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Nurses often forget or feel uncomfortable "telling" on physicians to their supervisor or chain of command when the physician doesn't give an order for something, but we have to remember we are patient advocates. This is a very important part of our job, especially in corrections. If you remind the physician that you will document and/or notify the supervisor and/or make suggestions about what you think should be done, the physicians will change their tune and give you orders. Unfortunately, there are still health care professionals out there in corrections who believe all inmates are faking it and thus, they withhold treatment, sometimes to the detriment of the patient/inmate.

We haven't been able to get the H1N1 vaccine for employees or our inmates. I can't even get it at my healthcare provider yet because they have run out of the vaccine and are only giving it to children six and under, pregnant women, and/or caregivers of children six and under. As far as measures in my particular state facility in CA, we isolate those who have symptoms and their cellie if they live in a cell setting to their cells for seven days or longer if their symptoms haven't subsided (in the case of the asymptomatic cellie, if he develops symptoms during the initial isolation, his isolation will be restarted and last seven or more days depending on duration of symptoms). We are swabbing those with symptoms that are suspect for H1N1, but it takes weeks to get the results back. I haven't heard how many confirmed cases we have actually had. We also do contact investigation (just as you would with any outbreak) although the guidelines on this are not really firm and especially difficult on a minimum support yard where the inmates work on and off site and interact at chow, at school, groups, etc. If an inmate has any chronic conditions that would make him especially susceptible to H1N1, we will usually isolate them in a single-cell in our infirmary for close monitoring by healthcare staff. Our Public Health nurses issue an updated memo as possible new cases are identified indicating which cells are currently under isolation and what date the isolation is set to expire so that custody and health care staff are aware. Early on, we were isolating entire dorms on one particular yard where inmates live in bunks in an open setting who had cases of H1N1, but this was disrupting too much of the daily prison program and was eventually deemed unnecessary by our higher ups. Our main issues now are just trying to figure out who is responsible for providing custody with N95's (medical or custody administrative staff), educating staff about the use of N95's and when they are and aren't necessary, and when are we going to get the H1N1 vaccine for staff and inmates alike. I imagine when we do get the vaccine, we will probably start with our HIV inmates first (as we have done in the past with seasonal flu shots), then those with chronic diseases, and so on and so forth.

Yes, state employees should have first dibs on OT before contract nurses as per our union contract. A contract nurse may be able to do OT if no one else signs up for OT and it has been offered to state employees who do not want the OT. I can recall LVN's and CNA's who are working contract doing a lot of double shifts, but it is not very common at my facility for a contract RN to do OT. There are state RN's I work with who eat up a lot of the OT and I should also note that a state RN can be mandated to do OT, whereas a contract RN can not. Thus, it depends on many of the same factors I previously mentioned.

Practicing nursing in corrections does not mean you stop practicing the art of caring, an essential component of our practice. We do have to distance ourselves more and probably should do this in other settings as well so that we can be therapeutic and prevent becoming overly involved with the inmate-patient. If we allow our emotions to cloud our thinking, how can we be therapeutic? I actually found it easier to leave work at work when I worked outside the walls, although I have had to learn to leave work at work in corrections, too, by not bringing my work home with me (i.e. memos that need to be written about a problem that I now make time to do while I am on the clock, not my own time). As the previous poster stated, a lot of people have had the same things happen to them in life and worse, and yet they didn't choose to be criminals. Sometimes I think part of the problem with our long-term inmates is they use their past as an excuse for their present behavior. They act as though they are the victims of the system, their own lives, society, etc., instead of accepting responsibility for the role they played in where they are at in their life. Instead of dwelling on where they came from, we should be helping them make a better life for themselves. That's being therapeutic, empathetic, as opposed to being sympathetic and enabling. We can make a difference in the lives of an inmate by encouraging them to be better people and setting boundaries with them on what is and is not acceptable behavior so that they can go back in to society with new ways of behaving and coping. I joke that I am helping to "rehabilitate" them as I work for the "Department of Corrections and Rehabilitation," that I'm not just a nurse. We will reach some, but not all. A lot of our repeat offenders of suicide attempts have issues of attention-seeking, hence why they make repeated threats of suicide and/or attempts. The help they need is beyond our scope of practice. All we can do is refer them to the appropriate disciplines and practice therapeutic communication. It is not riding on your shoulders to change them or their way of thinking anymore than it was riding on our shoulders to change our patients' ways of thinking outside the walls. It can be harder in this setting, especially since we work with the same patients every day. But you have to maintain a professional distance in order to survive nursing and to be therapeutic. This does not mean you stop caring, though, about your patients, just because they are inmates.

