I've been checking out a bogus complaint and found that the description was bogus but there was a significant health problem that they couldn't describe. He says he had an STD lab that he never got results from and I tell him that means it was good, but check and find that the lab was never resulted AND he was prescribed stuff that was never taken off AND look at that great big MRSA that he hadn't complained of yet.... The guy with "pee problems" that turns out to be new oncet NIDDM. It CAN corrupt, but the high stress of nursing in ANY field can impact your homelife.

I will never forget my first day doing sick call at prison, where I sat next to a nurse who repeatedly told inmates, there's nothing wrong with you, find God, get out. No assessment. Scared the hell out of me!!! In report, they all sat at the table and discussed sick call slips and infirmary patients, making fun of them and concocting ways to stop them from winning the game. I couldn't believe what I was seeing. Good thing I hung in there. I found that a great deal of that is facade. I developed a motto that went, we give great care but we don't have to be nice about it. And holy moly, there are even times when you can be nice. Gotta get your bearings and learn the ropes. There is also room for all different styles of nursing, and like every other facility in the world there are different levels of competency and integrity within the staff. I've seen every bit as horrendous stuff go on in LTC. I think most staff in prison go through a development of their prison persona...too soft to too hard, too gullible to too cynical, and if they stay they hopefully mellow into someone fair but firm. Sometimes they do harden into pretty evil, the ones that never toughen at all usually don't last. Although we've had some sweet and gentle ones that you would never dream could survive stay and thrive, including one little old lady who RV'd half the year with her retired husband. Drove us crazy with her little old lady dithering and honey and sweetie stuff, but she DID function and could get the job done. No one took her hostage or conned her out of too much. My daughter is a nursing student now, and she described her OR experience with exactly the same horror you have for corrections. But I can describe incredible experiences of staff giving from thier heart, giving beyond what was expected, for a patient at prison as well as LTC and dialysis. Sometimes so quietly that no one notices. Sometimes with that same not mattering look on thier face. Sometimes they are making big bad noises while going day to day giving exceptional care. In prison and the hospital and the nursing home and the ER, OR, rehab unit.

Damn, where'd that beautiful reply I was writing just go to?????? I hate it when a mishit key makes it go poof!!!! Huge job, taking over a mess. I'm working prn corrections now, but I've been a DON and been in corrections for 10 years. Who's in charge of the doctors? Are you wearing the HSA's hat as well? You have said you have a good group and that's your number 1 asset right now. Let them know over and over and over how much you value them and why, and prove it by delegating to them, challenge them. Can some of the best at computer documentation spend some time fostering those that hate it? Can the ones that work closely with the doctors kick those flakey orders back to the HSA or you for tactfully telling them 150 times that they can't order that (but perhaps can do x, y, or z)? With staff that big you are going to have to delegate. Some people can plow through huge sick call lists, some people can juggle the pharmacy show, some people can move place to place, find those people and put them to what they do best and make them feel like they are saving your butt because they will. Then instead of checking 20 people on a shift you can check with 3 or 4 and still do your reports. Eliminate the backbiting and tattletelling. Corrections has a greater potential for a team environment than most places because they don't have to be the greatest nurse the nicest nurse the BEST LIKED nurse to be successful.....It's us against them so much of the time, not getting burned by inmates or DOC. It's a tighter unit, no hospital has a big group of men discussing what a bunch of incompetent slutty nurses they have working there. Prisons do. Kind of makes the nurses appreciate having coworkers that defend and back up and help each other for the united front. So foster that unity. Don't let them rant about a coworker to you or tattle unless they are prepared to back it up with documentation and/or discuss face to face with that worker in your office. Tears and screaming happen, the air clears a little, sometimes resolution happens. Tattleling, lies, exagerations drop dramatically. Any mentors available? A well run medical unit at another facility in your state or corporation that you can get tips from? Years ago we used to charge for no shows. It worked well for cutting back but I seem to remember the NCCHC making us stop. DOC might be able to help somehow, like making them go to medical to sign the refusal....during yard time. The grievences are what they are. Sometimes just listening and having some empathy are enough to make them walk away feeling like maybe medical really isn't hating them personally, and helps the whole relation thing. Inmates are a dysfunctional bunch, we're trying to be better than that. Sure surprised me how many of those grievences ended up being the basis for (frivolous) lawsuits so keep your documentation in line with something you'd be comfortable explaining in court. I recently saw a stack I had made copies of and wrote the responses I really wanted to on them......SPEAK ENGLISH!!!!.......In my own little personal memoir file, waiting for that book to be written..... And remember, the worst day in prison is always better than the best day in a nursing home............

