cmryan12

Not giving pain medication that's ordered after a painful procedure is cruel and not why we are there. Not working to control her pain isn't going to magically fix a history of drug use. What it will do is impair her recovery and make her less likely to seek needed care in the future. Unless she comes in for detox and recovery of her own free will, you will not do anything to help any drug problem she may have. Those are decisions for her to make, and she has to do the work to recover. By all means, educate and offer resources while working to manage her pain. But please keep working to manage her pain, drug history or not.

Hey there, I worked my way through nursing school while working in county jails in a pretty large urban area. I started as an EMT, then LPN, and finally RN. I have some suggestions/thinking points. 1) There's a reason (actually several) that these jobs are lucrative. It takes a certain type of person, and a lot of experience, to tell the difference between a legitimate medical complaint and a malingerer looking to gain something. Not to mention the day to day abuses of attempting to care for people who sometimes don't care for themselves, and especially hate being held where they are. 2) Your medical part of the job will never be first. It's always the security of the facility and safety of the staff first. That can be a difficult adjustment. 3) While this can happen in any nursing job, don't discount your risk of verbal or even physical confrontations. You stated your height and weight, but that can potentially make you a target. 4) As a new grad, even if you've had medical experience before, there is a LOT we don't know. I had no idea until I was responsible for knowing it. In one of the facilities I worked in, I was the only nurse as an LPN, with only a Medical Assistant or EMT as my help. The physician was not on site. It can be scary. 5) Many times, you can send a patient to a local hospital for further treatment (though some federal facilities have their own hospital wings). Be prepared to have good reasons and justification when you call the physician for orders to send out. Depending on the patient, they may be a flight risk or require multiple law enforcement personnel to escort them to the hospital and stay there for the duration of the hospitalization. Where I worked, the county was responsible for paying the hospital bills. All this meant we had to be able to justify not only why we woke up the physician, but why we pushed to send the patient out. My point in all this is it might be good to consider some med-surg or other acute care experience prior to working in corrections. I really enjoyed my time there, and I miss it. I hope this gives you some guidance. Good luck! :)

I suffered with depression and anxiety after I started my first acute care job. I was lucky to have a wonderful doctor who listened and we came up with a plan (including meds) that worked for me. Fast forward a couple of years. I'm not taking any medication, I live 500 miles away from everything I've ever known, I work critical care, and I'm the most relaxed and content I've ever been. Some of it was getting beyond the new grad worry of "I'm going to kill someone with my raging incompetence". Some was being selfish and making the decisions that were best for me, even if they were difficult. I don't think anyone can tell you what to do to move past your troubles; it's a journey, and a personal one. What helped me was realizing I wasn't living life. I was going through the motions and wasn't the person I wanted to be, or the person my loved ones knew me as. I gave up worrying (it's not easy, but can be done). My dad always pointed out how it does no good. If you worry, and it happens, worrying changed nothing. If you worry, and it doesn't happen, you worried for nothing. It takes so much energy to keep up that thought process. It's exhausting. It helps to get some perspective for a while too. I worked Emergency and Trauma for a while, and seeing how quickly things can change and be catastrophic helps you remember that none of us have much time on this rock. It's easy to get caught up in the forest and miss seeing the trees. I love on my kittens, spend time with my family and friends, read, walk, and sometimes I sit in front of the TV and do nothing. I've strengthened my relationship with God as well. That's what worked for me. But you can find your own path. Listen to what your body and soul need, and give those things to yourself. Life is much better without all the extra worry and exhaustion. I promise. Best of luck to you!

I was working in a correctional facility, and we were taking care of a patient we initially thought was anxious about an upcoming court date. As the corrections staff was getting ready to move the patient to be watched more closely, the patient slumped on the bed and didn't respond to the correctional staff via intercom. The funny part is when corrections called for medical over the radio, the only thing I heard was medical's call sign and the pod the patient was in. The rest was static. The pod was close to the nurse's station, so rather than wrestle the radio, I walked over to see corrections staff attempting to move our patient, who required more than one person to move, to put it kindly. We did the best we could with our BLS equipment, but the patient didn't survive. We found out later that even if a surgeon had the patient already opened, the patient would not have survived. I remember crying in a corner for a bit, and then getting called over the radio by one of the sergeants. Sgt. Showed up at the medical office door with a man in a suit (at about 0400), who I assumed was psych. Nope, the facility head honcho. The news of the diagnosis helped, but I felt very conflicted for a long time. Now I work ICU, and codes or crashing patients aren't uncommon things. But I don't think I'll ever forget my first one.