Well, first off, "mandated furlough days" is true, but, you have to apply to take the furlough days through scheduling. In other words, you aren't taking 3 mandated furlough days a month (your salary has been adjusted to the 3 furlough days every month and the time is banked until you can use it). You can build up the furlough days and use them in place of sick time or vacation time, etc. Overtime is being used by nurses to make up for the 3 day a month loss in salary and then some. Depending on the facility you work at, how many nurses want the OT, and your rank in seniority, number of vacant positions, nurses on vacation, sick time, etc., will determine how much OT you will get. Hope this makes sense.

1. Can you explain how you know once an inmate trusts you. What signs and behaviors of trust are most common? The more questions an inmate asks you and the more they relax and share with you about what they are feeling or experiencing is usually a good sign that they trust you. 2. How do you ensure accurate patient education when using slang or non-standardized terminology? I will usually use both standard and non-standardized terminology or slang to make sure the inmate understands what I am saying and relate the two terms together. I also will have the inmate repeat back to me what I have instructed him to do if I am not sure he understands me and doesn't ask me questions. 3. What are some reasons why a nurse would prefer providing care to an inmate rather than a non-inmate? I prefer providing care to an inmate rather than a non-inmate because I only have to deal with the patient, not family. Also, inmates tend to be more appreciative of the care they are receiving and the fact we are willing to take the time to explain things to them and to provide advice. They don't tend to have the unrealistic expectations that non-inmates and family have of nurses. 4. What are some reasons why a nurse would prefer providing care to a non-inmate rather than an inmate? I miss the technical aspects of nursing, the resources, and the fact that I was surrounded by patient advocates "outside the walls." 5. What are some ways in which inmates can gain the trust of their nurses? I don't believe this is a setting where an inmate can expect to gain the trust of a nurse. There is always going to be some doubt in my mind about the inmate's true intentions when soliciting nursing care. I am going to be suspicious of an inmate who is trying too hard to gain my trust.