I don't think you would really want to commute from Dover to Beebe in the summer. Beach traffic can be hellish. Still, Lewis and Beebe are at the START of the resort strip and you could pull it off....commute would be probably 30 minutes to an hour, depending on weekends or holidays.

Sounds to me like you have an excellent background for dealing with inmates. Do what you've done, with fine tuning as you learn your new environment. It's all about assessment, and documenting that assessment. You've seen most of it in the ER and psych unit, I'm sure. Look at the scale and the weight. Lift up the arm and drop it to see if the unconcious guy will drop it on his face or move it to the side. And to keep your sanity, don't worry too much about the malingering. So what if they win a few? It doesn't make you stupid, just less motivated for thier particular game. What I found more difficult than stopping malingerers was keeping my objectivity after being in corrections for a time. I had to make the decision to turn back around and stop worring so much about being duped and worry more about a real assessment. These guys are not the most open communicators, they aren't real smart, or they don't know any other way to get needs met except by some kind of manipulation BUT that doesn't mean that there's not something significant going on sometimes. I've found some kind of astounding things looking at someone who came to sick call or an emergency visit for an off the wall or unrelated complaint. Sometimes too they really are satisfied when you tell them that whatever is worrying them is nothing to be concerned about, they can put a warm wet towel on it or take a couple tylenol and come back if ...... Once they know you'll actually look and evaluate with the purpose of treating things that need treating, and that you don't have a problem with making some people unhappy if what they want isn't what they need, you'll have respect of staff and inmates. If someone gets over on you once, learn and laugh and go on. The trickiest thing for you to learn is all the things you can't give out because it's contraband. That's up to your individual institution and sometimes varies by housing unit. Ask before you give out ANYTHING for a while.

We hold sodium (be it a hypertonic flush or sodium profile) the last hour of tx. The reasoning I have been told is that the extra sodium that last hour will send a patient out thirsty, they tend to drink and gain more if you do. I don't know that handing them crackers and broth for post hypertension gives them less sodium than that profile would, but I guess at post time we just want to be sure they don't fall and crack thier head or hip.

:smilecoffeecup: I believe this is one I took free a few years back....now nursing spectrum charges for it but it would be worth it.....really, really good stuff. Like why correctional nursing is the only specialty specifically governed by an ammendment to the constitution of the US and why. Here ya go...... http://www.nurse.com/ce/Course30a

The infirmary load can vary greatly. We only have 6 beds, but have been known to put a another mattress on the floor, or have 2 in the one bed suicide room. If you only have one nurse with additional duties of sickcall/treatments and have someone needing real care, it can get pretty busy. The iv thing comes and goes. For a while there will be a run of them, then maybe months without. Depends on the docs, depends on the patients. I've run TPN in that low tech old infirmary. No active TB at our place. They go to another facility that has a negative pressure room. Of course we have a reverse isolation protocol. There is no anteroom for good handwashing in and out (Our infirmary used to be a garage, I believe) but we stock a table with gowns, gloves, shoe covers, masks and the sink is just steps away. We do what we can with what we have.

