Writing Up Inmates

[Sheri257]

Just wondering how many times you've had to do this and what you do in these situations ...

Yesterday I was swamped ... isolation was full with 15 inmates that needed assessment and meds, there was regular pill call, plus TB med call and sick calls. I had another 15 inmates that needed to be seen by the doctor, 20 MD orders that had to be processed and faxed to the medical hub and, to top it all off ... I had to file four incident reports with one inmate who had a fresh tatoo that had to be documented, two inmates who had to be assessed and treated after getting into a fight and another inmate with an ankle injury who was in a W/C and needed attention.

I was already going to have to stay late to catch up on documentation but, this inmate waltzes in that afternoon and demands that a bandage for his foot be changed. Wound care is supposed to done at 0730 ... no other time ... but the other nurses let him get away with dropping in at whatever time he wants and giving him wound care on demand. (As it turns out, one nurse who lets him get away with this knows him and his family, which I reported to my supervisor.)

I told him I didn't have time, medical was really backed up and he'd have to come back at the scheduled time tomorrow. He starts yelling, saying he needs to sleep in at that time. Because I also work in a hospital ... my initial impulse was to do the "nursy" thing ... I firmly told him to keep his voice down and tried to de-escalate the situation by offering a bandage that he could apply himself in the waiting room. Instead, he threatens to sue and demands that a picture be taken of his foot. At that point I had enough ... I told the CO to take him out.

So ... I wrote him up ... which is probably unusual for this medical unit but, I don't want to be known as the nurse that can be taken advantage of. But it's difficult because the other nurses let the inmates get away with things that I never would.

My boss, for example, tells me not to do wound care at any other time and not hand out things like anti-fungal cream, etc. without a sick call visit but then he turns around and breaks those rules all the time.

In hindsight, I probably should have thrown him out after he started yelling and not even offered the bandage but ... I'm still making the adjustment from hospital nursing where you're expected to put up with that crap. And, since there's no consistency with how the other staff applies the rules, it makes things difficult since I'm the new nurse on this unit.

I'm just wondering how you've handled situations like this.

:typing

[BBFRN, BSN, PhD]

You were right to write him up. Word will get around quickly that you follow strict policy, and don't take any crap. Besides that, it may be unsafe for you to allow walk-ins. I've been there when I worked in corrections. Word did get around that I cared, but I didn't take any bull. Inmates told me they respected me for that. BTW, you'll get all kinds of threats to sue. Inmates are very litigious (as I'm sure you know). I made it a policy to document everything any time an inmate made that threat.

[Sheri257]

Inmates are very litigious (as I'm sure you know). I made it a policy to document everything any time an inmate made that threat.

Oh yeah ... I stayed late so I could document the whole thing. Just curious though ... how many inmates actually follow through on lawsuit threats?

:typing

[BBFRN, BSN, PhD]

My experience was that only a small fraction really attempted to follow through. Most inmates would love to obtain a free income a la the state penal system, though. Don't give them any reason to have a case, follow strict policy, and you should be all right.

[VegRN]

...you did the right thing. And yes as the other poster said, word will get around that you are strict and aren't going to take any crap. You will reap the benefits of this.

It's the other nurses that I worry about. Why are they allowing this? And why is your manager telling you one thing and doing another. They are headed for trouble.

Kudos for staying late to document this. Document, document, document.

In my experience as well, only a small amount of inmates who threaten to sue actually do. The one thing that you have to think about when an inmate threatens to sue is "Does he have a case" or "what would happen if he did sue". If a situation comes up and you aren't sure of the answer to this, check your policies as this will usually help you decide what to do.

In this situation, you say there is a written policy that says wound care is to be done only at 0730...no other time. Well, let him sue all he wants, the policy is on your side. If appropriate, give him a copy of the policy or the guideline he was given that said wound care is at this specific time.

