Vindictive jailhouse nurses

The following is a rant.

I have had it.

Up.

To.

Here.

With jail nurses. And self righteous correctional medicine PAs

What is it about this class of nurses?

Do they all get off on treating male prisoners from a posiion of dominance and absolute authority?

Why do they seem to be just plain mean?

Case 1.

20 y/o black male in prison for (who cares). Develops frank hematuria. 8 mm stone at upj. L-o-n-g way to go. Uncomfortable. Very uncomfortable.

Guard tells me, when I give him his do Audie phenergan and toradol prescription.. " don't even bother, doc, all the nurses will give him is motrin". PT confirms that they don't give anything but motrin. ( I checked.. They CAN dispense drugs prescribed, but take it on their own to decide whether or not the drug are REALLY warranted )

Case 2.

Colles fx, 45 y.o white male. Different guard. Different jail. Same story.

As I have heard since the 70s when I first became a PA.

it seems that there are a disproportionate number of sadistic nurses who gravitate into correctional medicine.

Somewhere along the way, we should remind each other that, irrespective of our politics ( I am a southern white right ring conservative, for godsakes!), our role in these jails or prisons is NOT AS THE PRISONER's JUDGE OR JAILOR .. it is as the health care provider.

And in this role, we are to be the patient's ADVOCATE.. we are to provide aid and comfort, and to the best we can, relieve suffering.. Not contribute to it.

Providing pain relief does not constitute a weakness of character.

Even in war, after first taking care of our own troops, we have an obligation to try and provide some comfort to our prisoners of war. To assure humane treatment.. Not in preference nor to the detriment of our troops, and to assure that we treat as we would like to be treated.

There seems to be a frankly mean streak that is deeply imbedded in some nurses ( and PAs) which manifests when they are placed in a position of power over another class of persons.

And it makes me sick

Rant over.

Well, next time it's time for you to use your position of power and demand they administer your pharm of choice. Depending on the inmate's crime, of course ;)

Well, next time it's time for you to use your position of power and demand they administer your pharm of choice. Depending on the inmate's crime, of course ;)

That's just cold, man. Chilly and cold. :)

Couldn't agree more. You have to treat all patients equally no matter how heinous a crime they have committed or how piss poor their personality may be. To me this is the #1 rule of ethics for a health care provider of any level: you must treat all patients equally and fairly. IDK what their problem is but if I had to guess, many people who gravitate to that field may be on a power tip. This is of course not to ignore the many people who take this underserved job to make a difference.

There are all kinds of reasons people act the way they do. their hx, family hx, psych probs (a degree of which we all have) personal afronts...doesnt make any of it right...and as a rule, these are not happy people, people who hurt others are seldom a happy lot. But the mean gets deep sometimes and some occasionally get mean down deep as well. Some experiences require a lot of time, work and distance to beqat or heal or whatever you call it. Heal thyself then heal others.

Depending on the inmate's crime, of course ;)

As a young medic working for commercial services with a lot of correctional facility contracts, one of the best things I learned was never to ask what they were in for. I transported a patient incarcerated for child molestation, and found myself thinking "do I really care if it takes a few IV sticks to get this line?". I didn't like that I was thinking this, and from then on out I made sure to avoid finding out the details of an inmates past.

Regarding jail nurses, I 100% agree. I had to give testimony to a state investigation once after a cardiac arrest in a jail. Male in his 20's, status asthmaticus, progressed from respiratory failure to cardiac arrest 5-10 minutes before my arrival. I arrived to find him in the room alone, sheet over his head, nurses sitting in the break room. I pulled off the sheet, found him warm to touch, and worked the code for the next 45 minutes enroute to the ED. My run form very clearly documented the condition of the patient and the staff location, which conflicted a fair amount from the nurses chart of "CPR performed until EMS arrival". I never heard what the outcome was for the staff, but I hope the fact that the state was investigating it lead to some type of punishment.

Being in a jail setting can change ones moral compass ..... maybe they are victims of circumstance? as you know some of these settings can be horrors for inmate and staff alike. Not saying the behavior is warranted

In a correctional setting, you are either a inmate (detainee) or a guard (detainer).

The mindset is that there really is no third class.

Its the whole "Them (inmates) against US (staff)" mentality that is intentionally fostered in correctional institutions that causes the problem. Most of the staff (especially medical and nursing staff) don't start out this way... but they are slowly socialized and intentionally indoctrinated into this mentality. Part of it is self protectionism, and part of it has to do with the dehumanization required to survive mentally and physically in this setting.