We test on intake and then annually. One active case in an HIV co-infected inmate got into population for a couple months, it was a bit of a nightmare contacting every inmate or employee that had contact with him to test, no one else was positive. Active cases go to a negitive pressure room upstate. Positive reactors get a review of symptoms and chest xray. I don't think my state does enough, especially in light of the fore mentioned case. I think we should be doing 2 step ppd's on all imuno-compromised clients and clients over 65. We have been lucky so far to only have the one active case slip by.

I can't believe no one said, all those disfunctional men you CAN'T TAKE HOME!!!! OK, quit booing at me, it's a joke (kinda). I love the variety, the pace differs from day to day, wide wide array of disease, injury, and disorders, coworkers from such different medical backgrounds to teach you new stuff. Also, if you have a good unit, correctional nurses love thier coworkers better than other places. The competiveness, backstabbing, meow meow seems to be a little less.

Darn! knew I was hitting a nerve, but what I'm really asking is, does anyone know where I could go for statistics, some facts, on how many other industrialized nations require a second language to graduate from a college or university?

I had an arguement with one of my nurse practicioners yesterday. Irregardless of how any of us feel about immigrants, legal or illegal, it's very frustrating to have to treat a patient when you or no one around speaks thier language. I've encountered it many times, and most of you have as well. As a military brat, I encountered other cultures that told me that in thier nation, they were required to take other language classes in school, from primary and certainly be fluent in at least one other than thier mother tounge to have a university degree. I sometimes think that we should require nurses to learn at least one other language. My practicioner got HOT and tells me I am nuts. That other industrialized nations do not require citizens to learn a second language in school. Back it up. Can any of you help me with where to find data to back up my arguement?

Ugly. Working anywhere it's nice to have the feeling that good care happens. Sounds like this place will be worse when you leave. Sometimes the care comes back up. Good luck to you.

An "optimal", normal day at my prison, weekday day-shift: Two nurses and a CNA taking care of the infirmary that can house 6 men for anything from medium risk psych "I said I was going to kill myself in the recieving room" to end stage HIV and the rare really acute thing like some TPN running or new CVA or something just out of ICU. Walk in, get report, assess the guys in the infirmary and then start sickcall/treatments while keeping an eye on the infirmary guys. Sick call is triage for any health complaints by the inmates, they drop a note and are scheduled to come over and be seen. The goal is to fix as many as you can with over the counter stuff, education, without dropping the ball on anything that might need a doctor immediately.....schedule for a doctor visit another day possible because he's already got a line scheduled for that day too, but weed out all the athletes foot/ acne/ mild back pain kinda stuff that you can. While all this is going on, there is a dental assistant and possilbly a dentist seeing THIER line of guys. The aformentioned doctor is seeing scheduled acute visits and chronic disease visits, there are guidelines set by an agency called the National Commission of Correctional Health Care that sets the guidelines and accredits facilities along the lines of JHCCO for hospitals. There's a nurse assisting him, taking off his orders, and perhaps doing HER own thing with infectious disease.... keeping the statistics and follow up for TB testing, MRSA & CA MRSA, that stuff. Discharge planning for guys getting released that need help with care for diabetes or hiv or whatever. There's a full time med nurse pouring for all the guys on the compound and ordering the meds they give themselves and keeping track of thier compliance, ordering the stuff for the infirmary and emergencies. There is a DON and a Health Services Administrator. There is a full time mental health staff with 4 or 5 counselors and a psychiatrist that comes once or twice a week. At our place, we have one MD 5 days a week and one NP 5 days a week. We use MD's from other prisons in the state to share call. We get to very good understanding with these docs. We interact almost not at all with doctors at the hospitals. They usually talk with our MD's if someone is sent out. NO special training. We will hire straight out of nursing school, though it's good to have a little seasoning on you because your assessment skills are so critical, as well as your confidence when telling these guys what they need to do, or what's wrong with them. One other thing common to prisons, we are also the emergency people. You can and do call 911 sometimes, but that's AFTER YOUR evaluation and notifying security and (unless there is no pulse or spurting big quantities of arterial blood). We are the response when they fall out of the top bunk and have a bloody head and won't respond, break themselves on the basketball court, hang themselves, or the infamous chest pains and seizures that happen. Also psych emergencies, like taking themselves or thier roomie hostage with a pen or a razor to a throat. All in all, it's kind of dynamic and exciting on a limited level. We do a lot without much money. MASH with a lot more rules. Did I answer them all? There's of course more more more that we do, but in a nutshell............ Oh, officers, we will have one in the medical department when maybe 8 or 9 inmates are in there loose, but there's lots more security that can get there quick and once you've been in for a while you become very effective at being security yourself. I'd swing a hole punch in a minute if I needed to. And I sure wouldn't let one of them grab it first. Good luck with your report.

