Crawsu

Medical is never involved in body cavity searches. We will draw blood with the patients permission for court ordered blood draws, but only with patient's consent.

Don't neglect to check out city and county jails. Ours pay higher than state jobs and have better benefits. It all depends on where you are. Good luck!

I honestly don't think anyone should attempt corrections without at least a year of hospital nursing under your belt. Inmates are master manipulators, as are many patients in the hospital, but you need to have some experience. I really hated hospital nursing, but I learned a lot there that has served me well. I don't think my nursing judgement would be as good as it is without that experience. You will be responsible for making decisions that will impact your patients lives:do you feel prepared for that? Corrections is a great field, but my opinion is that you need good assessment skills and a broad knowoledge base to be a good correctional nurse. Do a year or more in the hospital and you will be ready to try it.

I used to work 10 hour shifts and loved it. Get that extra day off a week, but not so tired you can't get much done. I find that my first day off after 3 12's is pretty much a throw away day as I'm so tired I don't get much done. Loved 10 hours, but not practical for management. Better for the staff, though.

It is sooo not realistic. The first season wasn't bad, but it has gotten sillier every year. I mean, really, if there are inmates who have been involved n fights etc, they would never be housed in the same pod. Surgery in the facility? I don't think so. Transfusions,not likely. A staff member assaulted and then allowed to work in the same facility, puleeze...it's a fantasy The staff is so involved with the inmates on a personal level, it is an example of what NOT to do if you work in corrections. Females housed in the same area as males? It's just stupid. Still, I do feel compelled to watch it, even though it's pure BS. :imbar

I don't know how long you've been in corrections, but I'm going on 10 years and I have been spat on once, by a psych patient. I was assaulted more than once in hospital nursing and feel much safer working in correctional nursing. For the most part, the inmates treat the nurses with respect as thay know we are there to get them health care if that is what they need. I have even had other inmates reprimand a fellow inmate who is disrespectful to the nurse. And I and other nurses on my unit have been thanked by inmates who were helped by virtue of being incarcerated and getting medical care they would not have gotten on the outside. Granted, I work in a jail setting, so our inmates are usually not long termers with nothing to lose. I suppose that dealing with lifers might be a bit more dangerous. Still, I have never felt threatened in this setting, and there were times in the hospital that I didn't feel as safe as I do in the correctional environment.

Oh yes, the "smelling salts" work every time. You have to hold it there long enough though. The really saavy fakers know to hold their breath and breathe through the mouth. I had one, "seizure" who actually knocked the ammonia ampule out of my hand. Then said,"I'm not having a seizure, Bi***!" I documented every word, too. Every "medical" problem at our facility is a "seizure". We are called so many times for "seizures" that are nothing but a bid for a lower bunk or time off from work. How many "seizures" are you called to respond to that are actually seizures? I think the deputies think that any tremor or twitch constitutes a seizure. The best one was a frequent flyer that was having a" seizure" and when we responded, I asked the pt., "Are you having a seizure?" She stopped convulsing, looked me dead in the eye, and said,"Yes, I have emotional seizures.." and I replied, "I understand that that is a very unusual condition" We rushed her to the infirmary and with a liter of gatorade and no TV she was miracuously cured!! The challange is in maintaining your objective data gathering. For every 10 fakes, there is that one acute abdomen, or a real MI, you can't be too careful... CYA!!! That is the correctionalnurses creed! :rotfl:

We have 3 night nurses for about 2000 inmates. We prepour meds for lock down units, but every inmate must show his/her picture ID with name for meds. You have to be careful and check ID"S. Many will take meds if offered even if not prescribed. Who knows why? My facility still offers tylenol and ASA if requested. I don't like the policy, but it is in place, and inmates do not want to hear about health risks for OTC meds, they want anything that's free and will give them time out of the unit. Many are looking for any excuse to sue the state or county, and will do whatever it takes to find grounds for a suit. We usually have 4 nurses scheduled for day shift, and that includes sick call, treatments, and med passes. I think that 4 on nights would be a luxury, wish we had such great staffing. We are accredited by NCCHC. Make sure that your prospective employer is as well, it will decrease the risk of litigation.

