nurseT

Gasp, do they do that at your place too? Amazing how long they can keep that crap up. I think the child molesters may be the best at it. We have a weekender right now who claims something every weekend. We joke about what it will be this weekend. I think he should run out of serious illnesses to claim pretty soon. Lets see... so far it has been "a stroke, an allergic reaction " my tongue is swelling, I can't breath", a heart attack, broken back, I've fallen and I can't get up, I just got diagnosed with seizures, I feel one coming now. Mid week, on the outside he threatened to kill his self to get a 72 hr comittment, he thought he could get out of jail for the weekend,the mental unit kicked his butt out friday am. Sheesh!!!

Don't bother argueing with the sheriff. Have the Doctor address the sheriff's problem. I do have a paper in place called " Jail staff Medical Documentation". On it are places for the officer to write the inmates name and age, cheif complaint, when it started, a set of vital signs. When the nurse was notified and her instructions. If they call me at home, these are all the questions I will be asking, so I tell them, Use this worksheet ahead of time to save you and myself alot of time. I have a VS machine that a child can use. And I triage from there. After I get the medical information, I may ask whats going on with the inmate re: get sentenced today, bad news from family? What. Sometimes I discover they are simply having a panic attack because it just sunk in that they will lose their kids due to being incarcerated. Panic attacks are real for the inmate and very common. I developed a panic attack instruction sheet to give to the inmates to read. It lists all the symptoms that you can experience with a panic atack and how to cope with it. They are allowed to keep a small paper sack for this purpose. My sheriff and jail commander try to tell me how to run the medical too. The new sheriff needs to be advised that you are his professional consultant. With great respect for their responsibilities, I just tell them, they can follow my advice or be responsible for makeing their own medical decisions because I have medical laws to follow and will not break them for any reason.

After a while you will get to know the repeaters. I had one guy with a history of psuedo seizure and took depakote. He came from another jail and said " They stopped giving me my depakote 4 days ago because I was leaving soon and they didn't want to refill it". He was famous for faking seizures also. I ordered him moved to the rubber room which he hated but I advised this was for his saftey. I told him I would order his meds but they would not be in until the next day. So an hour later he goes into a full blown seizure, tonic clonic. He kept having seizures back to back. Following protocol, I gave him some valium to stop the seizure activity and sent him to ER for a Depakote level and evaluation. They brought his levels back up to therapeutic and sent him back to the jail. Well after that , when ever he didn't get his way he would say, " I'm gonna have a seizure right now", he would wait for the officers to lay a mat on the floor and would lay down and pull off the best fake I've ever seen. But, I knew his depakote levels were therapeutic and this was put on. So when he would threaten to have a seizure, I'd say "OK, go ahead, your mat is on the floor". And he would get really mad and call me all sorts of neat things. I had another inmate who was not very smart at all, and he kept denying any health problems, but his bunky insisted the guy was sick. I segregated him in r-cells and had him observed over night. He checked out good the next morning and begged to return to the block. That TV is a good motivator. He insisted he was just a little constipated and he had a dry bowel movement. He was provided the usual nursing advice for constipation.The doctor was coming in but the inmate said he didn't need to see the doctor, so I let him go back to the block. The next day there is a different crew working. They tell me this same guy's bunky is complaining the inmate is ill. So I pull the inmate out into the darkened hall and it was immediately obvious his abdomen was huge, I had seen him the day before and knew it was not that big. He still insisted he was not that sick.I took him up to the exam room and before we even reached the room I had already decided without further fuss he was going to the ER. As far as I was concerned, he had an acute abdomen. I was thinking maybe a bowel blockage or even a perforated bowel. He spent 2 weeks in the hospital, 10 of those days in ICU. He had a bowel blockage, a UTI and and got worse after he got there. The ER doctor found out this inmate had had numerous surgeries in the past due to bowel blockages but the inmate was not very forthcoming with the information. So, You never know. At my jail, they are either faking or definately dying. Sometimes the officers ask me why I spend any time assessing certain inmates, and I tell them " One out of 10 is telling the truth, You guess which one ". This population behaves and lives by different rules, they lack education and some of their fears are legitimate no matter how stupid it seems. You have to Scale your instructions way down to a 4th or 5th grade level. And yet not give away too much information. I have grown women come in and havent got a clue about normal female functions, basic female anatomy. They are hillbillies who have been raised on old wives tales and practice inbreading, or illegal aliens from Mexico who think a pimple is cancer because they don't get healthcare in their country and their uncle died from a pimple on his nose. Or so they thought. So, better safe than sorry. Make a real good assessment of the guy. Request his old medical records. If he checks out ok, put him on observation, and document his behavior. If he falls over and his face turns black, call 911 and get the AED. You don't have to treat symptoms that you can't find or test every inmate for every disease possible. One thing I tell them is "I am the nurse, I get to make the assessment, and I get to decide if you are having an emergency, and I get to make the decisions" . Just always be careful.

