Correctional Nursing 101: Criminal Intentions and Inmate Challenges

In the 90s, I decided to try another area of nursing so I began working at the county jail. I had some experience in correctional nursing when our hospital operated an inmate ward but the jail was more challenging. Nurses possessed more autonomy because the jail did not have a full time doctor on duty. Therefore, inmates constantly tested the nurse's knowledge and skills by feigning illnesses, injuries, or involving the media. It is so important for the correctional nurse to possess excellent assessment skills and knowledge of disease processes.

Since the jail did not have certain equipment, such as an X-ray machine, or laboratory, we sent many inmates to the emergency room. Despite knowing they sometimes stage scenes and feign injury, the correctional nurse must frequently err on the side of caution. Otherwise, the correctional system is a hotbed for lawsuits.

Inmates are very astute to nurses who are less autonomous; they loved the night shift nurse. She would send them to the emergency room, in the middle of the night, for a toothache! Inmates knew if they presented an array of complaints, it would confuse her. When I arrived for the dayshift, she would be a nervous wreck, thinking the person was near death. They tried me several times but quickly learned I was not a pushover. In correctional nursing, autonomy is a job requirement.

Feigning Injuries

An inmate, "David", claimed to be despondent because he missed the birth of his baby. As I entered the cell, he was "hanging" from the bar with a sheet around his neck as another inmate held him around his knees. Although he appeared unconscious, his pupils were reactive to light, vital signs were stable, and there were no marks on his neck. I knew David faked the hanging but policy dictated I send him to the emergency room anyway. The other inmate was actually preventing an accidental hanging. I later discovered David used the ruse to receive visitors if hospitalized; the emergency room discharged him within hours.

I was summoned to cellblock H, which housed murderers and rapists, for inmate "George", who claimed he fell in the shower and could not feel or move his legs. As I performed my assessment, other inmates yelled to call his family and attorney (for a lawsuit), claiming we were denying the person medical care. The scene appeared staged, down to the cut on his hip. Although George tried very hard not to, there was definitely a response to needle pricks. Nevertheless, I sent him to the emergency room.

On the way, he peered from the stretcher and stated, "I bet I'll come back with some good pain medicine". Of course, I notified the emergency room nurse, informed her of George's statement, he was sent back on Ibuprofen. I "paid" another inmate, with cigarettes, for the truth. George used a razor to cut his hip then lay down in the shower just to get his last bit of freedom and a narcotic prescription. He faced life without parole for a local murder.

Alex wanted to prove to the visiting State Representative that inmates were denied proper medical care. An amputee with a prosthetic limb, he stated he fell while running in the cellblock, claiming to have an injured hip. His prosthetic limb went one way and he went the other. Some of their antics can be almost humorous if they were not always testing my nursing and autonomy abilities.

A thorough assessment and range of motion without pain revealed strong doubt of an injury. I did not send him to the ER but scheduled him for the next day clinic. According to an informant, there is always one available, Alex did not fall, again a staged scene. I actually used him as an example while explaining to the State Representative how challenging correctional nursing can be and the reason for rising costs of health care at the jail. Today, inmates pay for some medical services and medications.

Seizures

Faking a seizure is not as easy as some inmates think but they attempt them quite often. Bill had a history of hydrocephalus and seizures but he was not a good actor, his last seizure was obviously faked. It was too easy to control his tonic-clonic movements (inmates don't want to accidently injure themselves); in addition, he was too alert soon afterwards. There was no post-ictal state. The problem with "crying wolf" in jail is that when the real thing occurs, officers tend to respond slowly or not at all.

I found Bill lying on the floor during rounds, surrounded by officers. I sent him to the ER mainly because I wanted a baseline Dilantin level drawn. Bill, like other inmates, wanted to be admitted to the hospital hoping to receive visits from his family, namely his young son. It is sad how so many inmates commit crimes without thinking beforehand of the impact it has on their families.

Hoarding Medications

Acetaminophen (generic of Tylenol) was like cocaine to the inmates. Many inmates used the drug for trading, selling, and even snorting. Pain is a common, and sometimes real, complaint among inmates. When they can no longer numb back pain, headaches, or toothaches with illegal drugs, such as crack cocaine, the pain returns. We were administering Acetaminophen upon request, free of charge back then, as it was a standing doctor's order. I knew this was a dangerous practice since an overdose leads to severe liver damage.

I am very observant so I noted when inmates attempted to "squirrel" the pills in their cheeks, use hand tricks, or distraction instead of swallowing the medication. Unfortunately, because some less experienced correctional nurses were more gullible than others, they succeeded. Inmates will continue several types of trickery until they find just the right nurse and are successful.

The pharmacist would not purchase liquid Tylenol and I could not refuse their treatment for pain so I came up with my own solution. I began pouring a few drops of water over the pills prior to administering. Because these were generic Tylenol, they would start to dissolve immediately. The inmates hated the practice that is how I knew it was effective.

The Local Media

Whenever the inmates perceived unfairness at the jail, they would call the local television station. In1992, I began treating the first inmate who presented with the flu; then all hell broke loose. The flu bug caused an epidemic, affecting more than 200 inmates; I also became a victim. After the fifteenth call for doctor orders, I was given standing orders and the autonomy to initiate treatment without delay.

The layout of the jail, with four outside "pods" trailers, required much walking; with aching bones and muscles, I was in absolute agony. Then word came that one of the first inmates I treated called the TV station to report the flu epidemic and lack of care. I was astonished that they came within hours for a "story". However, there would not be a story from me, my job was to treat every inmate in a timely manner; I did not have time for their probing. I was quite ill myself so I stayed outside in the pods until they left. I think they put a priority on the story because the reporting inmate was the daughter of a famous blues singer.

Frivolousness is the operating word for lawsuits and most calls to the media; such as the inmate who claimed (and filed a lawsuit!), he was denied proper servings of peanut butter (protein) on his vegetarian diet. When given the extra peanut butter, we discovered it was a hot commodity for selling and trading. His cell contained multiple containers of hoarded peanut butter, and bugs.

Love for Nursing Rescued Me

I left the jail after just eight months because I love my nursing license and real nursing. I was one of four actual jail staff members while the rest of medical care was outsourced, even the pharmacist. Although, I love autonomy, the flawed system constantly placed my license in jeopardy.

The inmate challenges and criminal intentions were too much for me. I felt like a surrogate mom to people who were always scheming or testing my knowledge. It was like placing a Band-Aid on an invisible wound or kissing a child's scraped knee. The constant worry about frivolous lawsuits was just not nursing to me.