Understanding this "institutional dynamic" is the very reason why I have turned down EVERY offer of employment I have recieved to work in correctional medicine regardless of how lucrative the offer was. I also have this thing about "locked doors" and free "egress" so it wouldn't work anyway...

We are ALL more or less succeptible to "group-think" and mirroring the expected/accepted behavior of our peers, based upon the intensity of the situation, environment, level of danger and whats at stake.

In this sub-culture, the guards have some REALLY colorful names for and ideas about staff that seem to be toooo comfortable advocating for or identifying with inmates... and generally (?rightfully?) see those that do this as a "security risk." Sensing this... and wanting to "please," be successful, be accepted, fit in... they "fake it until they make it." So the caring, and docile feign callousness, and agression. Over time... they no longer have to fake it as it becomes part of how they see the world and how they operate.

Unfortunately... over time... these folks really can't function in any other environment.

Treating folks down at the local outpatient clinic as if they are convicted criminals on a cell block just ain't gonna be conducive to maintaining normal clinical employment.

Many of these staff (guards) belong on the other side of the bars and gates and shouldn't have keys... but by the grace of god, hasn't been caught yet.

The inmates do NOT tolerate fellow inmates getting too cozy with the establishment. The inmates are "generally" predators and manipulative geniuses who have NOTHING better to do than spend 12-20hrs a day plotting, scheme-ing and chipping away at their intended target's resolve. They are the ultimate opportunists and will look for a chance to exploit your "humanity" and beneficence then rape, and/or shank/kill you.

Its an inherantly ADVERSARIAL environment and thats just the way it is...

Some folks thrive in it... others don't.

Right now... we have a nurse who works part time at one of the larger county jails (facility was on the NATIONAL news recently because female guard was killed by inmate). Her "basic nursing skills" are up to par... but she is pretty warped due to her jailhouse experiences.

She regularly has to be reminded that SHE doesn't get to simply "blow-off" patient complaints. She also likes to "stir-the-pot" and insert divisive nonsense and "back-biting" into the daily interactions between nurses at our facility... and she is VERY critical of the medical staff even though she has only been a nurse for about 3 yrs and obviously has NO training in the "practice of medicine" in general and Psychiatry specifically.

I believe some of it is "personality disorder"... but a lot of it is the environment and purposful indoctrination...

Remember... Zimbardo et al... and/or the Abu Ghraib debacle.

Just some thoughts based upon personal experiences and my understanding of some human behaviors...

Contrarian

Btw... Keep in mind... that there are some PAs who will try to justify putting the interests of "the company/employer/prison" before the interests of their patients... which is really, on a molecular level... is what this particular discussion is about (patient centered care).

Working in corrections will burn you out.

With a family and after two years of no income,I took a job in a correctional facility right out of PA school. It was my observation that the most difficult people that I dealth with were the staff! As RCD stated providing appropriate care to PATIENTS is our role.The judicial system has spoken, these folks being in prison is the punishment. We nor anyone else can decide to add on additional punishment as part of our duties. I will admit that knowning why some of these people are in jail lessens my sympathy for them as people incarcerated, it doesn't lessen my obligation and responsibilty to deliver the appropriate care. Working in the stressful enviroment of implied threat to one's safety, along with dealing with master manipulators can and does wear on one, but when you decide to be negligent or abusive of those in your care............QUIT! It will do you and those around you , no good to continue your course of action or attitude or if and when you observe this behavior in a clinicial report it.

I errored on the side of caution many times which the staff did not support.

I take care of correctional patients fairly frequently, and I have seen numerous accounts of substandard care given by the staff at several facilities - treating a young male w/ an incarcerated hernia w/ milk of mag for his "constipation", and tylenol for his pain & fever. We got involved after about 48 hours of such treatment, with the patient coming in to the ED septic, and then requiring resection of 2 feet of small bowel. The callous disregard for inmate complaints is disturbing.

I am glad that my experiences are different. I take care of inmates all of the time, as well as illegals that are being procssed for court and deportation. They receive prompt and good care prior to arrival and the meds I Rx are given as written, as far as I know.

I must admit, there was one inmate that I was a little frustrated with. he had a Fx mandible from a fight. He was an out and out hostile and I remember thinking that there was probably a good reason why he was in the ED with a busted jaw. I admitted him for the maxial facial surgeon to take care of and when the maxial facial md examined him, the Pt hit him. No other MD's would se him so we had to ship him out... all HE did was prolong his pain and suffering, that wasn't our fault.