I was performing a flu shot clinic. A very tall gentelman was rolling up his sleeve and struggled with the sleeve around the biceps. He says "Can we do it like this?" My response, without thinking.... " If you can get it all the way up, because I need a big muscle". He promptly replied " I don't have any problems there". I laughed so hard, I guess I set myself up for that. It sure broke the ice for the people waiting in line.

I did not see the episode of 60 minutes. I wish I had. I read an article in the news paper shortly after the death occured. There wasn't enough information for me to make a decision. I do know that medical should not be involved when security has someone in the restraint chair. The restraint chair is for disciplinary purposes and security has appropriate rules reguarding time checks and release. If medical remains present during restraint chair use, take downs and cell extractions, security personel get a false sense of security. They will have a tendency to be a little more rough thinking medical will take care of the results. The only time I have been involved or present during such an episode was due to the inmate having a mental illness that caused the behavior in the first place. According to current laws, if the inmate has been refusing meds, or so nuts he doesn't believe he needs them, and becomes a danger to himself or others, I am then responsible to make the decision to medicate. Not to tranquilize, but obtain tranquility for the inmate. Our officers never discipline a mentally ill inmate. The only time the officers step in is to maintain a secure environment. Actually I was appalled at the news of a mental pt dying in a prison, and that he was seen twice that day by medical personel.

Say That 3 Times Real Fast. I Have A 20 Yo Female At The County Level That Has Been In Icu For The Last 8 Days Due To This Rare Genetic Disorder. We Have To Get A Registered Dietician To Design A Diet For Her When She Returns As She Cannot Eat Any Fat, It Almost Killed Her This Time. Anyone Ever Heard Of This? I Have Had The Sickest Of The Sick At The County Jail Over The Last 8-9 Months Or So. God,it's Been So Crazy. I Wrote The Judge A Letter To Try To Get A Compassionate Release For Her And They Just Won't. She's Not A Serious Criminal, Just A Brat. They Just Released Another 19 Yo Brat With Cystic Fibrosis. 8 Nebuliser Treatments Per Day, 2 Pulmonary Percussion Vest Treatments Per Day. Tube Feed While Asleep, Psuedomonas And Mrsa Combined, And He Was Diabetic! He P****d Off The Judge And The Judge Decided To Show Him Who's Boss. The Kid Was Non Compliant With Everything, Hung Upside Down Off The Top Bunk And Broke His Mic Button (feeding Tube). Convinced The Officers To Give Him Cans Of Tube Feed During The Day Since He Didn't Like The Food And Subsequently Ran Out Of Feed. Would Tell A New Crew " No I Don't Do The Percussion Treatments Until 10 Am, Then Tell The Next Crew That He Didn't Get His Treatments. All His Care 3 X Dly Took 2 1/2 Hours Each Time. The Officers Were Freaking Out. Then When I Put Him In A Negative Airflow Cell, His Cf Doctor Calls Me And Rips Me A New One. She Said I Was Punishing Him And He Was Sick. Evidently He Told His Family At Visitation That We Were Being Mean To Him And Had Put Him Solitary Confinement. Man, I Need Some Time Off!

She probably wasn't trying to insult you. Correctional nurses and ER nurses as well are just a different breed. We are more straight up with others and don't have time to pussyfoot around "feelings". She was most likely remembering herself at your age or nursing level. Looks don't mean anything. You could be a real dog and have the ugliest clothes. All men only think about what's under those clothes. I'm not bad to look at myself and pretty much wear what I want. Never anything outright sexy. That would be in bad taste in any setting. Sometimes I wear scrubs, sometimes business casual with a lab coat over top. If any inmate makes any kind of stupid remark to me the officers would intervene immediately. I've been called 2 things by the inmates: " You're pretty and That red headed Bee-eye-tee-cee-h". You will need to have good assessment skills. I would never suggest a new nurse start out in Corrections.