I wasn't there but from what you said, I would do things a tad differently. After you told him "no" to the late would care and he started raising a ruckus I would have said:

"Wound care is at 0730, you have already been informed of that. If you quiet down and regain control of yourself, I will give you a band-aid today, which you can apply yourself. I however will not be changing your dressing at any other time but 0730 which is the set time and which you are fully aware of. If you continue to be disruptive, I will have the officer remove you"

Always give consequences to the negative behavior and (only if appropriate) a chance at an alternative if they chose to behave.

If he tries to come back with "but everybody else lets me" and threatens to sue, just remind him of the policy. It really doesn't matter what everybody else does and in fact what "everybody else does" is the cause of this problem in the first place.

Again, you did the right thing

[Mudwoman]

I don't take anything off an inmate. The first time they yell at me, I have the guard take them back to barracks. I also never write any of them up. Word gets around. I have very few problems, and most all the inmates tell me that if anyone gives me a problem, they will take care of it. I only have problems with new guys and not for long.

[kito4149]

I am a new LPN working in the system, and I let the inmates know up front the rules and regulations. I also tell them, "You have been here longer than me so you should already know the do's and dont's". I have been working at the facility for 5 weeks and I've only had one run-in with an inmate. But, I learned through clinicals and my wonderful instructor that if you say you're gonna do or check up on something, KEEP YOUR WORD!!! I've seen a number of nurses (esp RN's) tell inmates they will check on something and go back and deliberately tell a lie or don't check at all. I make it a point to tell them the truth because I took the oath at graduation. If I can't get back to them, I give an officer a message to give to the inmates. That's how I earned my respect only after 5 weeks!! WOW!!

[Blackcat99]

I had the same problem with an inmate. He didn't want to get up for his early morning pill and would show up at 4pm for his 0730 med. I told him "No" and he grabbed my med box and threw it on the ground. I wrote him up and then he never bugged me again. Another inmate was verbally abusive and I told the shift commander about it and I told the shift commander that I would write him up the next time. He never bugged me again either.

[Sheri257]

That's how I earned my respect only after 5 weeks!! WOW!!

I guess it depends on how you define respect but, with inmates, it's just not one of my top priorities. They are, afterall, criminals who are often trying to take advantage of the situation.

Yes, I am there to do my job and deliver care without judgement. I don't make a point of ignoring them or disrespecting them and ... I do try to address their needs as much as I can.

But, to be honest ... I could care less what they think of me.

:typing

[Paul554]

Dear Sheri:

Of course you were right to write an IR on the inmate. But I noticed in your post that you took great effort to detail how "swamped" you were. The reality is that it does not matter. If you were busy or not, the inmate still has the responsibility to follow the rules. If he does not then its on him not you. After all how can we expect inmates to follow the rules if we don't? I have been a Federal Corrections RN. for six years and I have seen countless inmates try the same sort of tactic just to feel in control. Your response was entirely correct. Sadly there are many in our setting that attempt to placate inmates to everyone's disadvantage. It is a problem. But they eventually learn.

Paul

[uraqt2]

i very seldomly write up an inmate; however, when they are out of line they are out of line! it doesn't matter how busy you are an inmate has no right to not follow the rules. many people forget that an inmate became an inmate due to the fact that they don't know how to follow rules. it's too bad that people often forget that an inmate is not in prison because he/she follows rules and that they are there to be corrected. if staff ignores bad behavior then they are also promoting bad behavior. i strongly feel that if every staff member enforced the rules that there would be less conflict all around. inmates would know where there place is and staff would have better control. all in all you did the right thing and i hope that you never feel guilty about writing up an inmate and remember that you have to be consistent with all inmates. don't let one get away something and then write another up for the same thing.

[Sheri257]

i hope that you never feel guilty about writing up an inmate ...

i don't feel guilty ... not at all. btw ... they transferred this inmate back to a higher security facility. i'm not sure if it was because of my write up, other disciplinary problems or the fact that one of the nurses was a little too friendly with him but ... he's gone. one thing i know for sure ... he won't be able to make any demands or throw any tantrums at that facility.