Starting at a Corrections Facility

ronda919 · Jun 15, 2012

Hi, I don't have any advice, I'm starting in corrections the end of June, but how is it going? Do u like it? Now that you have started do u have any advice

red2003xlt, LPN · Jun 16, 2012

Wish I could tell you, but the state of Florida moves slower than a snail. They've called to touch and tell me that they're processing the paperwork. It's just a waiting game especially with all the budget cuts..

Good Luck! and do tell anything you can

red2003xlt, LPN · Aug 25, 2012

Finally got the start date Sept 14th:yeah:

red2003xlt, LPN · Sep 15, 2012

Hurray, my first day. Spent filling out HR forms and then 4 hours on the "floor" gotta love paperwork.

240zRN · Sep 15, 2012

Get a clinical assessment book that focuses on quick and dirty triage with emphasis on objective assessments. If it is anywhere like my facility, you would do yourself well to familiarize yourself with urgent care type clinical competencies (sick call protocols [flu/cold symptoms and treaments, abd pain [contipation/diarrhea], URI, ortho injuries [lots of these]) with an emphasis on OBJECTIVE assessments. An inmate's account of symptoms is often exaggerated. Just get familiar with overall ambulatory outpatient assessments.

Not sure how your facility is structured, but we have a central health area that acts as an inpatient housing unit where we admit long term care (think med surg/SNF) patients as well as a miniature little ED area where we do triaging and treatment of emergencies. We see chest pain MI's, drug overdoses, trauma (fights, stabbings, burns), etc. In this area we do things like start IVs, push emergent meds, and do quick procedures in order to stabilize the patient whether or not we are prepping for transport to an outside facility.

It can be scary sometimes depending on the personalities in your population. Stay firm fair and consistent; you will find yourself having a good time because many of the inmates can be well mannered and respectful; always remind yourself of where you work and don't go "the extra mile" like you would in a hospital to avoid showing unintentional favoritism. Also, correctional nursing is plagued by a mentality of justifying poor quality of care. Ive heard other nurses refer to inmates as cockroaches and delay or deny care based on this attitude. It is poor and do your hardest to avoid adopting it. Don't get caught up in custody's mentality or harshness and punishment; remember your role--you are there to give care.

Feel free to PM me if you have any questions in particular; and I wish you the best of luck! Correctional nursing is rewarding in ways hospital nursing is not-- I hope you too soon discover that.

miteacher, ADN, MSN · Sep 18, 2012

Get a clinical assessment book that focuses on quick and dirty triage with emphasis on objective assessments. If it is anywhere like my facility, you would do yourself well to familiarize yourself with urgent care type clinical competencies (sick call protocols [flu/cold symptoms and treaments, abd pain [contipation/diarrhea], URI, ortho injuries [lots of these]) with an emphasis on OBJECTIVE assessments. An inmate's account of symptoms is often exaggerated. Just get familiar with overall ambulatory outpatient assessments.
Not sure how your facility is structured, but we have a central health area that acts as an inpatient housing unit where we admit long term care (think med surg/SNF) patients as well as a miniature little ED area where we do triaging and treatment of emergencies. We see chest pain MI's, drug overdoses, trauma (fights, stabbings, burns), etc. In this area we do things like start IVs, push emergent meds, and do quick procedures in order to stabilize the patient whether or not we are prepping for transport to an outside facility.
It can be scary sometimes depending on the personalities in your population. Stay firm fair and consistent; you will find yourself having a good time because many of the inmates can be well mannered and respectful; always remind yourself of where you work and don't go "the extra mile" like you would in a hospital to avoid showing unintentional favoritism. Also, correctional nursing is plagued by a mentality of justifying poor quality of care. Ive heard other nurses refer to inmates as cockroaches and delay or deny care based on this attitude. It is poor and do your hardest to avoid adopting it. Don't get caught up in custody's mentality or harshness and punishment; remember your role--you are there to give care.
Feel free to PM me if you have any questions in particular; and I wish you the best of luck! Correctional nursing is rewarding in ways hospital nursing is not-- I hope you too soon discover that.

