Request for interview with correctional nurse

Reigen · Feb 3, 2007

Largest safety concern...

What it means for correctional RNs/LPNs is: they need to become skilled at providing quality health care in an environment in which security takes precedence.

Working in the infirmary part is not unlike working in a small hospital -- patients are assessed, meds are given, treatments performed. But there are two striking differences: seg patients in the infirmary are always cuffed when nurses enter their cells, and when correctional nurses count narcotics each shift, they also count instruments, tools and everything in the crash cart and surgical cabinet to account for any potential "weapon."

Then the RNs/LPNs then go about providing care to patients as best they can under tight security guidelines. Security is FIRST, then medical care.

There is always the potential for any of the items the OP has asked about to be used against not only nurses, but the entire staff. Do I think about those? Yes, indeed, however if I choose to dwell on those, I think that I would not be able to concentrate on the duties I am to perform.

By remembering to be aware thaat anything can/could/would/will be used against staff you stay ahead in the safety question. Respect and dignity towards the incarated population seems to assist in lowering fears on safety.

I have to say my biggest fear is that security will falter causing the inmates to take control and a riot start.

wisconurse · Feb 3, 2007

Thank you so much for your response! You have already mentioned several issues I had not thought of, such as counting equipment and attending to patients in handcuffs.

I also had not considered the overall threat of a large scale security breakdown. I was thinking in terms of one-on-one problems, so that is enlightening!

If you do not mind continuing, I will ask some more specific questions, of course if anything is too personal or should not be shared please just say so. I really appreciate your help! I am amazed by how people in the nursing profession are willing reach out to each other. Thank you!

When did you graduate from nursing school?

Have you been a Correctional Nurse since you graduated, did you work in another nursing capacity, or take time off after graduation? What other types of nursing (if any) have you done?

Do you work in more than one institution at the present time?

How many hours a week, on average, do you work in a week?

What shift(s) do you work? If you work more than one shift, how do you rotate through the different shift rotations?

What do you like about working as a nurse?

What type of facility is the institution?

What are the types of patients that this unit cares for?

In general, what are the needs of these patients?

What types of problems do you address or try to prevent, as a nurse working with these patients?

What other types of health care providers work with these patients and what are there roles with these patients? How much time, on average, might they spend with a patient on a shift, a day or a week?

What is the staffing level of the primary shift that you work? Do you know what that might be for other shifts?

How is patient care divided amongst the different health care providers? (For example does one C.N.A. provide the care to 3 patients and work 1:1 with one RN?)

Have you ever had an injury as a result of your employment as a Correctional Nurse?

You mentioned your concern about an overall security falter. Would you say that prevention of access to weapons, or objects that could be used as weapons is the most important preventative measure implemented in your area?

You also mentioned that security is first priority, would it be fair to say that putting security before medical care adds to the overall safety of all patients and staff?

Has a patient's health been adversely affected by security measures in your experience, or has a crisis clearly been prevented by following safety procedures?

Are you aware of any regulatory and/or reimbursement agencies are involved in this safety risk for the patient and the nurse?

Are you aware of the stance of any professional nursing organizations related to correctional nurses or correctional nurse safety?

How much additional training was required to prepare you for this job? What was the nature of the additional training?

Reigen · Feb 4, 2007

You are welcome, I hope this will be of assistance to you.

When did you graduate from nursing school?

LPN 1981 RN 1988 BSN 2004

Have you been a Correctional Nurse since you graduated, did you work in another nursing capacity, or take time off after graduation? What other types of nursing(if any) have you done?

I have done many different types of nursing:

Hospital:

Specialty experience in Medical-Surgical, Pediatrics, Orthopedics, Neurology, Cardiac, ICU, Telementry and Short Stay Surgery; Geriatric nursing services, Home Health/Hospice: Case Management/Intake Coordinator,Staff Developement Coordinator, and Corrections.

Do you work in more than one institution at the present time?

No at this time I am assigned to one prison.

How many hours a week, on average, do you work in a week?

36 hours three 12 hour shifts

What shift(s) do you work? If you work more than one shift, how do you rotate through the different shift rotations?

I work 7:00 p.m. to 7:30 a.m.

What do you like about working as a nurse?

Independence and Autonomy - Practicing nursing in correctional healthcare is a satisfying mix of independence and cooperation.

While functioning autonomously is rewarding, I also appreciate being part of a collaborative approach-- Specialty physicians, mental health, dental and other professionals are readily available to nurses in support of patient care. I think I am not only taking care of the patients but also doing a type of public health nursing as well.

