crystalwomn

You are absolutely right. If there are standing orders it might be appropriate. Some jails/prisons use standing orders. The National Commission on Correctional Health Care frowns on standing orders except in an emergency. If the employer is a good one and is using standing orders, I would expect to see rigorous training in the protocols and some type of testing for competence in the use of the protocols. If you don't find this to be the case I wouldn't touch the job with a ten foot pole. The standards for nurses in jail/prison is the same as that in the community. If in actuality nurses are ordering meds willy-nilly the state regulatory agency should be notified.

You had lots of very good answers and good advice. Please keep us posted on your progress.

Sounds like they have a pretty good program. Check out the NCCHC website and get a copy of the jail standards or prison standards. This will give you some idea about what types of P&P's should be in place. Make sure that if you are not comfortable at the end of five weeks they will work with you and give you the support you need to succeed.

While we have had new grads who have done well, they usually have had some type of urgent care/ER or other hospital experience. As the others answering this thread have stated, as a correctional nurse you must be able to function independently, have a broad knowledge of a multitude of medical issues, have great assessment skills and the confidence to respond and handle some pretty bad emergencies as a first responder. You also must have leadership skills as you might be the only RN duty and responsible for supervising LVN staff or medical assistants. This is alot to ask of a new grad. I would recommend you get a year of acute care experience preferralby in the ER before taking on the correctional job. Some questions to ask your new employer would be what type of orientation you will receive, how long will it last and what kind of support system will you have once you are on your own.

Patient's with a GI bleed often run fairly stable vital signs then suddenly crash. The best way to determine if they are actually bleeding aside from hemocculting emesis and doing orthostatic vital signs. If they are bleeding they will have a drop of BP when standing or an increase in pulse.

I am very pro NCCHC. But negligence is negligence. I work triage and we often see patients post MVA. Some have been cleared by trauma centers and in a number of cases those "cleared" patients have had life threatening injuries. Just the other night it was a patient with a pneumo-thorax. It is up to the nurse in triage to insure that the inmate has received a proper evaluation in the ER. We should know what the standard of care is because often inmate patients receive less than the standard of care because they are inmates. If a patient has not been properly worked up, then they should be refused. I have a number of cases where patients were accepted for booking who should have been refused. These cases have resulted in litigation. That being said sometimes there is no way a nurse can anticipate a bad outcome. While it may not seem fair, we are expected to pick up and act on subtle signs of trouble which is why I think it is important to practice defensively.

There are a number of publications. National Institute of Health has an office of alternative medicine and has done some very interesting studies. Also, there is a book "Reinventing Medicine" by Dr. Larry Dossey which gives examples of studies. Sloan Kettering has a great herb sight documenting pharmacological properties of herbs. You can also do a search on medline or google scholar.

First you can thank the powers that be that you are out of the facility. You can go to the union or file a complaint with HR and perhaps see an attorney about wrongful temination. Then you should go to the Office of Civil Rights, Department of Consumer Affairs and also explore filing a compaint with Attorney General about the sub-standard conditions. Inmates are covered by the 8th ammendment, failing to provide adequate medical is a violation of the inmates civil rights. So, filing a complaint with both the attorney general/office of civil rights should trigger an investigation. You could also report the head nurse to your state board of nursing, this will trigger an investigation. As to the facility. They are a legal disaster waiting to happen and you are lucky to be out of there. Unfortunately, there are many sub-standard facilities around the country and they give all of us a bad name. In my practice as a legal nurse I have seen worse but this facility is right up there. I commend you for trying to make a difference. Correctional nursing is a high stress job but done right it is the best kind of nursing out there. I would fight to have the termination over-turned because it is a blot on your record. I would find another correctional job in a facility that tries to give a good standard of care. There are many, many dedicated correctional professionals who are trying to make the system work. It is not worth the danger to your license to stay in such a sub-standard facility. You made an effort to improve conditions and should continue work for excellence in whatever position you go to next.

