Housecarder AMA: Jail Nurse

[housecarder]

Hey I figured I'd throw this up so people can start asking any questions. I'll give some basic info to get things started. Obviously for HIPPA reasons any stories will be general and no identifying information will be given.

I am a RN at a county jail. I usually work the overnight shifts here. We house about 1,100 male inmates as we are a contracted facility through the sheriff's office. We typically get non violent offenders awaiting trial, and if they go to trial and have less than a year left once sentenced they can stay at our facility. Otherwise they are transferred to the larger facilities. So we have a lot of turnover, but also several frequent fliers.

Because there are no state mental institutions we have several inmates who have severe mental illness or mental disabilities that flow in and out of the system for minor offenses.

We have a doctor, nurse practitioner, three psychiatric doctors, a dentist (only twice a week), and several nurses on staff to handle medical needs as well as a free clinic for STD testing and treatment. The doctors are only there during the day so at night the nurses handle any emergencies and call the doctors as needed.

All inmates are triaged and interviewed when they arrive at the facility and any medications they say they are on are verified, reordered by the doctor, and given during our four pill call times. During the day the nurses will have clinic hours for wounds treatments, blood pressure checks, blood draws, etc.

[ironbaby]

How fascinating!!

Have you ever wanted to help a patient but were unable to do so due to rules? If so, have you ever done it anyway? (Feel free to ignore if this question is too scandalous)

What are the most common ailments?

Are there medications that inmates are admitted with that have to be discontinued?

[ironbaby]

Have you ever had anything bad happen to you as a result of your work?

Have you ever felt unsafe?

[housecarder]

Mar 4, 2016 13:03:34 GMT -5 starbuck27 said:

How'd you get started in that type of work? Did you always want to work in a jail? What's the best part of the job?

I actually really like psych nursing. I don't think there are enough good nurses out there in the field and there is such a stigma surrounding mental illness.
I did an observation rotation there in school and told my husband that night that I wanted to work there. With all the guards it's probably the safest place to practice psych nursing if you get a combative patient.

My favorite thing about the job is that every night is different. Also, while we still give excellent care, I see many nurses having to bend over backwards at hospitals for things that are patient preference and not medically necessary. I have the advantage of being able to focus on the medical aspect and can tell my patients "this is policy, this is jail, not the Hilton" so to speak. I feel like I don't have to play the games they do at hospitals for "customer satisfaction".

[housecarder]

Mar 4, 2016 13:05:14 GMT -5 ironbaby said:

How fascinating!!

Have you ever wanted to help a patient but were unable to do so due to rules? If so, have you ever done it anyway? (Feel free to ignore if this question is too scandalous)

What are the most common ailments?

Are there medications that inmates are admitted with that have to be discontinued?

There are pretty tight rules about what we can and can't give them without orders. I don't step over that because the inmates would just as soon throw me under the bus and I'm not willing to loose my license over some Tylenol. However I have advocated for certain patients harder because I believed that the doctor had a grudge against them, or I've waited until the NP was on call to ask for orders because he is more willing to take my judgement as is.

We typically see a lot of psych issues, asthma, diabetes, wound care, blood pressure stuff. STDs are big too. It's amazing how long these guys will go without on the streets because they don't have insurance so when they get to jail their chronic conditions are out of control.

We have no narcotics unless they just had surgery or something. So they get Tylenol or ibuprofen for chronic pain. Also we only do accuchecks for blood sugar and insulin twice a day so some diabetics have to have their schedule adjusted. We just don't have the staffing to be able to do it more. Lantus (a long acting insulin) is pretty pricey for the jail so we try to move them onto something else if possible.

[housecarder]

Mar 4, 2016 13:05:50 GMT -5 ironbaby said:

Have you ever had anything bad happen to you as a result of your work?

Have you ever felt unsafe?

I honestly have never felt unsafe. As long as you are respectful they generally only talk shit. We have guards on every floor but I've gotten tired of waiting on a lazy guard and buzzed myself into a dorm of 40+ inmates before to get medical slips out of the Dropbox.