I'd be happy to answer questions, and if you posted them here I bet you get lots of replies.

That's so familiar and funny. The bad thing is, in corrections and dialysis, those guys make the rounds and frequently COME BACK to you! My amusement and shock, when having been gone from correctional nursing for 4 years, my first shift at the PRETRIAL building brings around my worst nightmare from 10 years ago. Who let him out???

congratulations on the victory. Hopefully it will bring real change to the facility.

Congrats!

Have worked 7 years for 4 vendors and never heard of anything like that. Biannual TB tests, yes. The freestanding dialysis clinic I work for tests for HBV and HCV, and tests titers for HBab biannually. I don't know anyone other than the sex industry that tests for HIV as a job requirement.

for the most part, my institution keeps them very inline. Lined up, badges on, glasses of water, and polite. I will always answer a question about thier medication if I know it, even if the answer is to put in a sick call to find out (lab values, when KOP will be in, changing a med or dose). Very seldom do they get argumentive, and if they do security will generally say something before I do, and they take thier pills or don't (also always an option) and move off. There are exceptions. Some buildings will not have them fully dressed with ID's, and I don't insist if security doesn't. These are buildings where the population doesn't shift as fast, minimum security for low risk offenders and a building for well behaved lifers that I generally know well myself. If I don't know them and they don't have an ID, I make sure the officer ID's them for me. The mimimum building is also where I've had the most problems with disrespectful behavior, depending on the officer on duty. There was one timid one that used to let some stuff get by, and one that seemed to champion the guys, actually challenged me once when I told an inmate arguing with me that he needed emergency care that he didn't. I knew he didn't because I'd spent about 15 hours in the past 7 days with him at the clinic and had seen blood work, xrays, ct's of the abdomen, as well as a few years of experience with him. The officer, in front of the inmates asked, how do you KNOW that he doesn't need medical care??? I responded, because that's my JOB. The guy was wanting prilosec when it first came out instead of zantac, and my company chose to spend several thousand ruling out everything rather than give that one nonformulary prescription, but he was not in need of a 10pm emergency visit with his normal gait and dry pink complexion............I digress. Your demeanor in a hell hole where they shout, toss urine, and masturbate will be your only weapon. If you can remain professional, firm, fair, it might take it down a notch, or may not. Places are very different. I've known nurses that worked in facilities where that happened and were able to decrease bad behavior as they passed muster with the population, but there were still times.....then you use your write up policies and have to look out for yourself. It's a balancing act sometimes, not alienating staff or inmates and keeping your own behavior above standards. Good luck!

It's not for everyone......yet a surprisingly varied group of personalities thrive in it. I've seen the biker tattoed type of nurse, the longgggggg term codependent nurse, the excellent ultimate professional nurse, the it's my job then I'm going home nurse, the olllllllllllllllddd why isn't she retired I hope she doesn't die on this shift nurse, the brand new grad nurse, the religion goes where I practice nurse all THRIVE in there. Nurses that can't make it anywhere don't, contrary to popular belief. There tends to be a great deal more autonomy (though sadly, this is declining), the problems that present are of a much greater scope than anywhere else I know to work, and it takes a great deal of creativity to get the job done. I like it because it makes me laugh everyday. I get to make a difference now and then. Good luck!!!!

Amen.

wecome!!!