Sent into a correctional facility...failed miserably :(

[HeyHeyitsMaay]

I worked in corrections when I was working in urban missions...as a counselor for a private drug and alcohol rehab where we'd also go into prisons and run bible studies and such. I'm very familiar with the needs specific to inmates, and how to interact with them. So it's not the inmates I have an issue with at all. It's that I know NOTHING about correctional nursing, whatsoever.

I've been working agency as I'm finishing up my RN, and got a call to go to a facility I'd never been to. Couldn't even figure out how to get there... it was a mess. I asked for all of the info I could think of that i might need, but was still out of my element as I'd be expected to be in any new facility. I wasn't even sure of where I was supposed to park.

Needless to say, it was horrible. Sharps are controlled and I had no access to them. I'm a diabetic, and b/c I started my shift late as I was given wrong directions and it was so far out in the desert clustered amongst other prisons, my GPS sent me the wrong way....and I was called so late at night that I was given an extra hour to get there b/c of the extremely short notice. My pill call started an hour and a half late and I was killing myself trying to figure out what I was supposed to do and how to do it in a place I'd never been. Usually I'm sent to med surg or LTC facilities and I do pretty well in those places b/c I've been to them before. But in prison, at least this facility, they pre-pour meds. As far as I know that's a HUGE no-no. Inmates are also not allowed to have whatever they ask for as far in terms of OTC's and bandaids and such. I had no clue that the inmates did their own BG's and gave their own insulin and that they don't use lancet pens but stick the lancets into their own finger manually. So what ARE they allowed to have, what in the world is the facility protocol and where do I find this out? The 1 other nurse I was working with was never available to answer those questions, and the inmates used the opportunity to attempt to take advantage of me which didn't work at all, but even the CO's were asking me vague questions about how long I've been a nurse because I had absolutely NO IDEA what in the world I was doing and it was obvious. I even specifically asked my agency...do you guys understand I haven't worked in a correctional facility before? "yes this is your orientation." "Is the facility aware that I've never worked as a nurse in a correctional capacity before? are they o.k. with this?" "yes, we did tell them and make sure it was o.k. before we sent you."

But I had no break b/c i was so far behind. I ended up crashing with a low BG, and attempted to warn the 1 other nurse I was working with well ahead of time...as I was placed into 5 separate pods in which I had to complete med pass for all inmates, which took me all day. After 8 hours of non-stop catch up, I again warned the other nurse that I had to have something to eat or I was going to get sick. She was oblivious, she honestly did not understand that I was serious. It was Sunday, there was no charge nurse, and it was me and a younger LPN who just couldn't understand that I was seriously out of my element with being forced to navigate the prison maze absolutely alone and not even able to find her, either by visually looking OR on the phone or radio....when I needed something.

I had glucose gel in my cart I was using to try to keep myself going until I could get a break, but it turned out to not be enough. When my BG gets low, I get really "stupid" (nothing at all makes sense to me and I can't think of the words I need to communicate with other people) and hysterical. I felt it coming, went into a room with my med cart and locked myself in after walking back and forth between two separate units three times, outside, uphill pushing a med cart trying to find the other nurse b/c I'd run out of insulin needles and the diabetic inmates had been waiting for quite some time.

I ended telling her that she had to finish the dinner med pass, as I sobbed uncontrollably in the floor of the room I'd locked myself and the cart in while I waited for a CO to escort me to the reception part of the building so I could leave. There are VERY few agencies where I live, and the work here is few and far between because of the part of the country I'm in. I did not let my agency know what happened, and I'm pretty confident that the other nurse I was working with didn't either. She was just happy somebody else came in so she didn't have to do med pass alone.

But I felt like a total failure. After that shift, I e-mailed my agency and explained that going forward, I absolutely love to be available to help out in a pinch, but that I needed to re-iterate that I am not available on Sundays, and that I wanted to suggest that at least a cursory orientation of the facilities we go to be provided before being sent to them for work. I realize that there are hazards like what I outlined above associated with being an agency nurse and the blind situations we're put into. We should be aware of that when we take on the responsibility of agency nursing. But I feel like a moron. Not only do I feel like one, I know that I looked like one too. It's nobody's responsibility to care that I'm a diabetic or make sure I eat. It's mine alone. I can't expect special treatment. But I felt so small when that happened, and I was humiliated. Now I'm wondering what I could've done different, or what kinds of questions I should be asking, or how to prevent something like this in the future. Thanks in advance for your help!

