suesmith48

All of your very well-reasoned responses lead us to one thing - the importance of the CQI process in helping us to resolve our dilemmas... tlc365 - you discuss near constant distractions that delay your med administration process. First, the fact that you are having so many distractions is more than just an inconvenience that slows you down. Accordng to the Institute of Medicine (in the To Err is Human report) distractions during the med administration process is a major contributor to medication error. Some hospitals have moved to place a "NO DISTRACTION" zone around med carts. It sounds like you have some process problems, like medication distribution and communication. Addressing the problems has the potential to save med administration time (which will save $$) and decrease medication errors (which cost $$). Orca - right on! We walk a fine line between respecting custody for the very difficult job that they have and losing our nursing values. Certainly we need to acknowledge the importance of safety and security, but we can do that and maintain our identity as nurses. It just takes some critical thinking (well, integrity and a good moral compass help as well).

I believe that there are many reasons for this type of behavior on the part of the nurses, and that there is some variation in the reasons from one nurse to another. Certainly one reason is that it is so easy to become overidentified with the dominant custody culture, but I recently heard a presentation on "Failure to Rescue" (based on hospital incidents, not correctional incidents) that offered another, very important reason. The presenter reported that root cause analysis done at the hospital found that the nurses had become overly task-oriented and had lost their ability to stand back and see the big picture for their patients. In our setting, it is extremely easy to become task-oriented - considering the 3 hour (and longer) pill-calls, huge sick calls, relentless intake procedures and endless paperwork. The hospital system making the presentation I attended did a number of things to address this, including the Failure to Rescue presentation.

Hi Lorry, After 20 years of correctional nursing, I could go on and on and on - here are a couple stories that come to mind (and please keep in mind that these nurses were both known as good nurses): A nurse from one of our county jails told me this story and another confirmed it. They had a man frequently arrested for various charges, usually drunk and disorderly. He liked to play "tricks" on the nurses and would complain of chest pain, knowing that they would have to see him. Sometimes he'd even laugh and admit to it. One night, a CO came to the booking nurse saying that this man was again complaining of chest pain. She was busy and told the CO that she would see the inmate when she finished seeing the booking detainees. The CO summoned her again in less than an hour - the man was unresponsive. He had suffered a heart attack and did not survive. The family sued the county jail and her (resulting in her termination) and reported her to the state board of nursing (where she did have to defend her actions). One evening in one of our state prisons, a nurse received a call from one of the housing units - the CO said a young inmate was complaining of an asthma attack. The nurse was busy with other duties, but did review the inmate's medical record. She found no history of asthma and told the CO to have the inmate sign up for the next day's sick call to be evaluated. The CO called back about an hour later - the inmate was unresponsive - he did not survive either. The nurse was disciplined for her actions. Sometimes inmates do complain of symptoms they are not really experiencing (so do patients on the "outside"). However, the only reliable way to make sure is to see and assess the patient - which takes less time than responding to an emergency, enduring the resulting investigation, defending your actions at work and potentially before your Board of Nursing and explaining it to any subsequent employer.