1. Using the common nursing stereotypes (battle ax, angel of mercy, etc) describe your relationship with inmates. I think inmates tend to view female nurses as sexual objects who they can manipulate to do their bidding. I have heard an inmate or two call me Nurse Ratchett, but I also heard that one time when working in a public hospital. 2. What are some methods that you use to build repore and trust with inmates? The methods I use are 1) Don't promise an inmate you will do something if you aren't going to follow through with it (i.e. look in to why they haven't received a prescription and get back to them about what you learned) 2) Keep an open mind when they are discussing their medical problems and don't make fun of them if they can't write, spell, use foul language to describe body parts, or discussing topics uncomfortable to them 3) Even though a medical problem may not be an emergency to you, the nurse, it may be to the inmate so take them seriously and reassure them & 4) Educate the inmate on how to take care of themselves and their family in the future (especially when discussing communicable diseases) to show that you do care about their health. 5) Irregardless of how the inmate treats me, I will still make sure he/she gets the medical care he/she needs or request another nurse intervene if my nurse to client relationship has bee strained. The inmates respect this because I don't withhold medical treatment as punishment. 3. Are you ever aware of the charges being held against your patients, if so does that effect the way you care for them? I have been aware of the charges held against some of my patients, but I do not allow that to affect the care I provide them. I would be just as much a criminal as they are if I did. Florence Nightingale is my role model for the nursing care I provide to inmates as she cared for people most other people were unwilling to care for (the poor and sick) and was willing to do so even though it cost her her family's wealth and support. 4. How do the inmates attitudes and philosophy related to healthcare compare to non-inmates? An inmates' attitude and philosophy tends to vary depending on their age, socioeconomic status prior to coming in to prison, education level, length of time in prison, prison or jail system, etc. Inmates as a whole tend to be less educated about their chronic health care problems and the medications they take and are reliant on the health care staff to maintain their health instead of being pro-active. Their attitude is that the nurses and doctors should be responsible for their health, instead of us being in partnership with them to maintain their health. When their health isn't maintained, they tend to blame us, not themselves. 5. Can you explain the inmate culture as it relates to healthcare? The inmate culture also varies. Some inmate's will wait until they are deathly-ill before requesting medical care while others will call for medical assistance for every fart or freckle. 6. How were your perceptions of nursing changed or effected when you began taking care of patients that were being held against their will? My perception towards nursing didn't change as much as I became more of a patient advocate than I had ever been when working "outside the walls." I have had experiences that made me realize how scary it can be to be locked in a cell and at the mercy of C.O.'s to get you the medical care you need. 7. Do you believe that the bedside manner you use with inmates would be appropriate in other fields of nursing? Please explain. I can get away with saying things to inmates (not that I abuse this privilege, but sometimes I have to use foul language to get the point across to an inmate that I couldn't use in another setting) and being "real" with them in a way that I couldn't be when working outside the walls where it is more "customer-oriented." I often find myself playing the role of nurse and mother-figure, correcting behavior, teaching them, and providing them with advice on how to "fly right" and to take care of themselves. This bedside manner would probably be most appropriate in this setting, a psychiatric setting, and drug rehab setting. Because other settings are more customer and patient-oriented, I don't think this would be well-received. 8. Would it be difficult for you to acclimate to another field of nursing? What would you have to changed? One aspect of working "outside the walls" that I don't miss is the expectations of patient's family members. I don't have to deal with family members in the prison setting so I can focus on the patient. It would be difficult for me acclimate to having to contend with family again if I went to working outside the walls. I would probably work the night shift to avoid some of the issues I hated dealing with. 9. What events led you to becoming a correctional nurse? The hours, desire to work in a nontraditional setting, the benefits, retirement system, and pay led me to apply for a position as a correctional nurse. 10. Has it been your ambition since nursing school to be a correctional nurse? It was not an ambition for me to work as a correctional nurse while in nursing school (I never considered it). I thought I would spend my career working in the emergency room. It has worked out well for me, though, as I once wanted to be a police officer. I'm now able to combine my love for nursing (including my interest in emergency nursing) with my interest in law enforcement.

This is a very difficult situation to be in. I witnessed a CO verbally abusing an inmate and finally had to step in and say "Okay...I think that was enough." It was difficult to do, but in my heart I knew it was the right thing to do seeing as how the inmate was already suicidal and this was not helping matters. As far as a CO physically abusing an inmate, this can be difficult. I have seen inmates with injuries who reported to me that they were caused by CO's. I completed an incident report documenting the injuries and the inmates' statement and turned in a copy to the Sergeant. I made a note in my own documentation for the patient's UHR and that I had notified Sergeant so and so and treated the injuries as needed. It is out of my hands from there. If the CO did what was necessary in order to gain compliance from an inmate who was disobeying a direct order, then they hopefully will be cleared by the investigators. I try to give the CO's some benefit of the doubt as I do not do their job, but I have seen some injuries that seemed excessive, although I was not there to know what had occurred that caused the injuries in the first place. I have seen situations where the inmate was given an opportunity to comply with a direct order and chose to be smart-mouthed and custody made him comply through physical restraint and I honestly felt I would have handled the situation the same way as the officers had I been them. It's a fine line, but if you are going to intervene, choose how you do it carefully, may be by suggesting the inmate's behavior is due to a medical or psychiatric problem and request that you be allowed to evaluate the inmate. Hope this helps.

