I Am A Nurse at a Jail in one of the Most Violent Cities in the US. AMA!
The "butt naked room" is the slang term used by staff and the inmates to describe the Inpatient Mental Health Unit (IMHU), where inmates who are suicidal, homicidal or otherwise mentally unstable are sent. Inmates are stripped naked (hence the butt naked room), given a suicide smock and placed into a special cell with nothing but a special blanket (similar to the smock) and a toilet. There is no bed, or anything in the room, to prevent someone from doing self harm. They are checked on every 15min, and the lights are always on. They are not allowed to leave the cell except to shower (3x a week), to see their lawyer (visitor booth on the unit), or to see medical, which there is an exam room on the unit, as well as a visit room for the lawyers to use. They are almost never allowed to leave the unit. They are not allowed to have any items except for a wad of toilet paper. They are given showers every monday, weds, and friday and if they are there for an extended period of time (more then a week) we supervise them with a toothbrush and allow them to call their family. They are seen daily by a psychiatrist and are fed normally, but with no utensils. Inmates can be held there indefinately until determined not to be a threat to themselves or others, and the usual stay is 3 to 4 days. The unit is staffed 24/7 by 3 officers, 1 LCSW, and 1 LPN or CNA. 2 times a week they up for status reviews to see who can be sent back to general population and who is going to stay.
That kinda seems like it might make them even more mentally unstable.
Most of them just power through. It is extremely miserable though. I cannot imagine being in their shoes. But I would be even more sad if one of them killed themselves, most people will be released from jail/prison so they have the ability to do great things, even if they made mistakes.
Sounds cruel and unusual
It may sound cruel, but it's sometimes necessary to prevent someone from harming themselves or others. The normal stay is 3 to 5 days, the unit is designed to stabalize people, and get them back into general population.
Ah - i don't think you are using the term "necessary" correctly. It implies that you have to take that course of action above all others. In reality, there are a ton of things we could do short of locking someone up alone and naked that wouldn't demonstrably worsen their mental distress, like solitary confinement has been shown to do.
It's perhaps the only option you have at the moment in the anachronistic and cruel system that is the US prison system, but it's definitely not "necessary".
I do not disagree with you.
I should have added some information about how people are admitted to the IMHU.
Inmates are only admitted if they have a serious risk of self harm. They are usually admitted by a psychologist (LCSW) or they have attempted suicide.
If an inmate claims to be suicidal or is suspected of being suicidal, they are immediately sent to psychology dept. They will then evaluate the inmate based on condition, past history, and if he has a plan and means to commit suicide. If psychology feels that the inmate is not a threat, then they are realeased with a behavioral watch order which means that officers have to log the inmates actions for 48hours on the log, and check on the inmate hourly and will generally refer them to the psychiatrist for medication. If the psychologist feels the inmate may be a threat to himself or herself, they are admitted to the IMHU after being medically cleared. They usually stay for 3 to 5 days, and are either placed back into general population, placed into the SNMU (special needs medical unit) for inmates who are special needs and are low functioning, or put into admin segregation for those who are high funtioning with special needs.
I agree we could handle it better, however, mental health is challenging in jail, and to prevent people from haming themselves it is sometimes, necessary to remove all posible risks.
Not what I expected from bobbarker.com
I also highly recomend Maximum Security All-In-One Shampoo TM it is both cost effective and convenient!
They are a prison supply company, when I saw that they supplied some of our stuff. I was hoping it was a site comprising of clips from Happy Gilmore.
As a medical professional doesn't this seem insane to you? I'm no expert, but taking someone who is suicidal, isolating them, taking away basic utensils, it seems a bit much to me. I get not letting them have steak knives, but maybe a flimsy plastic spork and singe dignity might help.
I advocated letting them have a book, limit it to one book, but something for them to read. But I was shot down when I brought it up to the team. So I don't get involved in the IMHU since I don't work in that unit.
Can you explain what "LCSW" and "LPN" mean?
A Liscensed Clinical Social Worker (LCSW) is a mental health provider with a minimum masters degree and a liscense to practice social work (psychology) in the state.
