Protections of civilian nurses from fed. inmates

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New to the site, but really need some help from other nurses. I work the federal prison unit at a hospital that has a contract with the FBOP. I am a civilian employee of the hospital. 

The situation is that we have an extremely volatile and manipulative prisoner serving a life sentence. He has had almost a hundred instances of self harm (cuts, eating batteries) and is currently on month 2 on my unit waiting on a transfer to a prison medical facility. These transfers take 6-8 months on average.

He has somehow gotten privileges that he shouldn't have, such as being allowed personal items and mail delivery to the hospital, as well as items at bedside. I don't know about you guys, but when I have someone in this hospital that says they will hurt themselves, everything gets stripped out. He calls us all horrible names, things I won't even repeat, threatens to kill us and kill our families. Yesterday he assaulted staff, punching officers and spitting hepatitis C blood at nurses.

The prison doctor is so tired of his horrible behavior that he keeps rejecting his discharge back to the prison. The prisoner is medically cleared and doctors have all signed off on him.

What can I do about this? I'm not a government employee and abuse isn't part of my job, he has been attacking us for months and no one at the prison seems to be willing to help us.

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Specializes in mental health / psychiatic nursing.

The process for how to transfer him back will depend on what his specific jurisdiction is and on why he is hospitalized to begin with.  You need an interdisciplinary care consult including unit leadership, and possibly hospital leadership to determine next steps and get this patient moving along.  If he is assaulting staff, staff do have the right to press charges.  Prison isn't obligated to help you per se, but your hospital should be working to make things safer for those caring for him. 

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13 hours ago, Fishfeels said:

I don't know about you guys, but when I have someone in this hospital that says they will hurt themselves, everything gets stripped out.

So what is the prevailing thought about this on your unit? I ask because I guess if I assessed someone as a threat to self or others, I would institute the appropriate precautions as soon as I got on duty and let the chips fall where they may.

If the patient willfully assaulted me I would contact law enforcement and report the assault(s) each time.

I suspect if you do the above two items your management will see fit to get more involved in the situation.

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7 hours ago, JKL33 said:

So what is the prevailing thought about this on your unit? 

Its absolutely wild to me that the older nurses tell me "that's just the way it is." I heard a story about how an inmate hit a nurse and broke her tooth, the hospital refused to acknowledge it and she had to pay out of pocket for the repair. A lot of the other girls say they give him what he wants so he doesn't cause problems. The over arching mentality is "oh well, not my problem!"

But I am not going to have my license threatened due to the negligence of someone else.

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18 hours ago, verene said:

You need an interdisciplinary care consult including unit leadership, and possibly hospital leadership to determine next steps and get this patient moving along. 

A couple of the nurses filed incident reports today, those get routed above management. We have gone to lieutenants, captains, management, house supervisor. An officer also filed paperwork at the prison today. I just can't believe the DOJ would let prisoners out into the world to abuse the public. So negligent. 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
8 minutes ago, Fishfeels said:

I just can't believe the DOJ would let prisoners out into the world to abuse the public.

There are so many inadequacies in our justice system, I think that sometimes there are just constraints on what can keep people incarcerated. If they've served the sentence that was determined to be appropriate for their crime I don't think they can be held without cause. However, it also sounds like some incidents go unreported that could potentially impact the inmates and their release. 

Unfortunately, even outside the corrections system there seems to be an acceptance of patients behavior, including violence against staff. I'm sorry that you're in this position and I hope that something is done to address your specific problem. Stay safe. 

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Specializes in orthopedic/trauma, Informatics, diabetes.

Do you not have some sort of safety reporting system at your facility to report unsafe conditions? We have a system where we can identify unsafe conditions and we have the backing of most of the leadership. 

This person should not be getting privileges. We have a contract with both local and Federal prisons and when we have a Fed prisoner, there are 2 guards in the room at all times. They are the ones that enforce the rules (same rules at the hospital as in the prison). Something is very off, and very unsafe. I would have to refuse to take this pt on as an assignment 

Hope you can get this resolve! Stay safe. 

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Specializes in mental health / psychiatic nursing.
4 hours ago, Fishfeels said:

A couple of the nurses filed incident reports today, those get routed above management. We have gone to lieutenants, captains, management, house supervisor. An officer also filed paperwork at the prison today. I just can't believe the DOJ would let prisoners out into the world to abuse the public. So negligent. 

I work in forensics and am no stranger to the kind of patient you are describing.  Unfortunately you should be very disturbed both at who is let out, and who is kept for a long time, our legal system is far from perfect. 

Glad RNs are filing incident reports and officers are filing reports at prison.  Documentation is critical in these sorts of situations. 

Is there a behavior plan in place for the patient? If not, get one ASAP. 

Staff NEED to be setting boundaries with this patient, if there are no interventions in place, the patient is controlling everything and you have a very, very messy situation on your hands. 

IDT/leadership need to be looking at taking a hard look at resources, interventions, instituting behavior plans, and modification or restriction of privileges, if not modification and restriction of rights (e.g. mail is a right, however staff may need patient to open contents in front of staff, inventory, and have contents locked away if they are contraband for setting). 

This is a tough place you are in and I sincerely hope it gets better for you soon. 

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I should know better than to ask, but you don't have a union, do you?

Clearly many people are taking the path of least resistance, or even trying to win a popularity contest.  Is the inmate particularly well-connected, or are the key people just that lazy or easily intimidated?

How does he get to have what constitutes contraband?

I agree, documentation is key.  Is there any documentation that goes outside the system?  I would have a low threshhold to implement that on the slightest pretext.  Also involve local law enforcement whenever remotely appropriate.

The powers-that-be will not consider this guy a problem until EVERYONE starts making it their problem.  If your own coworkers are undermining you, then start refusing to have him for an assignment and they can enjoy having more of him.

The gist:  you need to start aggressively rattling lots of cages and don't let up until he's gone.

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For those of us who don't have direct experience with this exact situation, why is a federal prisoner with attendant guards punching anyone in a hospital? Why able to spit blood on nurses (after the first time)? They wouldn't be doing these things in any ED I've been in; not sure why inpatient is different. You need to demand some things from your employer. I'm not there, but I suspect that at least some portion of this is about the fact that it's easy enough for your employer to feign helplessness and blame someone else for this situation. The fact is that you are not an employee of the prison system, you and your coworkers are employees of your healthcare system and are therefore due the same basic safety expectations as they would uphold anywhere else in their system.

Maybe I'm not giving them a fair shake, but I imagine a situation where your own employer is taking a great big shrug on this whole thing and acting like they can't do anything. Which is just not true.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I agree with JKL.  The brass has to get as sick of this guy as the poor schmucks who have direct contact.  Only then will someone make a move to send him on down the road.

I suspect money is changing hands somewhere.

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