In the prison I work in, we are identified by our last name, not our first name. So we answer the phone or are called "RN Jones" instead of "RN Sally" by other staff and inmates. I think this creates a more formal situation and understanding of authority so that the inmate doesn't see us as being on the same level. Technically, we are supposed to wear ID badges that have our first initial and last name and title, but I and most other nurses I work with don't for our safety. They do know how my name is spelled, though, if I have given them passes to medical for treatments, doctor's visits, etc., as this is required in order to issue them a pass. I just choose not to have my name on parade for everyone to see. If an inmate asks me for my name, I give it to him and make sure he knows how to spell it properly (hahahahaha...I think all correctional nurses can relate to that one). It probably wouldn't be hard though, if your last name was unique, for the inmate to get information about you, just as any one could get information about you if they really wanted to from the internet nowadays. But, I know when I worked on the outside in an ER, we feared this same thing and did change our ID tags to have our first name and initial of our last name to protect ourselves, after rumors of gang members following a nurse home after she treated a victim of a drive-by and gang members (patients or visitors) started threatening nursing staff in the ER. One way we can protect ourselves is by not listing our name and address and/or phone number in the phone book. My employer also allows us to register with the DMV to have our address blocked (just as law enforcement personnel are allowed to) so if you try to look up my information in their system, my employers' address will appear, not my own. Otherwise, you just don't think about it. Patients have gone back to hospitals and shot/assaulted their doctors/nurses when they didn't like the care they received so no workplace seems to be exempt from violence anymore.

To be a young female RN in this field working with male (and female prisoners, too) is to be open to cat-calls and being stared down like a piece of meat. And sometimes your ears are party to conversations that will disgust you. Young female RN's (and really, any new staff of any age or gender) are sometimes looked at as being vulnerable by inmates and fellow staff alike, so the inmates will try to manipulate you, while your fellow staff will probably try to protect you. But if you remain professional and set boundaries with the inmates (just like you do with children) and do your job, you will be fine. This may involve telling them that you don't appreciate being talked to or stared at. They may or may not listen and custody/officers may or may not back you up. Make sure you find out what your rights are during orientation so you are able to defend yourself even if no one else does. Is it a dangerous environment? It can be...But the hospital environment can be dangerous, too. The difference is you may have to respond to riots, but if you remember to wait until the officers have secured the scene for your safety and that you are always aware of what is going on around you and to not find yourself alone with an inmate or with an inmate behind you without you knowing about it, it will go a long way towards keeping you safe. I worked in an emergency room before I worked in corrections and there were situations in the ER that left me probably more scared than I've ever felt in the prison setting. At least in the prison/jail setting, you know you are dealing with criminals. On the outside walking on the streets or the people you are caring for in the hospital, you don't know who is or isn't a criminal. So when you look at it that way, you actually feel a little safer in the prison or jail setting. And at my institution, we wear personal alarms and whistles. I sometimes wish I had a personal alarm for when I'm out in public. Don't be naive, though, to think that the officers will always be present to protect you. There's usually not enough of them to be all places at all times. Be aware of your surroundings just as you would be if you were walking down a dark street at night by yourself. Be cautious, but not paranoid. And find out what safety measures the facility employs. They may even have cameras keeping an eye on what is going on within the facility.