A Liscensed Practical Nurse (LPN) is a healthcare provider who is certified to practice nursing skills. They are below an RN (registered nurse) and above a CNA (certified nursing assistant) in scope of practice.
Has anyone been able to hurt themselves in that room?
Yes, people many head bang. There are a few padded cells on the unit if needed.
I take it they're deprived of sleep by keeping the light on 24/7, and I haven't misunderstood you?
They are not super bright its a single florenscent tube. They have the ability to turn off the main light (all four tubes). We call this the night light. It allows the officers to see inside at all times when they do their rounds. Most of the time all they do is sleep.
Is it bad that I want that suicide smock? It looks comfy as fuck :/
It's really not any where close to comfy unless you're into heavy, scratchy material.
Remember that it has to be heavy/thick enough to resist being able to tear it or tie any kind of knot or braid with it.
And ours had come with Velcro but after a few uses/washes the Velcro became all gummed up and they wouldn't hardly stay fastened on our inmates.
If it's so tough then isn't it a potential noose?
No. The material is so thick that you can't make any kind of usable knot with it.
Yup. And it's quilted, so it is extremely dificult to tear strips of fabric out of it.
Do you know what every patient is in jail for when you are caring for them? do you think it impacts how you speak to them / care for them? truly curious, not an assumption.
I rarely know what an inmate is in for. I only know if they tell me, I have seen them on the news, if I have a specific reason to know (sometimes it is in the medical records if their charges have medical relevence or are a safety risk like assulting staff). I honestly don't care as long as you are respectful and let me do my job. I see everyone as a patient, not an inmate, I purposely don't use the word inmate at work, becuase it is dehumanizing.
Do you have a generic example of a charge with medical relevance?
Drug use, assult on staff member, DUI, other things, that might indicate a problem.
Do you feel like being around prisoners all the time has had a negative or positive impact on you in general? (I.e. do you think you have a lower tolerance for wrongdoing because you see the consequences of getting caught, or do you have a higher tolerance because "I'm not as bad as the guys in my jail."
Hmm, this one made me really think, I don't really know what a lot of my patients have done, so, I cannot really compare my own actions to theirs, however, I can say that at the end of the day I do feel positive most of the time, because I help people who no one else wants to help or thinks theyndeserve help. So my job is rewarding in that regard. Working there also makes me never want to get in trouble. I will say that. Hope that answers it.
What’s the protocol if you start being attacked by a inmate?
When we "in" the jail outside of the clinic we carry radios with panic buttons, there are usually guards everywhere, and I make a point in staying visible, amlot of it is preventing attacks, but if we do get attacked we are supposed to press the panic button and scream for help. I personally have never been attacked. In the clinic we have wall mounted panic buttons for when we are in exam rooms with the patients, and there is always two officers in the clinic at the desk.
Any alarm rings if an inmate is an structural engineer and comes with the body fully tattooed?
Well, personally, I don't have anything to do with security, I only report things that I am legally required to report. (Inmates who tell me they they are going to escape, sexual abuse, suicide thoughts or threats, and/or threat of violence against others), otherwise anything you tell me is confidential.
Has an inmate ever asked you to smuggle anything in for them?
Yes, I have been asked, I politely decline.
Weirdest thing ever found in an inmates prison wallet?
Hmmm, wierdest thing was a guy who was getting moved into disciplinary segregation tried to stuff snack cakes up his butt because they take your commissary when you get in trouble. He ended up in medical after he could not get it out.
How did you get that job? You've been doing it for a long time. Do you like it?
I knew early on I wanted to work in correctional healthcare, most jobs required experience so after I graduated nursing school I worked for 2 1/2 years at a hospital and then applied for this job, it took over 3 months to get it, but they need nurses, so as long as you have no criminal record and pass a urine test and have documented experience they will hire you, in my experience.
2nd part, I really enjoy my job, never the same thing or people each day. It can be challenging but, that's why I enjoy it.
Has any situation ever made you say "What the fuck?" out loud, or come very close to doing so?
The guy who impailed himself on his bunk was one of those along with the sugar eater. We also had a guy who tried to electricute himself by sticking a paperclip in the outlet, he failed, becuase all the outlets are ground fault protected, so he didn't even really get zapped.