I agree... In corrections you need to be able to think on your feet and react wisely to situations that may arise. In most settings there will be protocols or standing orders that allow more independent practice. If you present yourself as inquisitive and wanting to learn, you'll cinch the job. Corrections presents you with a lot of different situations that will challenge your critical thinking skills, and always there will be opportunities to learn more about a range of medical and psych problems. Speaking of psych, play up any experience with psych as most of your patients will have need for it. Jails are the new psych hospitals. at least it seems that way. Good luck, hope you find this a rewarding field. I think that you may find that as an LPN you will still be able to function fairly independantly and if that is what you are looking for then corrections will offer the greatest opportunities. I was going to tell you about the great LPNs that I work with, but won't go into that here. Suffice it to say that you may find that you are more appreciated in the corrections setting than in the hospital setting. You will be judged on your actions and not on your degree in nursing.

Well, for starters, I would make sure all officers are educated as far as infectious diseases go. The most recent info on Hepatitis A B C and the risks and so forth, also diabetic education for officers, also the latest info on TB and not to freak out every time an inmate has a positive PPD, so many have come from other countries where they have gotten the vaccine. For your nurses, if you have good protocols in place, then they will be able to refer to those for most situations. A good orientation to the facility, hopefully involving the officers to orient the nurse to what is contraband and how it can be used to fashion weapons, etc... emergency response for unusual situations, what is the chain of command, what situations might the nurse encounter where securing the area would take precedence over medical care. Hopefully something he/she won't ever have to use, but should know. Things like, does medical remove piercings on the inmate? Does medical do cavity searches? Does medical remove Tasers? All those things that come up when there is no one there except the nurse. Good for you for getting the position authorized and hope you can use it to promote education of all the staff.

Good Luck! Hope you enjoy Corrections. It's been great for me, and hope it will be for you as well. Keep us posted on your progress. :balloons:

Well, I work in corrections at the jail and the parameters are very clear. No relationships with inmates whatsoever. You have a choice between your job and pursuing a relationship with the inmate. You choose either. I don't know how this would apply to hospital nursing, but it seems a bad idea, either way. Many inmates can appear very charming on the surface, but don't believe everything they tell you, because many are sociopaths and adept at manipulating both people and the system Sorry to say that this is just a fact when dealing with most offenders. If a friend or relative is incarcerated it is your duty to notify the dept. so that your contact is minimized at best. Best of luck to you whatever decision you make. Just be warned that most are master manipulators. Remember Ted Bundy, he had all his friends fooled, and went on to commit many heinous crimes. I would advise against it.

He probably had court ordered meds as a part of the parole agreement. Otherwise, inmates have the same rights as anyone else, and probably more so because of the threat of litigation. Anyone can refuse meds or treatment, and if you force it on them it is a crime, assault and battery, if I remember right. Inmate or otherwise. Get a signed refusal and document, document, document. If it's not written, it wasn't done. CYA...

He probably had court ordered meds as a part of the parole agreement. Otherwise, inmates have the same rights as anyone else, and probably more so because of the threat of litigation. Anyone can refuse meds or treatment, and if you force it on them it is a crime, assault and battery, if I remember right. Inmate or otherwise. Get a signed refusal and document, document, document. If it's not written, it wasn't done. CYA...

