Notmywil

Go to Nursing Behind the Walls and there is excellent info posted there on MRSA prevention.

We're never too old to learn, so I'll share something I just learned. TWO SQUIRTS When you use hand sanitizer, do one squirt in the palm of your hand, then dip your fingertips from the opposite hand in the sanitizer. Follow by rubbing all over your hands. Then rotate and place a second squirt in the opposite hand, dip the fingertips and rub all over your hands. Apparently the infection control folks have tested competency and we keep missing the most critical parts of our hands----the fingertips and around the nails. (We won't even discuss what problems cracked nail polish and acrylic nails can be!) I know old habits die hard, but this technique is worthy of making a new habit! Pam

Personal hygiene in a crowded environment is always a problem. Same issues at my institution. If drainage is not well-contained, all the inmate does is spread the MRSA, so isolation from the general population becomes a measure to limit risk of transmission. Think about all the things they touch that are rarely (to never) disinfected (e.g. inside recreation facilities/weights, door knobs, railings). I am seeing MRSA wounds on abdomens, wrists, back, knees--you name it. I am also seeing it take more than one round of antibiotics to take care of the problem--so follow up after initial antibiotic therapy is essential. Many of the inmates come to me and tell me that they have a wound that looks like a spider bite. We have some really tough strains of MRSA to deal with--some only susceptible to Vancomycin (& and we're praying the bugs don't get resistant to that!) In addition to antibiotic therapy, I often use sustained-release silver dressings--often irrigating the wound with non-cytotoxic dilution of sodium hypochlorite, then rinsing with sterile water (to avoid neutralizing the silver in the dressing). My disclaimer is, of course, that all the things I've mentioned need to be ordered by a physician. Summer is a tough time for outbreaks. Bottom line, I feel your pain!

MSNBC has a series called LOCKUP and Folsom prison is featured on one of those. If you visit their website, you can view the video online! There are many other prisons featured there as well. Good luck and congratulations! Hope you'll keep up posted. http://www.msnbc.msn.com/id/21134540/vp/14027992#14027992

Don't wear anything sleeveless...this is not allowed. (I suppose bare arms must be considered provocative?

I appreciate your reply so much! I wonder who inmates like this think they are hurting. I confess that although I wish I could blow it off and think nothing more of this situation, it does irritate me and I really wish it didn't. However, there has been only one other person I've ever had to "write off" my conscience and "turn them over to themselves" (like I really ever had any control of the situation in the first place!!). In the other case, it was a person who had had a wound for 9 yrs. that was the size of a grapefruit (so help me!) on the calf of her leg. I got it down to pea-sized and she began sabotaging every thing I did. The day she referred to her wound as "my friend," the light finally came on for me and I realized how much attention and control she had gotten of other people during the course of time she had "her friend." So my next move for THIS inmate is to ask his doctor to refer him to psychology and ask that they allow me to sign off his case completely. Your response lets me know I'm not alone in this experience. Thank you so much!

Here's a suggestion: There are a number of hospitals in Louisville: Norton Healthcare Baptist Hospital East Jewish Hospital University of Louisville Louisville Veterans Administration Contact them directly and ask for information. Let them recruit you!

Hooch: prison made alcohol Shot: (i.e. writing the inmate a shot= Incident Report)

(Could be a book title, huh?) I had a frustrating day yesterday. One of the hardest (& thankfully very infrequent) roles is when the nurse has to be the "police" to a prisoner. Since I am usually in a "healer" role and have been for all 23 of my years in nursing, I absolutely hate it when somebody I've been trying to help starts acting out, being a "thug" and causes me to have to write them up......which resulted in a particular inmate being taken to SHU yesterday. It all started when I wrote him a shot (Incident Report) for missing a call out for wound care--about 2 mos. ago. With all the MRSA we have these days, proper wound care is serious business (no matter where you are, but especially in a crowded environment). Accountability is an even bigger issue. The only escapee we ever had from our institution had missed a call out and was not reported by the department where he was scheduled. So accountability also becomes a security issue. After I wrote this inmate a shot, he began refusing wound care...JUST FROM ME. Of course I counseled him each time & had him sign refusals. Since I am the only nurse available on many days and he could not do his own care because he has paraplegia, the care went undone. He is mentally competent and has a complex wound.......and I have reported this many times to Medical Administrative staff. This all culminated in a hostile situation when I counseled him that he had refused 24 times and his wound has gotten much larger since. This inmate has a history of assaults on staff--yes, even though he's in a wheelchair. I work alone on weekends and holidays in my area, but of course I have a body alarm. I'm not afraid, but I'm not stupid either. He began shouting, angrily waving his arms at me (in front of other inmates) saying I was denying him care (can you believe the absurdity?). I told him that wasn't true, that's enough and ordered him to be quiet. Of course he didn't. I radioed control that I was having an issue with an inmate and the stampede of help immediately arrived as he continued to hurl verbal accusations against me. He's in the hole because he was behaving like a thug. This morning he is in "timeout" wearing an orange jumpsuit and I am still wondering what can be done. I can't FORCE him to have wound care, but our institution cannot let inmates pick and choice who their caregivers will be. Please let me hear your thoughts on this. (I work in a Federal Prison.)