Hi! I just wanted to post a similar experience I had. I was an experienced nurse, but new to a specialty. I actually moved out of my home state for this job, and had everything riding on it. I had received some feedback that I wasn't efficient, but it was buffered with "it will come with time". I hadn't received any other negative feedback, but my orientation was extended a couple of times. The second time, I asked what I could improve, and was given the same response as before. A week before my orientation was to end, I was asked to a meeting where I was offered a different position. More feedback was given, and I was floored. Long story short, I started job hunting, and ended up at a different organization. I can't (and won't) say anything bad about the previous organization. I should have pushed more and kept my personality quirks to myself until people knew me better. Live and learn. My point is that sometimes the culture of an organization doesn't mesh well with an employee. I think that's what happened to me. Just as it's important to have an employee who works well with the organization, it's also important that the organization works well for the employee. Hospital culture will be long established before a nurse takes a position. It won't change because of an individual nurse (unless it impacts patient care), and a nurse shouldn't have to change or hide his/her personality to fit in. I understand wanting a "prestigious" hospital job. But you also have to consider how much you'll like going to work. A good team of coworkers can make all the difference. I agree with PPs that it sounds like you made up your mind. It sounds like a good choice to me. Either way, my best to you. You're not alone. :)

I saw a post on this thread about reality orientation in patients with dementia and it reminded me of a story from my days on stroke/neuro. We had a lady who had what I like to call goldfish syndrome: they're only able to remember things for 5-10 seconds, then the cycle repeats. This lady was convinced she was in her "younger days" and get very upset when we told her the year. She had wandered down to the end of the hall where our large windows were. The CNA was attempting to get her back to her room for lunch with no success. The CNA had gotten me and told me what was going on. I went to the patient and struck up a conversation with "HI! Whatcha doing?". She told me she was watching Hitler March across the battlefield with his bombs. I said, "Well, if there are bombs going off, should we move back to your room where it's safer, without these big windows that could break?". The patient got right up and let me lead her to her room. No fuss, no being upset. We chatted while she ate lunch, and things went beautifully after that. I always thought it had to be difficult to be a patient with dementia, especially if someone is telling you that what you believe to be true isn't. I always looked at the situation, and as long as it wasn't harmful, sometimes it's better for the patient if we go to their reality instead of trying to bring them to ours. It isn't about it being easier, but about being better for the patient, especially in cases where the alteration in mental status is permanent. My own two cents, but it comes from a place of care and respect for our elderly. I always figured if you made it 70, 80, or 90-some years, you earned the right for me to meet you "at your place" in a way.

My understanding regarding the HAZMAT suits (because I asked where ours were) was that the reason EMS and health care workers/first responders that have been dealing with the ill patients in Africa aren't trained in appropriate donning/doffing procedures. And they're likely caring for more than one patient with the disease. While I think I would feel more safe in a space suit should I be taking care of an Ebola patient, I wonder if that's because of things like the germ study with the gloves, or knowing that those paper gowns don't catch everything. Disclaimer: this is what I have heard only, nothing that has been confirmed. Though honestly, I'm not really sure whom to believe at this point.

Hi! I'm very sorry for your no-win situation. I am currently an LPN in a county jail. I don't know what state you are in, and therefore, the policies and procedures may be different. In my facility, we can accept suicidal arrestees. The arresting officers will bring them straight to the jail (unless they are injured) and it is then the responsibility of the intake officer and, if applicable, nurse to assess the situation. We have psychologists in house (except for midnight shift, which I just happen to work), and a psychiatrist on call. We have the option of refusing a new arrestee, which would then send them to the ED. As a general rule, if a new arrestee is making suicidal statements or has even had a recent attempt, as long as any medical injuries have been addressed, we accept them and put them on a suicide watch. They receive a "suicide-resistant" blanket (looks like a moving blanket you place over your furniture) and a mattress and that's it. A correctional officer then has to see the inmate every 15 minutes at least. Of course, there are variations that are possible depending on the situation, but that's the general procedure. I'm wondering if the correctional facility that you are dealing with does not have medical or psych staff available. There is the chance that they are doing a "dump job", but I wonder if maybe they don't feel they have the resources to manage a person in the condition you have described. My facility has a padded cell, and another facility I am familiar with has a restraint chair for patients who are actively trying to harm themselves. Nurses are in the facility 24/7/365 with the ability to medicate dangerous patients if ordered by the psychiatrist/judge. This may be something to speak to your supervisor about. He or she may be able to speak to someone at the correctional facility to find out what the situation is. At the very least, it seems an appropriate concern to voice. A patient like that takes a lot of time and energy that could be redirected to patients who actually need it. I hope you are able to find a solution to your problem. I wanted to respond to let you know that not all correctional facilities run like this, and maybe that would be something to look into. Keep your chin up and keep venting if you need to! Good luck!