[mcarthur]

First of all you needed to contact an officer if the nurse was not available and let him know you needed help and he needed to get someone available to you even if by phone. You were working impaired. I don't want to say more as you are stressed enough but it would not be good. You need to be more aggressive in these situations. Although you were there with one other nurse there has to be a protocol or someone available for you. you did wrong in not telling your agency. A in case of a potential lawsuit B your agency needs to know what their are sending their staff into I worked in corrections per diem and it is a different culture

[TriciaJ, RN]

You didn't fail; they failed you. The fact that they sent you there in a pinch with no orientation and 1 overworked coworker tells you they were desperate for a warm body. They were lucky to have you.

Do tell the agency what happened. They need to know what they sent you to and make plans for how not to let that happen again. If you're at all willing to work there again, ask for an orientation. If either the agency or facility are not thrilled to pay you for the chance to have you come back, then they are total morons.

And never leave home without a stash of granola bars. Good luck!

[suanna]

This is why most of us don't have the cojones to go into agency nursing. I think I'd rather join the armed services and go to the lands of sands. At least there they let you carry a gun and shoot if you are shot at.

[Kashia, ASN, LVN]

Sad and very good example that agencies are businesses and will tell you , the nurse, anything to get you to go to a place. I know because I have learned hard way through my agency they are strictly a business. And, my experience once was, when I explained I had never worked that area before and they replied with oh its nothing, you'll just be "taking lab slips over to the lab" - and then when I got there and obviously had no skills in this area, my agency flips the script and puts it on me when I

was having a hard time. So now....I never never go into areas I am not experienced in.

[NewGoalRN]

I'm sorry to hear that you had a bad experience, however, as a diabetic nurse knowing that sometimes we don't get breaks or things can go awry real fast, you really should take snacks with you and have them on your person. I'd say, have a small bag of jelly beans on you at all times or some hard candy in a wrapper for exact times as what you experienced.

You could have also called one of the guards so you could get some juice or soda or something. No excuse for crashing. Your safety and health first or you're no good to yourself or your patients.

[uRNmyway, ASN, RN]

Could you not keep protein/meal replacement bars on your person at all times? Seems to me that if you cant actually stop, you get protein for long-lasting BG control, as well as maybe feeling a bit more full as just sucking on some glucose gel... :S

[sharpeimom]

my husband has been a type-1 diabetic since he was eight and always has snacks both in his

backpack, in the car, in his office drawer, on his nightstand, and in his pocket, so he's always

prepared. i also have a stash hither and yon.

he uses luna bars, clif mojo bars, jelly beans, those round striped mints, individual-sized

containers of peanut butter with crackers. easy and it works!

[Orca, ADN, ASN, RN]

You didn't fail; they failed you.

Dead on. Inadequate orientation and training set you up to fail.

I am a DON in a western state corrections department. My agency used to do an equally bad job of training people who were filling in. I started in the agency per diem pool years ago. I will tell you a couple of stories that may make you feel less alone, and show you that you aren't the problem.

I hired on, and I went to my first facility. I was given one day of orientation on day shift. This was supposed to prepare me to work nights - alone. It didn't. The routine is totally different on days, and what I was shown on days gave me no hint as to the layout of the yard, which was important because I had to go out and see diabetics late in my shift. Fortunately the swing shift nurse stayed over for an hour and showed me the basics, and I had an officer who was familiar with the infirmary and its routine. He knew exactly where we needed to go and when, which saved me when it was time to see the diabetics. When I left in the morning, I got complaints from the day shift because I hadn't replaced the syringes I had used for the diabetics - which I did not know how to do, and had not been told that I needed to do.

When I went to my second facility, my orientation to pill call was this: "You're doing pill call on the yard tonight." I had no idea what the medication system was, I didn't know where the housing units were, and I had never even been in the yard medication room in this facility. The nurse I was on duty with apparently decided that he didn't want to do pill call that night, so he would dump it on the new guy, with no training (I had worked strictly inpatient infirmary before that night - and the infirmary had its own med room). How I made it through that night I have no idea. The nurse I was working with disappeared while I was out on the yard (in retrospect, I believe that he went in the x-ray control room to sleep, but at the time I didn't know enough about the place to look there). He was fired shortly afterward for poor performance (big surprise).

Because of my experiences early in my career with this agency, I am very careful not to assign people duties they have not been adequately trained for. I'm also happy to report that we do a much better job of preparing nurses before we send them out on the yard.