What type of facility is the institution?

male Medium-security 768 beds currently.. scheduled to build further beds starting March 2007 opening Spring 2008

What are the types of patients that this unit cares for?

Orthopedic injuries, sports injuries, diabetes, hypertension, HIV, ingrown toenails and other chronic illnesses

In general, what are the needs of these patients?

Facility health care staffs oversee all stages of patient treatment, from care planning to clinical outcomes. The nature of the population served provides additional perks for health care professionals: all are ambulatory,no bed pans to change at our facility. Acute care is a reality, but a rare and short-term occurrence, as serious illnesses and injuries are transferred to community health care facilities.

Correctional nurses have a great deal of autonomy, provide acute and chronic assessments, dispense medications, manage acute illness and injuries, perform health screenings, and educate inmates on various health related topics. Correctional facilities also reflect the society at large, therefore the incarcerated population is aging and has a wide range of health issues that need to be addressed while serving their sentence.

What types of problems do you address or try to prevent,as a nurse working with these patients?

We place emphasis on education that may include group meetings to discuss care and maintenance of various illnesses and other educational health care programs; successful readjustment into society upon their release through addictions treatment and psychological counseling.

What other types of health care providers work with these patients and what arethere roles with these patients? How much time, on average, might they spend with a patient on a shift, a day or a week?

We have LPNs, RNs, NPs, MDs, Dentists, Psychologists, mental health counselors.

Time with each is variable MDs, Dentists counselors and Psychologist are in the prison a set amount of hours per week between 20 and 24 per week.

What is the staffing level of the primary shift that you work? Do you know what that might be for other shifts?

On the shift I work, one RN is staffed. Day shift has between 3 to 4 nurses. If an Inmate is in the medical Department overnight, then a Medical Correctional Officer is also assigned.

How is patient care divided amongst the different health care providers? (For example does one C.N.A. provide the care to 3 patients and work 1:1 with one RN?)

On day shift care is divided between sick call, medication administration line, segregation visits, and triage. One night shift these and restocking, ordering medications and supplies are the responsibility of the night nurse.

Have you ever had an injury as a result of your employment as a CorrectionalNurse?

No

You mentioned your concern about an overall security falter. Would you say that prevention of access to weapons, or objects that could be used as weapons is themost important preventative measure implemented in your area?

This is a primary concern, cells are routinely "shaken down", that is searched by correctional officers for items of contaband.

Within the medical Department we count things that most nurses would take for granted, rolls of tape, plastic syrgines, needles, lancets, the metal hooks used for securing ace wrap bandages.

You also mentioned that security is first priority, would it be fair to say that putting security before medical care adds to the overall safety of all patientsand staff?

It takes many types of employees to meet these challenges: correctional officers, administrative office personnel, and food service workers, as well as professionals in the educational, social and healthcare fields.

Certainly, for example, I once had to respond to an inmate"s cell: I was told the Inmate had used a razor and had cut /slashed his wrists. Medical care had to be done after security correctional officers secured the inmate, sweeped the cell and searched the inmate for that razor /weapon.

Has a patient's health been adversely affected by security measures in your experience, or has a crisis clearly been prevented by following safety procedures?

I am aware of a time where kitchen "tools" were not counted and a large knife was found missing. A lock down of the faciility and search was done, the item found and confiscated, upon questioning the reason for the item taken, "was do do in someone".

Are you aware of any regulatory and/or reimbursement agencies are involved in this safety risk for the patient and the nurse?

American Correctional Association,

State Accreditation: Joint Commission on Accreditation of Health Care Organizations and the National Commission on Correctional Health Care, the most rigorous industry standards for corrections and health care provider organizations.

Colorado Department of Corrections

NAADAC (the National Association for Alcohol and Drug Abuse Counselors), The Association of Addictions Professionals.

These organizations work to improve the quality of health care provided in jails, prisons, and juvenile confinement facilities by developing and maintaining nationally recognized standards for correctional health care.

Are you aware of the stance of any professional nursing organizations related to correctional nurses or correctional nurse safety?

There is a standard of care much like the American Nurses Accosciations standard of care, far to long to post here.

How much additional training was required to prepare you for this job? What was the nature of the additional training?

My company provides a 40-hour orientation program for all new, full-time employees. Included in this training are the following:

--Corporate history, philosophy, goals and objectives

--Facility policy and procedures

--Job responsibilities and personnel policies

--Employee standards of conduct

--Communicable diseases/infection control

--Institutional safety

--Special management offenders

--Suicide prevention

--Unit management

--Use of force

--Emergency procedures

--Sexual harassment

Employees also receive additional training specific to their job assignments.