We only dispense methadone to pts that are current in their program on the outside. Currently we have only 14 people on it. The clinic brings out the doses and the Dr.'s orders with it. It has to be locked in a safe, seperate from everything else. The clinic has to verify all the particulars, we just dispense it. Of course, almost every junkie that comes in tries to tell you they are on it, some have been in the past, but not currently. One guy came in and told me he'd been in the methadone program, but it was too expensive, so he went back to heroin. When I asked him what it cost for both, it worked out that the methadone was cheaper. However, he said he was a musician and that the methadone stifled his creative energy. Go figure... :chuckle

I've been in corrections since 1996. Went to the interview solely out of curiosity. They gave me a ton of backround check stuff to fill out, then said, "If you want the job, fill this out and send it in to the Sheifff's dept," Been at it ever since, and would reccommend to anyone who is fed up with hospital nursing. You get a little bit of everything, but not as much of the "customer service" garbage you get in hospital nursing. You actually get to treat patients for their problems, and you can really have an impact with helping to diagnose and educate patients. There is a lot of bogus stuff, where inmates claim certain Sx because they know they will get sent to medical, but there are also thoses cases where you discover an undiagnosed illness and actually get to do some good. The doctors. at least where I work, are more prone to view you as a peer, and listen to your input. You usually have a more independent practice than you would in other settings, due to standing orders, etc..that allow the nurse to order meds under specific parameters. Would highly reccomend this specialty to nurses that have enough experience in other settings to make judgements based on a patient's presenting Sx. Look out, if they tell you that you"re their favorite nurse. That probably means that you have broken some rules somewhere. As Aurora said, be firm, fair, and consistant and you won't have any problems. Would recommend at least 1-2 yrs med-surg or any other hospital specialty before trying corrections. However, don't expect a jail or prison to meet JAACHO standards. The certification for these institutions are under an entirely different system. The main thing to remember is does the Tx rendered live up to community standards. Always remember that safety standard of the institution take precedence over medical concerns(excluding emergency Tx). In other words, if a pt. is scheduled for clinic and they have a court scheduled for that time slot, the court appearance is paramount. If you are able to be independent within your prescribed standards of practice, then I would think you are a prime candidate for the job. Being independent in your home health care practice would be a BIG plus. Emphasize it. Don't be afraid to negotiate for pay. THere is a shortage of nurses right now, and esspecially in corections, so don't forget that you have a valuable commodity and should be paid accordingly. Good Luck!!!

In the case I read about, the patient had swallowed the methadone, then regurgitated it for another inmate to take. I just feel that the methadone clinic is getting the gov't money to distribute this stuff, so they should take care of dispensing it as well. It takes our nurses away from taking care of of sick people, not addicts. Sorry, but I'm not on the methadone bandwagon. This was pushed on us by our psych dept. who now say they don't have enough nurses to deal with it. We end up dealing with everything that nobody else will deal with. Psych is only there 8 hr 5 days a week, we are there 24/7, so have to deal with all. It is just a nuisance to us and takes away from pt. care that is really needed. Most of the methdone clients are shooting heroin as well, so what dos that tell us about the effectivness of methadone tx? My main c/o with this is that the dept, getting the grant money should take care of the program. Not take nurses away from their main job of treating sick inmates.

Jails are for short term violators. Jails rarely have prisoners sentenced to long terms. Most in my facility are there for a few days, months, or years, then leave for a few days months or years and come back again. Jails are also where people come from prison while they are going to court for trial, so we get a little of everything. Most of them are there for drugs, ETOH, or domestic violence. With the females, it's usually drugs, ETOH, or prostitution. Prisons are for longer term sentencing, for more serious violations, although now with the 3 strikes type of mandatory sentencing guidelines there are more people going to prison than ever.

Yes, the local clinic brings the supply. It is brought out in a locked box and we have the key in our safe. It all has to be cosigned by 2 nurses, then the orders have to be taken off, and med sheets made for each individual. The methadone clinic verifies that a person is actually in a methadone program before it will be dispensed to them. It has really been a headache for us as we have only 4 nurses on staff to do sick call and one of has to stop seeing pts. in the middle of sick call to dispense and/or check in methadone. Plus, almost all the junkies want to claim they are in the program when they book in, which requires us to call the clinic, fax over the claim for verification, etc... I also found an interesting case on the internet about an inmate that overdosed on methadone. 2 people on the program got their dose, went back to their dorm and induced vomitting and then gave the vomit to another person not on methadone. The person (it's gross, aak) drank the vomit, and died of overdose!! GAG!!!