I am so happy to see these words in print! There are so many of us who are disconnected (not of our own choosing) from our Native American roots. My great grandfather was full-blooded Cherokee. Can I prove this? Of course not. My great-grandfather's name was Sizemore. I wish so much that I could reconnect........I wish I could "meet" my relatives and learn of Native American ways. I have a longing for the spiritual understanding of my ancestors. Even in the simple ways, I have the desire to have my feet on Mother Earth instead of the asphalt and concrete of my everyday life and to feel the wind on my face and connection with nature. I wish I had known enough to understand a uniquely different spiritual "experience" I had when I was only 19. My mother was buried the day before my first child was born. For about 6 mos. after that, I felt a "presence" with me 24/7. "It" was in every room I entered in my home and was even in my car with me when I drove. I didn't understand it. I wasn't on any medication or drugs of any kind whatsoever. Because I didn't understand it, I was very upset and it was really stressing me mentally. I dared not go to a doctor, because he would've give me a diagnosis that would've haunted me for the rest of my life. That was over 30 years ago & I am happy to report that I am as "normal" as anyone else (what is "normal" anyway?) :) As a nurse, I have been fascinated by the books by Lewis Mel-Madrona COYOTE HEALING, COYOTE MEDICINE, etc. I have always felt there was a part of "me" that was missing--that spiritual connection that my Native American ancestors so clearly embraced.

The major differences a nurse new to corrections would notice is accountability & security issues. For example, nurse have long been used to being able to carry our own scissors to work. These could easily be used as weapons. Scissors, syringes (even those without needles), must all be taken out of a secured pyxis (in our institution)and, once used, disposed of in sharps containers. A lost pair of scissors would necessitate a complete lock down and search until they were found. This actually occurred on our unit and resulted in strip searches of the inmates. Upon arrival to work, I go through security screening like you would encounter at an airport. Unfortunately, not all staff members are trustworthy, and this is how a lot of contraband makes it in to institutions. Cell phones are strictly not allowed on the premises! Even hand sanitizers are in locked dispensers. There are likely institutional policies that govern such items as glass bottles you might bring in--the glass could be used as weapons. Silverware you might bring it to eat your lunch are objects that could be filed down and made into shanks. Plastic containers you might discard could be used to brew "hooch." Beware accumulations of fruit (i.e. orange peels)--they can brew hooch out of some pretty disgusting things. A lost key.....especially a Folger Adam key, would cost you your job. I couldn't possibly count the number of times I have to lock and unlock doors each day......even to go to the bathroom. The nurses station is all enclosed and never left unlocked unless another nurse is in there. Extension cords could be used for escape, so they are checked in and out. The caring, compassionate nurse who is used to being a problem solver has to be on guard because we are in an environment of master manipulators. There is so much more. Correctional nursing is such a dual role, but it is the most rewarding job I've ever had. The ones that can make your life MOST miserable is OTHER STAFF MEMBERS! (Can I hear an Amen?)

I've been a nurse for 21 years and I've never had more job satisfaction than since I've been working in a prison. I've done public health, labor & delivery, acute care, LTC, Hospice, specialty practice in wound care....and my final stop before retirement is corrections. I would have come to corrections sooner, but if you were older than 37, that was too old.....until they got a waiver for health care professionals. I believe the average age for nurses is still around 42-43. Regarding safety...at any hospital I've ever worked, security was inadequate. Not so in a correctional setting. In the hospital setting, you have mostly female nurses do the lifting and tugging. In male prisons, you have male inmate workers who do this. These are the same inmates who spend their free time in the rec yard doing weight lifting! What a great way to put their strength to good use! :wink2: Thankfully, I can actually concentrate on nursing--but with the dual role of corrections. Furthermore, I find the inmates as a whole appreciate the care provided to them by nurses. I came to prison expecting to provide the same quality of care I would try to give any patient, regardless of the practice setting. Respect is a huge issue in any setting, but even more so in prison. I came to the prison nurse role without judgement in mind. The courts have already done that. I have made my share of mistakes as well.....mine just haven't sent me to prison. I always ASK my inmate workers to help me and they are always pleasant to me in return. So we have a mutual respect for each other.........but I still don't forget that I work in a prison. Fortunately I have maturity working to my advantage. I don't smoke, don't do drugs, and didn't come to prison to find the love of my life! You may find it amusing that I mention this, but in prison, these can become even bigger issues because inmates can use these things to manipulate staff. I've worked with all kinds of personalities throughout my years of nursing, and this has helped me weather the storms as well. Every day has its new set of challenges; it is never boring working in corrections!