Eta warning.
*trigger warning, rape*
I did feel uneasy about one inmate trying to insist I allow him to come down to medical for a bandage change even though I didn't have an officer. His chart showed that it had been changed earlier that day and had no drainage so I told him he'd have to wait until morning when we had more staff. After he cussed me out I found out he was there on several rape charges and had been forceful with another nurse trying to shut the door to the clinic room (doors have to remain open).
*end warning*

There have been inmate on staff fights. One inmate was a paranoid schizophrenic and thought the officers were out to get him. One officer provoked him and when he staff tried to calm him down he broke a female lieutenant's nose.

Personally the only thing I've had happen (other than catcalls and cussing) is a needle stick from a patient with hep c, but that can happen at the hospitals too. So far I'm clear of any transmission.

[requiressnacks]

Have you ever had a crush on a patient?

[requiressnacks]

Any weird sex-related injuries?

[teachermomtobe]

What is the craziest thing you've ever seen?

[housecarder]

Mar 4, 2016 13:30:49 GMT -5 requiressnacks said:

Have you ever had a crush on a patient?

There are obviously good looking patients and many are very street smart so they know how to charm their way around. I've also had several patients that were there for issues with PTSD or some thing like that. I have deep empathy in times like t, because our society and system has failed them. Being on the medical side we have to look past the "criminal" label and see the person.

But an actual crush? No. We heard too many stories during training for me to ever drop the professional side. There was a nurse who was caught calling an inmate from home and putting money on his account. She was fired from all 3 of her jail jobs and lost her license. She kicked out her fiancé, bailed out the inmate, moved him in with her, got pregnant, and he was back in jail within 3 weeks. This man was small, had tattoos all over his face, no money, and several STDs. But apparently he knew how to charm his way into what he wanted.

[samanthasays]

Mar 4, 2016 13:29:58 GMT -5 housecarder said:

Mar 4, 2016 13:05:50 GMT -5 ironbaby said:

Have you ever had anything bad happen to you as a result of your work?

Have you ever felt unsafe?

I honestly have never felt unsafe. As long as you are respectful they generally only talk shit. We have guards on every floor but I've gotten tired of waiting on a lazy guard and buzzed myself into a dorm of 40+ inmates before to get medical slips out of the Dropbox.

I did feel uneasy about one inmate trying to insist I allow him to come down to medical for a bandage change even though I didn't have an officer. His chart showed that it had been changed earlier that day and had no drainage so I told him he'd have to wait until morning when we had more staff. After he cussed me out I found out he was there on several rape charges and had been forceful with another nurse trying to shut the door to the clinic room (doors have to remain open).

There have been inmate on staff fights. One inmate was a paranoid schizophrenic and thought the officers were out to get him. One officer provoked him and when he staff tried to calm him down he broke a female lieutenant's nose.

Personally the only thing I've had happen (other than catcalls and cussing) is a needle stick from a patient with hep c, but that can happen at the hospitals too. So far I'm clear of any transmission.

You are so amazing, I would not be able to treat a rapist. I would rather go all Dexter on their ass. 

[housecarder]

Mar 4, 2016 13:31:41 GMT -5 requiressnacks said:

Any weird sex-related injuries?

We have an older man who came in with a prolapsed anus. I didn't ask how that happened. Another inmate recently had to have surgery to remove a testicle that had twisted and had swollen up to about the size of a grapefruit.

But as far as inmates having sex with each other and we are preset strict on handling any sexual issues. If there is any reports they all have to be investigated as if it was rape so they are sent to the hospital and evidence is collected there. If it is found to be truly consensual then they can downgrade the investigation to sexual misconduct because it's still not allowed.

[wildflower810]

Mar 4, 2016 13:36:38 GMT -5 housecarder said:

Mar 4, 2016 13:30:49 GMT -5 requiressnacks said:

Have you ever had a crush on a patient?

But an actual crush? No. We heard too many stories during training for me to ever drop the professional side. There was a nurse who was caught calling an inmate from home and putting money on his account. She was fired from all 3 of her jail jobs and lost her license. She kicked out her fiancé, bailed out the inmate, moved him in with her, got pregnant, and he was back in jail within 3 weeks. This man was small, had tattoos all over his face, no money, and several STDs. But apparently he knew how to charm his way into what he wanted.

