What do you do when the CO's won't take action?

[katkonk, BSN, RN]

I had a situation last time I worked at a particular unit. I am curious as to whether any of you experience the same, and what did you do....or what would you do? We had an inmate in the psych observation cell that was in a psych crisis...hearing voices, hallucinating, talking to people that weren't there, hurting himself...etc.

This was day 2 of this, and he had been brought into the cell the day before due to cutting himself. His hallucinatory problems were becoming worse, and of course he was refusing his meds. Psych had not talked with him yet, as it was the weekend, and they never visit on weekends. Now the C/O's weren't shaking these guys down, because there had been a couple in a row that still had razor blades on them. This guy that I am referencing did too. He had cut his arm the day before, and the provider sutured it (long, but relatively superficial laceration down the length of his forearm), plus some other misc. cuts from sawing with a blade. Well, he showed us through the tiny window of the psych cell that he still had a razor blade. I was standing right there with the C/O when he showed it to us and told us that he was going to cut himself again. Well, the C/O, when I asked if they would go in and take it away, just kind of laughed at me. He said, and I quote "We aren't going in there unless he decides to use it". I replied that we "kinda knew that he was serious", not to mention his personal history of such behavior since he was in his early teens. I just could not believe that they would just sit back and wait for him to do something before they would go in and get him. And that is exactly what happened. The only reason they FINALLY went in to get him, after he opened his sutured laceration back up, and added a few more, was that the inmate made an allegation of a sexual assault. They said they had to have him examined and take his statement due to that allegation. Otherwise, they would have just let this dude sit in the psych cell dripping blood all over. It was more than frustrating. And this was the top ranking officer on the premises at this time, so there was no one else to call. So, what have you done, if you have encountered this type of behavior?

:argue: :smackingf

[Eirene, ASN, RN]

I would have called the Captain or Major immediately.

[Guest371144]

What is the chain of command at your facility? If the person on-site refuses to act, it would be appropriate to go to the next level, as uncomfortable as that might be. You may need to get the support of your nursing supervisor (Admin on call on the wkend, maybe). This must have been a distressing situation for you. Kudos for your concern that proper treatment be given.

[katkonk, BSN, RN]

It gets to be a very tricky situation. I work through an agency, so I have no one that has any vested interest in standing up for me. As I mentioned, I ended up not having to worry too much about it. Knowing the nurse manager at that unit, I don't believe that she would have supported me-or anyone else who "bucked" the C/O's authority. The C/O in question was the LT on duty. As it was in the afternoon on a weekend, no captain or major was there. (And I noted on the walls as I came in the front door, pictures posted of this LT getting his 25 year outstanding service award...hmmmpf!) Also, it was only the 3rd time or so at that unit, so I wasn't really familiar with who to call, etc. The first duty is to the patient, obviously, but as an "agency nurse" if I were to stir up trouble, I would definitely not be asked to come back. Very very frustrating, but at least I learned one rule about the inmate alleging sexual assault, and the resultant mandatory interview and investigation! A VERY good thing to know.

[Guest371144]

Wow - what an ethical dilemma for you! So many considerations. It is a whole different ballgame in corrections, isn't it? I am so sorry to hear that you wouldn't get the support of your nurse manager. That is such an important part of that role. When I am in those situations I ask myself - what would I be wanting to report that I did from the witness stand if there was a court case? It often helps me make the hard decisions.

[Jaila]

Wow unbelievable! Something like this has never happened where I work that I am aware of. But I have a really good working relationship with my sgt ( who is the highest rank we have on nights), and all it would take is a radio call from me to get the situation handled. Unreal that your officer was so lazy or "whatever" about it. We also have the numbers of higher ranking officers on hand for other questions/ situations... But wow is all I can think to say. Good luck to you whatever the outcome...have you taken it any further??

[katkonk, BSN, RN]

Wow - what an ethical dilemma for you! So many considerations. It is a whole different ballgame in corrections, isn't it? I am so sorry to hear that you wouldn't get the support of your nurse manager. That is such an important part of that role. When I am in those situations I ask myself - what would I be wanting to report that I did from the witness stand if there was a court case? It often helps me make the hard decisions.

Yes, believe me...I always have the witness stand scene playing in the back of my brain. Something like..."and what exactly did you do, Ms. nurse, when you learned that the officer was not going to remove the razor blade from the inmate".

[katkonk, BSN, RN]

Wow unbelievable! Something like this has never happened where I work that I am aware of. But I have a really good working relationship with my sgt ( who is the highest rank we have on nights), and all it would take is a radio call from me to get the situation handled. Unreal that your officer was so lazy or "whatever" about it. We also have the numbers of higher ranking officers on hand for other questions/ situations... But wow is all I can think to say. Good luck to you whatever the outcome...have you taken it any further??

I haven't taken it any further YET. However, there are different ways to approach things like this. I think some risk manager that works for the university that provides the health care for the state facilities might be interested to know that their nurses are being placed in dangerous situations (from a legal perspective, that is). That is a law suit just waiting to happen. Then again, they may not care. They may simply think the nurse needs to have her/his own professional Liability Insurance, and leave it at that.

[Orca, ADN, ASN, RN]

I would first report it to a custody supervisor and my own supervisor, then document everything in an informational report. I know that any officer in my system who did not act after seeing that an inmate had a weapon would be in serious trouble.

[travduck, BSN, RN, CNM]

At the time of the incident documentation both in the patient chart and in a LOC (letter of concern) should have been done. A quiet query to the C.O. as to whether or not he was documenting in his log the fact that he had been informed that the inmate was in possession of a lethal weapon would have been in order ie: "Officer So and So, right?, what time are you using in your log of when I informed you of the inmate possession of the lethal weapon and suicidal actualizationinstrument. I want to make sure that my log jives with your log." If your patient had been seriously suicidal a slice from a razor blade across a jugular or other artery would be very difficult to repair and to explain, for both of you. Also a call to the SRN II or SRN III or the psych doctor on call would have been appropriate if no action were taken after your query to the C.O. Also notification to your TTA would be in line, as to be set up for something if you call. Your *** would not then be grass though it would be green.

[katkonk, BSN, RN]

Also notification to your TTA would be in line, as to be set up for something if you call. Your *** would not then be grass though it would be green.

hmmm...TTA? I am sorry, I do not know that Acronym. I am in Texas...please enlighten me. And THANK you for your comments.

[travduck, BSN, RN, CNM]

TTA is the triage and treatment area which handles emergencies and other things.