Thanks for the suggestions. I really needed to hear from some other nurses. I am the only health care professional in the jail and sometimes just need the support. Yesterday the Commander told me he had a wedding to attend and it turns out this mother will be there too. Some mutual friend / family. He was dredding it. He knew she would try to corner him. I told him to blow it off on me and then when she called I would refuse her call. Thanks again.

Tell him when he obtains the education and experience you have, then he can "sit behind the desk and write". I used to work in a nursing home and one day I offered to work as an aid as they had a call-off. I thought it would be great to work a whole day without any responsibility for a change. I asked another aid to help me with a 2 person assist pt. This aid did not know me or my position. She starts telling me about how "Those nurses are so lazy, they have such an easy job, I work as a "Q" and I know there's nothing to do after you pass meds". I told her that I was a nurse and I could promise her that she sat that day and the other nurse was twice as busy makeing health assessments and documenting it, making appointments, doing all the treatments on her own pts as well as the pts the "Q" gave meds to since a "Q" did not have the education to complete all the other tasks her pts required that day. That shut her up and she hated me after that. Who cares. Bottom feeders always think they work harder.

Dumb Girl!!!

OK, This Mother is driving me crazy. The inmate is a 23 YO male who has already spent time in prison for 2 counts of possession and theft. While out on parole he gets arrested for burglary. He likes to claim his mental problems cause him to misbehave. He is on Lithium and Celexa. He is quite intelligent and knows all the magic words to get attention. He wanted a Lithium level done because he wanted to up his lithium and add Straterra to his cocktail. After the Doctor sees him and his Lithium level is therapeutic, the jail doctor said no.the kid is still not satisfied. He wants his records to send to people on the outside who are waiting for this information. His Dad is a Vetrenarian and his Mom is calling all kinds of outside doctors trying to get them to visit the jail and give her kid more meds and someone to talk to about his problems. I told this kid and his mother that he could not get orders from outside doctors and bypass our medical department. She calls constantly and talks about how she wants him fixed so he can lead a normal life when he gets out. She has had 3 different doctors call me. They all say she told them that the kid has no doctor. The kid's family doctor told me the mother "doctor shops" and the kid was better off in jail. She will call me and try to tell me she wants another Lithium level done and blah blah blah. I have told this woman, and told this woman the rules. She does not listen. She is a high maintenance, high anxiety control freak and pesters everyone until she gets her way. She will even threaten to give prescriptions she has with doctors orders on them to her lawyer. Should I refuse her calls? I have warned the sheriff about her and told him she'll probably be calling him next since she has not got what she wanted from me. What would you say to her to shut her up? She will not take no for an answer, she calls prepared with an answer for anything you might say. You know, I never, and I mean never,,, get calls from the mothers of female inmates. What is up with that?

Oh, ours are labeled "Medical Request" and they must be specific in their complaint. I don't see anyone without a request, as a general rule, to keep some sort of order. However, there are exceptions. I make folllow up assessments and if there is an urgent or emergent need. I am the only nurse with a little over 200 inmates. If I didn't enforce some order, I would get pulled in a hundred directions all day and never accomplish anything. It's easier if you keep in mind that the jail is not a healthcare facility. I find them neccessary and helpful. I can triage who needs to be seen and who simply needs a written response by reading these.

What do you mean by "medical kite"? Inmates telling you another inmate is sick?

I've seen them release inmates from custody to avoid paying for their healthcare. This is the first time I saw them deliberately take someone out of the hospital like that. Thankfully no complications occured. But they get a false sense of security when they go against advice and nothing happens. They think they are smarter than the doctors and nurses. They only need to be unlucky one time. Most of the time I'm pretty tough on the inmates, they have to actually be sick to get my sympathy. But yanking a Pt off a hospital bed really knocked me out. I guess I lost some respect for them since they lied to me and they are supposed to be the cops. You know? I hid that chart since I don't trust them now. I'm not sure they're not above falsifying a record. God, how did they get away with putting off cardiac surgery! Does the Sheriff and his designee get the left overs out of the medical budgets? Cause they act irrational.

Anyone Ever Find Out Your Patient Was Yanked Out Of The Hospital And Brought Back To Jail Ama? Less Than 48hrs After A Major Surgery?