That is a lot of not smart life decisions all at once.

[housecarder]

Mar 4, 2016 13:34:12 GMT -5 teachermomtobe said:

What is the craziest thing you've ever seen?

Medically we had a man who was going through liver failure and was hallucinating. He would sit in his cell talking to himself and smoking pretend cigarettes, even asking them on the floor. He told me John Wayne was in there with him and was going to die of thirst if I didn't get him some water.

While I was there on observation they had a man who was schizophrenic and believed he was pregnant with triplets. He was on a multivitamin and one nurse would always call it his parental so that he would take it.

[wildflower810]

What is the thing you dislike the most about your job?

Are you ever in contact with family members? Do they try and influence your job?

[housecarder]

Mar 4, 2016 13:37:18 GMT -5 samanthasays said:

Mar 4, 2016 13:29:58 GMT -5 housecarder said:

I honestly have never felt unsafe. As long as you are respectful they generally only talk shit. We have guards on every floor but I've gotten tired of waiting on a lazy guard and buzzed myself into a dorm of 40+ inmates before to get medical slips out of the Dropbox.

I did feel uneasy about one inmate trying to insist I allow him to come down to medical for a bandage change even though I didn't have an officer. His chart showed that it had been changed earlier that day and had no drainage so I told him he'd have to wait until morning when we had more staff. After he cussed me out I found out he was there on several rape charges and had been forceful with another nurse trying to shut the door to the clinic room (doors have to remain open).

There have been inmate on staff fights. One inmate was a paranoid schizophrenic and thought the officers were out to get him. One officer provoked him and when he staff tried to calm him down he broke a female lieutenant's nose.

Personally the only thing I've had happen (other than catcalls and cussing) is a needle stick from a patient with hep c, but that can happen at the hospitals too. So far I'm clear of any transmission.

You are so amazing, I would not be able to treat a rapist. I would rather go all Dexter on their ass. 

We don't have their charges in our system and I like it that way. But word gets around. And some cases are very public.

*trigger warning* child abuse*

I was very glad when a man charged with almost beating to death his gf's 2 year old didn't need any medical care. That would have been hard for me to have compartmentalized.

[housecarder]

Mar 4, 2016 13:46:44 GMT -5 wildflower810 said:

What is the thing you dislike the most about your job?

Are you ever in contact with family members? Do they try and influence your job?

I hate having to always distrust my patients. And the catcalling and harassing. It's easy to get caught up in it and name call back which several nurses and officers do.

For example if an inmate yells at you, saying "you a dusty bitch, ain't nobody been up in that pussy" and you respond with "your mother" (yes I've heard this exact exchange) now you have sexually harassed that inmate and he could press charges. Now if you don't respond you can press charges on him for sexual misconduct, but you have to keep your cool and not stoop to their level.

We get calls sometimes from concerned family, but we aren't allowed to tell them anything because of HIPPA laws. The security side normally deals with them on that.

Although my mother works as a manager for Goodwill and recently messaged me about her employee that got arrested and sent to my facility. She was asking me to tell him hi and asked how he was. I had to tell her that I couldn't let him know my connection to her or give her any info on him. Any inmates that I would know I have to report and they are possibly moved to another facility.

[ironbaby]

Do all the regulations, red tape, etc. (which there is enough of in regular nursing, I imagine) ever get to you?

[housecarder]

Mar 4, 2016 13:42:26 GMT -5 wildflower810 said:

Mar 4, 2016 13:36:38 GMT -5 housecarder said:

But an actual crush? No. We heard too many stories during training for me to ever drop the professional side. There was a nurse who was caught calling an inmate from home and putting money on his account. She was fired from all 3 of her jail jobs and lost her license. She kicked out her fiancé, bailed out the inmate, moved him in with her, got pregnant, and he was back in jail within 3 weeks. This man was small, had tattoos all over his face, no money, and several STDs. But apparently he knew how to charm his way into what he wanted.

That is a lot of not smart life decisions all at once.

