debdouc

I work overnight in the largest county jail in my state. We serve up to 600 inmates, usually in the neighborhood of 500. What I like about working in a jail is that I get to create a compassionate experience in a system that is not intended to be compassionate. The variety of the job is cool: part office nurse, taking care of walk-ins; part acute care, taking care of and monitoring acutely ill people, especially those withdrawing from drugs/alcohol; part registration nurse, conducting medical admissions assessments on all new arrests who are going to housing; part triage nurse, assessing new arrests who have injuries that may require attention in the emergency room prior to accepting into the jail; part emergency nurse, responding to medical ELIS calls, assessing, stabilizing, and sending out patients when necessary; and documenting, documenting, documenting. The challenge of working overnight is that, while I have a fabulous LPN with me with a separate scope of practice and tasks, I only have available an on-call provider. One of the best parts is having a fair amount of autonomy and far less commotion than the other shifts. I also like the 8-hour shifts so much better than the 12-hour shifts that are usually the rule in hospitals. Working in a jail usually means working for a vendor that contracts with the jail. Medical is separate from security and security runs the show. The environment is tightly controlled and nurses new to the environment often find it intimidating. For instance, there are locked doors and sally ports for every unit, hallway, entry, and exit that require being buzzed through by control. I, personally, find it comforting to know that I am never alone with a patient, that there is always an officer present during any encounter. In that respect, it's a far safer environment than my other job in adult psychiatry in a community hospital. If this is something you're considering, I'd say to give it a shot. It's the coolest nursing job ever. It's broadened my horizons, taught me a lot about leaving my attitudes outside, and given me the opportunity to practice all sorts of nursing in one location.

I appreciate Davey Do's remarks: no name calling and some clarity on the importance of introspection. The PA's behavior speaks much more about him than about the nurse. I appreciate the difficulty of the situation as well. The nurse did well to retrieve the information and to present it quickly and without attitude. This gray haired old nurse has learned that right actions require no defense and to become defensive (even if it seems appropriate to the situation) casts doubt on the rightness of the action. If the nurse believes that further action is necessary, my recommendation would be to present it without blame or attitude within the chain of command as a concern and then to let it go.

I can really appreciate your position here but would like to point out some possibilities for you. My comments come from my experience with Preceptor A , who was a 20 year fabulous nurse from a diploma program. She was also a horrible preceptor, going about her business and not giving me much attention unless she didn't like what I was doing. I was stressed because I wasn't getting what I needed and didn't know how to change that. When my externship was over and I had my license, I requested a change in preceptor, had had enough experience with all the nurses by that time to know who would provide me with the best learning experience, and requested the change, got it, and had a remarkable experience with Preceptor B. I learned, was able to question and interact with Preceptor B in a fulfilling way, and ended up doing well. 1. Morning care is part of nursing school clinical process and is an important part of the learning process. Once you're a licensed nurse, though, it's important to think about your job and realize that, while providing basic care falls within your scope, so does timely charting. The CNA also has the scope of providing basic care but not timely nursing charting. Ultimately, if you are busy doing basic care rather than getting your charting done and something goes south with the patient, the clinical picture, represented by timely and accurate charting, is incomplete and you, your patient and the entire clinical team are disadvantaged by not having adequate information available on which to evaluate the patient's change in status. 2. Many, if not most or all, hospitals and physicians set parameters for blood pressures and heart rates when giving blood pressure medications, indicating that these need to be done just prior to giving the medication. If you are not comfortable with the time lapse between v.s. and medication, get your own set to make sure it is safe to give the medication. Many charting systems request these be entered along with the medication administration. You haven't hurt anyone by getting a second set and are following the provider's orders in doing so. Patient safety is the ultimate goal. 3. Many facilities require that premeal blood sugars and insulin be done when the meal trays are delivered to the floor so that the patient is less likely to experience a dangerous drop in blood sugar. You might want to check your facility's standard of care and act accordingly. 4. When questioning your preceptor's practice, it's a good idea to ask in learning mode rather than in challenging mode. Just because your preceptor does things a certain way doesn't mean that that should be your model for practice. Ask and do the best you can, understanding that everyone is a teacher, whether by fair means or foul. 5. Reread your dressing change orders to determine whether it is to be sterile or clean. In my experience, hospital dressing changes are sterile because we have the means to do so and it is about patient safety and wound care. If the order says clean rather than sterile, act accordingly. 6. I've never heard that scanning medications in advance of hanging them or giving them was appropriate nursing practice. It gives an inaccurate picture of patient care and medication administration. It makes no sense on any level, especially when considering the opportunity for medication error. It doesn't even make sense from a time management perspective. Scan the medications when you are giving them and do your best to prevent medication errors that will ultimately be traced to you if you do otherwise. It's your practice and your license, no matter what your preceptor says. You don't have to challenge or argue about it. Just do the right thing. I've read many of the responses to your post and can really appreciate the wealth of experience represented. Ultimately, we each, individually, are responsible for our own practice and the consequences thereof. We are also responsible for our patients and their care in which we participate, and to the facilities for which we work. Sometimes it's a juggling act to keep all the plates in the air. Best wishes to you as you continue your journey.

I have worked in corrections for 3 months now (coolest job ever!) and am learning that giving and receiving report is an experience unique to the environment. It's different from cardiac telemetry, ICU, psych and long term care. I don't know how to do it well and am looking for a way to organize my thought process, ask questions that will be useful to me and to the next shift, and to make sure I cover all the necessary aspects of the job during my shift. We have a log that I fill in religiously and I read the previous logs as well. Turns out that's not enough. HELP, please!