Oh I understand that....and when I don't know, as I cannot diagnose (technically) I call the Medical Director, a DO, and let him make the call whether or not the inmate needs sent out. If he decided otherwise, I make sure I CYA by documenting, documenting, documenting....If I have an inmate c/o chest pain, in our treatment room in Medical, we have a 12 lead EKG machine..I hook him up and look at it. I have 17+ years of nursing experience under my belt all of which was in acute care, with 12 being in critical care. (my CCRN certification expires next yr). I realize that not all the nurses I work with, have my level of experience....one of them, the prison was this RN's FIRST nursing job....not sure that's a good thing, imho.
My hospital that I left, just went through Stroke Certification to gain Stroke Center status...and the 1 thing I was told was not to go looking for zebras (i.e.--Bells Palsy) vs stroke.
Our Prison system has what's called Nursing Evaluation Tools...that basically tell you what to assess with the presenting problem.