You'd be surprised how often it happens. With male and female staff.

The jail regularly checks the numbers the inmates call to the staff phone records. And the rule is that if you happen to meet someone in jail and want to date them, you have to wait a year after their release to start a relationship. One nurse started dating an inmate after he was transferred and released. No one would have know but she said something to another staff member who turned her in.

[housecarder]

Mar 4, 2016 13:58:56 GMT -5 ironbaby said:

Do all the regulations, red tape, etc. (which there is enough of in regular nursing, I imagine) ever get to you?

Not really. It's all there for safety reasons so it's easier to handle. And the doctors and security staff are pretty good about taking my judgement at face value so if I say something is necessary they make it happen. We just have to make sure to document everything because it's a much higher chance of being taken to court over something there.

[icedtea]

I can't think of a question yet, but wanted to say this is all fascinating. Thanks for answering!

[housecarder]

I added a trigger warning to the title so that talks of abuse or sexual misconduct wouldn't catch anyone off guard.

[housecarder]

Mar 4, 2016 14:05:53 GMT -5 icedtea said:

I can't think of a question yet, but wanted to say this is all fascinating. Thanks for answering!

I honestly really love my job. I have the temperament for it, so I can keep my professionalism and temper in check.

If I have a really bad day, as I'm leaving I look up at the windows from the parking lot (because they are always watching) and wave bye. It makes me feel a bit better.

[housecarder]

*trigger, sexual harassment*

I'm also no saint. There are several inmates I refuse to work with anymore because I can't objectively. One is a man who has several times exposed himself to the nursing staff, said crude and harassing things to me, even stating that me taking his blood pressure was giving him an erection. When told his comments are inappropriate he simply states "you know you like it." Or "you act like you ain't never seen a dick before". It takes a lot not to respond hatefully to him so I minimize contact with him. Thankfully all the harassment charges from nurses have put him in restricted housing so he's in a locked cell and not a dorm so I don't run into him unless I go to his cell.

[PirateCat]

What's the most creative catcalling you've heard?

[housecarder]

Mar 4, 2016 14:21:06 GMT -5 PirateCat said:

What's the most creative catcalling you've heard?

Honestly it's not creative, it's usually banging on the windows and "I love you!". If you ignore them you get "stuck up bitch". They all use the same ones so you can start to come up with standard replies.

I will say that there are some inmates that will stick up for the nurses and that will be funny. The guy I can't stand was screaming at me from his cell about me sucking his dick and another inmate yelled at him that no one wants to touch his old shriveled dick so I didn't have to say it.

Now that I'm obviously pregnant I get a lot of "there goes my baby mama".

Eta: They all think they are geniuses when they say they need their hearts checked because we made them stop, or that they are having trouble breathing because we took their breath away.

[housecarder]

We did have an inmate on suicide precautions in one of our medical cells that had a false eye. He took out the eye, announced that he was going to kill himself, and used the flat side of the back to try and cut his wrists. That was an interesting night.

[sleepymonkey]

What do you think of the corrections officers treatment of the mentally ill inmates? Because mental illness is so stigmatized and not understood by many people, I can imagine that there are officers who do not treat them very well or understand that it's the illness talking and not just them being an asshole.

[housecarder]

Mar 4, 2016 15:11:02 GMT -5 sleepymonkey said:

What do you think of the corrections officers treatment of the mentally ill inmates? Because mental illness is so stigmatized and not understood by many people, I can imagine that there are officers who do not treat them very well or understand that it's the illness talking and not just them being an asshole.

There are times it bothers me, but because we are a private company and not run by state law enforcement the training is pretty good and treatment is fair across the board.

It's hard to see a paranoid schizophrenic get sprayed with mace because an officer was unaware of how her actions were causing him to become combative, but on the flip side, when a man who is 6 foot plus and easily 250lbs of just muscle uppercuts another female officer because she was trying to calm him down and breaks her nose certain uses of force have to be implemented for everyone's safety.

[ladytiffany24]

I haven't thought of any questions yet but just wanted to say how fascinating this is. And to let you know that you are a saint for what you do!