I also said wtf the first time I encountered a smearer (someone who throws thier own feces, and smears it everywhere). But now I am used to that.
How is addiction treated in prison? How is it possible that prisoners are able to maintain addictions to hard drugs while under lock and key? What are the punishments for someone who is caught habitually using and do they have access to treatment while imprisoned?
I am not really equipped to answer this question, unfortunately for two reasons, first I work in a jail, our main goal is to stabilize people, not offer long term solutions, second, our jail has a dedicated team of medical staff to handle detox and drug treatment, they have their own seperate Doctor, PA, and nurses, and CNA's. They do extensive work with Methodone (opiates) and Librium (alcohol) and provide palative care such as diet and vitamins.
Our jail provides extensive resources for those substance abusers, we also have weekly NA and AA meetings.
Inmates smuggle drugs in a variety of ways, this is a jail, so a lot of people are coming in, and things get hidden. If an inmate is caught with drugs he faces internal punishment, as well could face a street charge.
I believe the prison system offers similar treatment programs, as the state runs this jail, and runs the prison system.
What percent of the inmate pop has drug problems?
Has the fentanyl crises infiltrated prison too? Do you deal with a lot of overdoses?
We do have overdoses, occasionally, most of them are delayed (given narcan and taken to jail, narcan wears off, opiates havn't yet). But occasionally we have them in the jail itself. We give narcan and all is well.
What was the craziest suicide attempt?
I have two that I will share:
We had one guy who tried to impale himself on the bunk. The bunks are made of 1inch square steel tubing and had a 6 inch piece that jutted up past the matress. He straddled it and then jumped onto it landing on his anus. 6ft 2in 210lb guy landing on it naked smack dab on his Anus (butthole), makes for a pretty traumatic injury. The was a lot of blood, and other fluids because his bladder burst and his bowel was swiss cheese. We had to call the Fire dept and they extracated him and took him for emergency surgery. The guy returned after several weeks in the hospital and now poops in a bag and has to cath to pee for the rest of his life. I was told by his celly that he had been found guilty of murder that day and was awaiting sentencing when he did this. I can guess he got life from how our state handles murder and has to deal with that on top of prison.
The second one was a guy who tried to overdose on sugar. He bought several packs of drink mix which is pure sugar and half a dozen candy bars, along with other items, and tried to eat them all. I think we figured he ate over 12,000 grams of sugar. He vomited most of it up, but his sugar was off the scale of the glucometer so he went to the hospital and once returned he was sent to the butt naked room for a few days.
Like....why? I'm sure there were other ways but what compels someone to go "You know what a good way to go would be?".."Bleeding out of my asshole."
A lot of suicide attempts are extremely impulsive, resulting in half baked ideas which then result in even worse circumstances.
That's the whole problem with people who are suicidal, they don't think clearly. That is why the extremes of the butt naked room are in place, to prevent someone from doing anything to harm themselves, and once stabilized work on the issues that caused the feelings.
I'm a PPD converter who negatively reacts to Isoniazid.
So if I go to jail to I just get locked up where I can't cough on people?
You would be placed in a medical isolation cell for contagious inmates and be required to wear a mask. If you got time, you would be placed in a medical ward.
In the hypothetical case that I end up locked in your prison what would be your advice to break out of there?
Well, bribe the guards, I dunno, it would be pretty hard to break out of our facility. We have only had two escapes, both for inmates on work detail picking up litter outside the jail.
How much freedom are you allowed with patients ? As far as giving meds, insulins, or any IV meds? Is there a doc always on staff that you can get orders from?
So we have pretty broad standing orders for emergencies, however for more routine things, we do not.
For emergencies, we have standing orders for ACLS drugs, King Airway insertion, and defibrillation, we have orders for other emergency drugs as well like Epi, Nitroglycerin, and others.
Our clinic is staffed 24/7, Day shift has both a Phsycian, and mid level (Nurse Practitioner or PA), swing shift has only mid level provider, and night shift (my shift) only has RN as senior provider.