Also the company works closely with local, state, and federal organizations in the planning and presentation of training programs to ensure that training is efficient, effective and beneficial to local agencies, institutions and organizations.

wisconurse · Feb 6, 2007

OH! Thank you so much! This is so much more than I expected. I REALLY appreciate you taking your time to discuss your work. The more contact I have with nurses, the more excited and proud I am to be working toward becoming one. Thank you again!

Very Best Wishes,

Laura

Reigen · Feb 7, 2007

Again you are most welcome. If you have any other questions feel free to either post here or PM me, and I'll do my best to answer or research an answer for you.

Reigen

CCHP-RN · Feb 12, 2007

If you are still needing information, please let me know.

I have been a corrections nurse for 9 years now. I am currently the VP of Nsg within a private correctional healthcare company and would be glad to give you whatever information you need.

nomadicV · Mar 19, 2007

I can help with your project as well, I've worked corrections (County and Federal) for approximately 12 years--just fire your questions off!

nomadicV · Mar 19, 2007

sorry, didn't see that you'd already posted your questions: here's my response

when did you graduate from nursing school?

1980

have you been a correctional nurse since you graduated, did you work in another nursing capacity, or take time off after graduation? what other types of nursing (if any) have you done?

typically i held 2 positions for approximately the first 6 years of nursing--one of which was in corrections. i've been out of corrections for about 2 years now

do you work in more than one institution at the present time?

no, i worked federal corrections only for about 7 years

how many hours a week, on average, do you work in a week?

depending on need and crisis 8-24 (yes, 24) hour days but typically 45 hour work weeks

what shift(s) do you work? if you work more than one shift, how do you rotate through the different shift rotations?

all shifts rotations could be weekly

what do you like about working as a nurse?

i'm one that believe that for some, nursing is a job--a method to make ends meet but for others they are nurses internally--i fit the second category. it's not so much that i like aspects of nursing it's what i am. in order to try to give you useful data, i'll say providing care at the point of need.

what type of facility is the institution?

any facility that is not a home is an institution. even if it's home-like. authoritative and decision-making structures that don't include the inhabitants is even more institution-like

what are the types of patients that this unit cares for?

corrections has all illnesses and injuries imaginable. prisons and jails have the responsibility to provide care for anyone delivered to them regardless to the cost of their keep or care. the closing of government run mental health facilities has led to the criminalization of mental illness as well as the criminalization of homelessness. these people enter with health neglect issues that are compounded due to lack of medical intervention.

in general, what are the needs of these patients?

education, intervention and stabilization

what types of problems do you address or try to prevent, as a nurse working with these patients?

correctional needs (institutional security) takes precedence over medical judgment in certain cases. being aware of safety issues and manipulative behaviors is not typically required in the non-correctional setting.

what other types of health care providers work with these patients and what are there roles with these patients? how much time, on average, might they spend with a patient on a shift, a day or a week?

providing care in-house is cost effective and security wise. psych and dental in house as well as via telemedicine helps with this effort

what is the staffing level of the primary shift that you work? do you know what that might be for other shifts?

staffing levels depend on the type of facility and census

how is patient care divided amongst the different health care providers? (for example does one c.n.a. provide the care to 3 patients and work 1:1 with one rn?)

this is not really applicable to corrections except in the case of facilities with in-patient medical units. these units don't use cnas and 1:1 is only in effect with acutely suicidal inmates in which correctional staff cannot watch.

have you ever had an injury as a result of your employment as a correctional nurse?

no

you mentioned your concern about an overall security falter. would you say that prevention of access to weapons, or objects that could be used as weapons is the most important preventative measure implemented in your area?

prevention of contraband is certainly a vital component of preventing uprising, but i can't say that it's the most important. containment is also vital

you also mentioned that security is first priority, would it be fair to say that putting security before medical care adds to the overall safety of all patients and staff?

has a patient's health been adversely affected by security measures in your experience, or has a crisis clearly been prevented by following safety procedures?

yes to all

are you aware of any regulatory and/or reimbursement agencies are involved in this safety risk for the patient and the nurse?

are you aware of the stance of any professional nursing organizations related to correctional nurses or correctional nurse safety? ncchc and aca are very involved in this issue

how much additional training was required to prepare you for this job? what was the nature of the additional training? approximately 3 weeks didactic and 1 week ojt