All of us in corrections need to read this article and take heed. I have cases much worse on my desk currently. A four million dollar settlement for deliberate indifference sends a clear statement that the court means to punish those responsible. Corrections is a speciality which is a minefield of potential lawsuits. We serve a population who are usually poor, uneducated and who often abuse drugs or alcohol, and who are at risk for injury due to the lifestyle they lead. It is unfortunate that the public's preception of the correctional nurse is that of a nurse who can't make it in the real world so signs up to work in a facility where no one cares about sub-standard performance. This perception is far from the truth because there are many, many correctional nurses, doctors and medical adminstrations who have fought for years to raise the standards of care nationwide. It is cases like this one that give our profession a black eye.

Jail intake nurses frequently deal with patients who have been involved in accidents or altercations. The RN is the first line of defense in intake. Those nurses who work a regular position in intake must possess excellent assessment skills. ER clearance does not mean a patient is stable. Any inmate who may have a significant injury at the time of arrest needs to be closely evaluated by the nurse. If there are any indications the patient is not stable then the nurse needs to refuse the patient and return him/her to the emergency room via appropriate transport. Once accepted into the jail inmates who are voicing complaints require assessment. My advice to my staff is never to ignore something unless you are sure it is nothing. This means it is the duty of the nurse to adequately assess the patient. If the patient is symptomatic then appropriate action needs to be taken. If the nurse feels the patient needs further care and is denied permission to send the patient out it is the obligation of the nurse to go up the chain of command in an effort to obtain care for the patient. I personally have called our medical director numerous times in the middle of the night when there is a dispute. The nurse also needs to clearly document each encounter and actions taken. Failure to do so could have dire consequences for both the patient and nurse.

Great information. I am very involved with NCCHC. They also have a professional certification which is a Certified Correctional Health Care Professional. Information about this certification can be found on their website. Their standards are focused on medical /mental health. The have a national conference in October and I believe it is one on the largest conferences out there. They also have accreditation programs for jails. In California, the Institute for Medical Quality, has an accreditation program. There are many people and many organizations seeking to raise the standard of care in our jails and prisons. Correctional nursing is a speciality. This year the American Nurses Association came out with standards for correctional nurses.

If positive PPD and negative CXR we recommend treatment. They are counseled before starting RX on the importance of compliance. This is due to unfinished course of meds and the incidence of drug resistant TB. The health department prefers not to start treatment if the patient is not willing to be compliant and finish the course of medication. Patients are also referred out to the county TB clinic.

I would be cautious. A few questions you might want to ask are do they have any P&P's at all. If so, what resources were used to develop them. Is there a Medical Director who is an MD and is there an MD available 24/7 either on site or on call. Do they have a written contract for emergency and specialty care. One answer, the right one would be that current P&P's are based on National Commission on Correctional Health Care Standards. The wrong answer to any of the above questions is no. A no answer should make you very hesitant. If you do take the job. You can find correctional standards of care at the NCCHC website, ANA standards for correctional nurses and American Correctional Association Standards.

Inmates have a right to refuse any and all treatment. It is the same as in the community. Refusal needs to be docurmented and the patient needs to be informed of possible consequences. The patient should then be referred to the provider, depending on what is being refused the patient should be referred either immediately or at the next sick call so that the provider can discuss the refusal. In a suicidal inmate Mental Health should also be notified. I usually will ask why the patient is refusing. Often if you start a dialouge with the patient and explain why the treatment is needed they will comply. However, forcing vitals on someone who is refusing is considered assault. For forced care the patient must be declared incompetent and this generally requires a court hearing.

To those of you who posted about cabbage leaves. I'd love to hear more. I am working on an article on holistic modalities of treatment in corrections. I just posted a new thread. This is the type of thing I am very interested in. A suggestion for educational materials. Try planned parenthood. You also can google whatever patient instructions you are looking for. Take the best and easily understandable. Check to see they meet community standards and write your own.