As a RN I cannot prescribe meds persay, but I can authorize "bridge orders" for inmates who come in with medical history and report being on certain meds. As inmates cannot bring meds into the facility, and it usually takes 3 to 7 days for them to see a mid level or doctor. When I put a bridge order in, it still needs to be approved by a mid level or doctor, however it get the process going for the inmate to recieve a small supply of meds before they are formally seen.
Medical procedures we have pretty broad discretion on at night, and I can consult via telemedicine or call the Medical Duty Officer who is the "on call physician"
Can you tell us a bit about your most bizarre/fascinating incident and/or prisoner you've dealt with?
Sorry I have been putting this question off. I answered it already (kinda) in another question.
I will say we did have someone try to kill themselves in the IMHU by eating the styrofoam tray that the food comes in. But they passed the styrofoam without issue.
How often are you (sexually) propositioned by inmates? Was there an instance that stands out as particularly bizarre or comical?
Short answer is no. Long answer is I am a dude, 2nd, I am gay, but not outwardly stereotypically gay. So no inmate directly knows I am gay. And we have a very small female population and in most cases we try to have same sex provider with female population for any one on one interactions.
Have you seen any other nursing staff (or regular staff) mentally succumb to the constant stress of a dangerous work place? Like the gangs knew of their family and threatened them, etc.
We have a high turnover rate among the CNA's, however, a lot of the core staff have been here for a while. I think in this industry, it's either for you, or not for you, and you figure it out pretty quicky.
We are "threatened" on a daily basis by inmates ("Do you know who I am!" or " I am a [insert gang here], I will have you killed!"), but talk is cheap, I do not know of any medical staff being threatened or intimidated outside the jail. There have been officers who have been extorted though.
How do they extort officers?
I cannot get into the details of that sorry. We had a rather large scandal a few years ago, and it would disclose my facility.
When you say "one of the most violent cities in the US" and then mention a large scandal a few years my head goes to Twin Towers.
Nope. Sorry. Try again
Baltimore and the scandal was the inmate that knocked up a half dozen female guards. That’s my guess
Nope. Try again. Even if you were right I wouldn't tell you.
Im not sure if this was asked but if an Inmate cannot pay for his/her medication, what happens?
Inmates are not charged for medications. However, they are charged for Medical and Dental sick calls (they are not charged for mental health or med refills). The cost is $2.00 to their commissary account (it is there to cut down on abuse and fraudulent sick calls) follow up appointments are free. If an inmate has no money the account just goes negative, we never refuse medical attention to an inmate because they can't pay.
How do you cope with the (assumed) stress from your job? What helps take your mind off of your job in your free time?
One thing that definitely helps is walking through the "gate" at the end of my shift. When I am off, I am off, but it can get stressful. I enjoy reading and reddit.
Do you have favourite inmates? Do you believe any of them are innocent? Do you walk around and is there a culture of getting social with them or are you in the medical area and they are referred over only when they are hurt?
I wouldn't say I have "favortie" inmates, but there are inmates that I like to deal with, that are extremely polite, and I treat regularly. I make small talk with them while they get treated, and will briefly talk with them on cell rounds, but Imkeep everything professional.
Why do you treat them regularly? Are they constantly in fights?
We have dozens of inmates that have chronic conditions. We have diebetics that come 3x a day (before each meal) for insulin shots, we have inmates who need wound care and dressing changes, and we have a few that require other injectable meds. As well as inmates that get vitals taken daily to monitor conditions such as COPD and high blood pressure.
I would say 80% of what we do is "routine" medical care.
What are some of the least likely methods used by inmates to assault other inmates have you seen?
Well, there is "soap in a sock", but that's typical, since we don't have any padlocks. I don't see a lot of unusual assults, most of them get into fist fights, and to be honest they fight like sisies.
Are shanks really used as often as media would have us believe? (e.g. Daily use in the yard)
How many shanks have you had to remove/place in snitches?
Shanks are not very common here. The most common type is that made from a shaving razor and a pencil, they use it to slash people. It is not very effective for killing someone, but will require them getting stiches. We don't have a "yard" we have a gym which is like a high school gymnasium, which they are allowed to go to one day a week. Rec is normally 2x a day for 3 hours and is held in the common area of the cell block.