Your tips are very helpful. I am having some difficulty with some patients who complain of chest pain, but don't show any signs/symptoms of having chest pain or even being in distress at all. How do you handle this? I have been following the protocol that is in place, and I still call the doctor on call, but I'm not sure what else I can do, but it happens quite frequently.

GKell · Sep 18, 2012

If you can find no clinical proof other than subjective chest pain, then you can start asking about psychological issues such as anxiety which can cause chest pain. The other option is that the inmate is just wasting your time on purpose.

240zRN · Sep 18, 2012

Chest pain offenders are a phenomenon any correctional nurse is all too familiar with! I will preface my answer with one very huge tip; if you are even marginally unsure as to what disposition to give to a patient who comes in with chest pain--FOLLOW PROTOCOL. CA corrections has created an environment that emphasizes protocol due to the litigation it has gotten itself into. Furthermore; as nurses we are not able to diagnose and in turn are not able to rule out diagnoses. It is always in a nurse's best interest to ASSESS and gather as much information as possible regarding the chest pain and give it to the doctor on call; let the MD make the disposition and document/track your communication. The last thing a nurse ever wants is treat a cardiac event as chest wall pain and dismiss him to the unit back to the yard.

I once had an inmate who was AOx3, calm, able to verbalize full sentences cooperative, zero shortness of breath, CMS intact, ambulatory--the whole 9. 12Lead showed ST elevation on anterior V2-V3-V4 (get very comfortable with the 12Lead). We sent him to the hospital for observation and a full work up.

I also had an inmate who came in c/o CP, SOB, diaphoretic, obtunded, etc. Vitals WDL 12Lead intact, kept him in our triage area until I could get an MD to sign off on his 12Lead and give me the okay to treat him with RN protocols.

There will be some RNs who feel comfortably making dispositions, but I don't personally share their approach. I'd rather not gamble my license by playing doctor regardless of how many cardiac patients I've had in my career.

Long story short. If you get a chest pain. ASSUME MI until you can have an MD/NP sign off and make a disposition for you. Until then, do the whole bit, whatever the protocol on your post says. 02, ASA, Nitro, 12Lead, start an IV if you can. The worst thing you can do is get an MD grumpy for "wasting his/her time with chest wall pain." I've noticed most MD's are great in handling these situations if you have gathered all the information for them. Get vitals, get a quick history, get him on a monitor and be able to describe simple waveforms (STEMI or no STEMI?, if STEMI, what leads?), have access ready if you can.

I know it's a lot, and especially when it happens frequently; but the more you do it the faster you will be and the more comfortable you will be making your own dispositions in the future (I've ruled out C/P as some obvious chest wall pain a few times). Encourage your pt to be a good historian; was an injury involved? did they just do 100 push ups? Push on their pecs, have them do ROM and see if it gets worse/better with movements. If you're ever in doubt, though--just follow protocol!

miteacher, ADN, MSN · Dec 12, 2012

Do you have many nursing protocols for different situations? Im curious if most prisons are set up like this where you follow protocols and then call the provider

Orca, ADN, ASN, RN · Dec 12, 2012

"Chest pains" are probably the hallmark complaint in prisons. Some inmates consider any discomfort between the neck and the waist as chest pains. Some have gotten it down to an art, knowing what symptoms to report in order to get attention. 240zRN gives you sound advice when telling you to assume MI until you rule it out. I had much rather be accused of doing too much in a given situation than too little. We have a physician on staff during regular business hours, plus a physician on call for other times. The physician is a vital resource when deciding what to do with a given situation.

In response to miteacher - we have so many protocols it is impossible to know them all.

miteacher, ADN, MSN · Dec 21, 2012

"Chest pains" are probably the hallmark complaint in prisons. Some inmates consider any discomfort between the neck and the waist as chest pains. Some have gotten it down to an art, knowing what symptoms to report in order to get attention. 240zRN gives you sound advice when telling you to assume MI until you rule it out. I had much rather be accused of doing too much in a given situation than too little. We have a physician on staff during regular business hours, plus a physician on call for other times. The physician is a vital resource when deciding what to do with a given situation.
In response to miteacher - we have so many protocols it is impossible to know them all.

What about fake seizures? That seems to be another issue as well that I keep encountering.