Correctional nursing can sometimes feel like you are . You are stuck in the middle between custody, inmates, nursing administration, and medical doctors and it feels like the only person who is on your side is, well, YOU. I even had another NURSE go behind my back and talk to a physician to cancel sending an inmate out who had severe abdominal pain because she had seen the inmate the night before (along with a different doctor) and they had felt he had been faking it. The inmate had gone mandown several times that day before I arrived to fulfill my four hours of mandated overtime (lucky me) to again have this inmate go mandown. My assessment of an elevated temperature, tachycardia, tachypnea, and a hard, hot, red abdomen had me second-guessing the "assessment" of perfect vital signs and normal abdomen of the previous shift's nurse. Custody fought me each step after I contacted the doctor to send the inmate out because the other nurses didn't feel there was anything wrong with the inmate. Now it was me versus other nurses and custody I finally told one officer to "Shut-up" and walked-away to tend to the inmate (16 hours on the job will do that to ya). So I'm thinking this is done and over with. Until I get a call back from the doctor to cancel the transfer, that the inmate will be seen in the triage and treatment area by the same nurses who saw him the night before so that THEY could assess if there was a change in the inmate's condition. The inmate refused to be transferred to the triage and treatment are where he felt he hadn't been treated fairly (which I tended to believe was probably the case given some of the nurses there) which left me in a predicament. If I sent him back to his cell, he would only continue to go mandown and the next mandown might be a critical emergency or full arrest (I suspected peritonitis, which if it leads to sepsis, has a pretty high fatality rate). I attempted to talk the inmate in to going to the TTA hoping they would see what I was seeing and send him out. Another C.O. who came on for the new shift who also saw something wasn't right with this inmate tried to help me convince the inmate as well. The inmate was not going for it. So I tried to get the inmate to sign a refusal for treatment, hoping to get him to change his mind, and also knowing full well if he didn't, that this was not the end of this and I'd be seeing the inmate again (probably to transfer out as an emergency) but when the inmate said "I'm not refusing treatment, I'm just refusing to go to the TTA" a lightbulb went off in my head. I called the doctor back and said "Doc, he's not refusing treatment, he's refusing to be seen by the nurses in the TTA again." The doctor finally had to agree to send the inmate out, bypassing the TTA. Report from the officers who went out with the inmate=emergency surgery due to a perforated bowel. In hindsight, I wish I would have just gone over the doctor's head and sent the inmate out considering the doctor allowed other nurses who were not even present to assess the inmate to second guess my assessment and nursing judgement. It took me hours to get this inmate out between the back and forth with the doctor, TTA, inmate, and custody finally putting together a team to send this inmate out. I'm lucky the inmate didn't die in front of me considering this had been brewing for at least 24 hours. Total hours worked for the day=19 hours by the time everything was said and done and I was officially relieved. Sure, I once again gained the respect of many in custody staff. But even when you gain their respect, you have still have to listen to the ******** and moanin' about doing your job. But like someone else said, one moment, you are doing too much for the inmates, then the next moment, not enough. As long as you go home at the end of the day knowing in your heart that you did the right thing by the inmate and by your license, it don't matter what anyone else thinks (including those in nursing administration who also like to nit pick what you do or don't do because you forgot to fill out this or that insignificant piece of paper for auditing purposes, despite the fact you saved an inmate's life). Correctional nursing can be thankless at times and more than thankful at others. It's not for everyone.

Review how you will respond to emergencies. Don't let all your answers be "Refer inmate to RN or MD." If it is a medical emergency and you are first on scene, you will be required to act until a higher level of medical/nursing authority arrives. Always remember to make sure the scene is safe before entering it (that custody is present and has secured the inmates and is keeping an eye on you), to wear PPE's (personal protective equipment), to size-up the scene (see if there is any evidence of what might have happened to cause the medical emergency such as a syringe indicating a drug OD or blood on the floor indicating trauma) and check the LOC and ABC's of the patient. This will guide your treatment. Some of the questions may also be related to how you handle security situations (inmates fighting) or inmate's behavior (how you would respond if an inmate was coming on to you or is being verbally assaultive). You might also want to review some simple mathematic calculations related to drug dosages for liquid medications or splitting tablets and common side effects of commonly prescribed psych medications (which are prescribed in large amounts in correctional settings) such as antipsychotics and SSRI's. Hope this helps.

Another thing I forgot to add to my previous post is my recommendation to purchase Dickie workpants with a belt. The belt is useful for hooking your personal alarm and key chain with CPR face shield and medical keys to so that you don't have everything stuffed in your pocket (which makes it easier to hit your alarm by accident or to lose your keys).

Hello, I'd recommend buying a pair of tennis shoes (not Crocs or slip-ons) because you just never know when you may need to run towards something (a mandown, etc) or away from something (a fight, riot, etc). You can not wear jeans and blue or orange colors (as these are the colors worn by inmates, depending on their status). Sometimes you can get away with a multi-print scrub that has blue or orange in it (depending on who is working at the gate or in control), but I'd play it safe at first and just buy some solid prints that are not blue or orange. Good luck to you.

Sheri, We're having to do 7219's mostly not because of an injury or incident, but because ANY inmate who goes in to the Ad/Seg unit, has to have a pre-ad seg 7219 done. We are locking up SNY's in Ad/Seg b/c we don't have room in the SNY yards/housing units. THe other day, they needed twenty 7219! Crazy! Thankfully, the LVN's stepped up to the plate to handle those while I finished doing the inmate's intake screening.