I work in a county jail setting and they have recently started giving methadone to inmates that are incarcerated. Has anyone else had to deal with this situation in a correctional setting, and if so, do the methadone clinics handle it, or is your staff expected to take care of it. We have more or less had it dumped on us. It actually came about due to the psych dept. and they were handling it but unfortunately, both our psych nurses have left( wonder why ) and it has now become medical's responsibility. Any input would be appreciated. The real kicker here is that we do not give narcotics in this facility, and if an inmate comes in on methadone for pain control they are put on withdrawl protocol. Only pts. from the methadone program are cotinued on this. Does that make any sense? Think this has something to do with grant money, not pt care, But that's an opinion on my part. Any thoughts on this?

We usually begin our clinic sick call @ about 0730 and it runs until about 0945 or so. Usually have 90 - 100 names on the list, but subtract about 30 for the diabetic care which is usually started about 0545-0630. So...scheduled interactions account for aproximately 60-70 per day, including a smaller list on both Sat and Sun. Our LPN's do see pt.'s as we work under protocols that are signed by our doctors. All our interactions are signed off by the MD's. So we are basically working with standing orders, anything that falls outside the parameters must be referred to MD or called to doc on call. We do require a $7 copay for sick call unless the pt is indigent in which case all care is free. The $7 covers all care related to the original c/o so that includes all meds, referrrals to specialists, etc. The rest are drop ins basketball injuries, fights, work injuries and so forth. We try to staff at least four nurses for this, but would like to add another for the incidentals, such as triaging, phone, med confirmations, etc... Our population runs between 1800-2000, depending on what is going on in the community. Recent prostitution stings have upped our female population, for example.

Addendum: No workmans comp from pushing carts, they are reasonably light weight and easy to move. Mostly made or some sort of plastic with easy rolling wheels. There are even carts on the market with motors. We do have one person on light duty, post surgery, who cannot push a cart per Dr order. I find that pushing the pills out of the blister packs to be more of a pfoblem, but as I said before, there are many options on the market and would suggest you check them all out before making a decison. We might have chosen something different had we been allowed a trial of each type available.

Med errors have probably gone down as the carts are stocked identically. We are a County facility, so having packs for each individual is not as feasible as in a prison setting, too many coming and going. We take more time with this system, but it is better if you have agency or newer nurses passing as it is all alphabetical by generic name. We have a cheat sheet on every cart that lists the brand and generic name in case you need to check. The med passes vary in time spent, depending on patient and number of meds per each, familiarity with the pt and his or her meds, etc. Passes run anywhere from 30 minutes to 2 hours, depending on the building and the mumber of patients. Some of the longer ones involve dormitory type settings, where there are 3-4 dorms per building. Having a pharmacist on duty does expedidte getting unusual meds, etc. plus the adantage of having a resource there for questions on newer,unfamiliar drugs and side efects, etc. We are trying to get to computerized MARS, which will free up lots of time for the nurses, and reduce med erors in transcription as well. Hope this helps.

Just reread your post and realized that I didn't completely address your query. We have med carts that we take out into the jail, at least one officer is standing by as meds are passed. Generally we pass at the doorway to each unit. Lockdown units must be passed cell to cell, and in those cases we use med cards for each individual, with the meds dispensed in the infirmary, then carried to the unit on a tray. Each patients meds are in a souffle cup with the med cards in a slot next to it on the tray.

We do 14 plus med passes per day in our facility. Recently changed from bulk to blister packs. Each med cart is stocked alphabetically by generic name. We now have a full time pharmacist and assistant and they package the pills in plastic frames using a machine that backs the frame with a foil backing. Given a choice, I think I would go with cards instead as the machine we use causes some capsules to break easier, or get foil stuck to the cap as it is pushed out. Esspecially bad are dilantin and tetracycline. The machine uses heat to adhere the foil to the plastic frame and I assume this is what causes the problem. Hope this helps.