Our jail likes to refuse inmates at intake for claiming to be pregnant. We then have to take them to a specific hospital to get medically cleared. How’s the policy where you work regarding that?
We can refuse inmates who are incoherent, unconcious, clearly intoxicated, bleeding, or other obvious injury, and pregnant. The police are responsible for taking them to the hospital first, then once cleared, we will accept them.
Any unusual punishments? I see you have stated a lot of unusual ways of suicide.
What's the food like for the staff and the inmates?
What would you do if one inmate was mute, deaf or blind? Or missing a limb?
Do you tell any information to friends or family? Any reactions (like your choice to work at, death)? (You can skip this question if you like.)
Is there any items that are prohibited although they are usually harmless due to scandals or previous incidents?
We have strict policies that no cruel or unusual punishments. Food cannot be used as a punishment (except taking away commissary privileges). Usual punishment for inmates is disciplinary segragation which is lockdown for 23hrs a day, no commissary, no phone, no visits, and usually lasts 7 to 14 days depending on the offense. Also before they are sent to Seg they have the right to a administrative hearing which is made up of 3 staff members who vote majority for if the inmate did the offense or not.
Food for both staff and inmates is the same. We serve the same thing in our break room. It usually is a meat (hamburger patty, chicken patty, fish patty, mystery meat, chicken, or hot dogs) 3 slices of bread, a vegetable (carrots, pees, greens, brocoli, or mashed potatoes), sometimes rice or pasta, and desert is usually 2 chips ahoy like cookies, or fruit. Some rare meals are hard shell tacos, spegetti and meat sauce, and baked chicken. All food is pork free. And served with milk for lunch and breakfast and a juice box for dinner. Sometimes meals are substituted for a bag lunch which is mystery meat sandwhich or PBJ and carrot sticks, and 2 cookies. Breakfast is usually grits, or oatmeal, hardboiled egg or powdered eggs, eggo like waffle, or eggo like pandcakes. Meat for breakfast is turkey bacon or turkey sausage. Sometimes they give cereal. Its horrible food. Don't go to jail.
We have several inmates who are handicapped. Blind, deaf or mute inmates are usually put in administrative segragation for protection. Handicapped inmates are assigned to ada compliant cells.
I occasionally will tell stories. Mostly to my friends at the volunteer fire station.
Not that I can think of. All bags have to be clear, and we have restrictions on what we can bring in.
I am a recovery RN at a state hospital, so we do all inmate surgeries. As with any patient, I get pain under control before discharge. When I first started there, all my inmate patients told me it takes hours after they arrive back to the prison infirmary to get any pain meds. I spoke to a friend of a friend that was a prison RN and they said it’s the ‘red tape’ to get the orders in. So now I always give their first dose oral med right before leaving (about an hour drive) whether they are in a lot of pain or not. Does the ‘red tape’ ring true for you?
At first I thought maybe drug seeking, but after the friend mentioned the red tape, I felt like it was the humane thing to do in my practice.
Yes, there is an extreme amount of red tape! When a person is arrested they are screened by an LPN and are asked if they take any meds, if they do take meds or have a condition that they should be taking meds for, they note it. If it's on my shift (overnight), I put a bridge order in the computer for those medications (if they seem reasonable and are in the formulary). That then has to be approved by a mid level or doctor, that is then sent to the central pharmacy the next day to be filled and comes the following day. So from the time they arrive st the jail to the time they first get their meds is usually 48 to 72 hours. The bridge order is only good for 10 day supply. All inmates who are assigned housing units (do not bail out or have no bail) are automatically scheduled for a full medical checkup by a mid level provider to take place within 7 days of arrest, and then can be prescribed more meds.
As an RN on night shift I cannot give more then a handful of OTC meds to inmates apart from emergency treatment.
There is also red tape for sickcalls. Inmates submit the form in the proof picture to a special mailbox on the unit. They are collect twice a day (noon and midnight) and are triaged by the charge nurse as either emergent, urgent, or routine. If it's emergent, I immediately call the inmate for treatment, if it's urgent the inmate must be seen within 24hrs, if it's routine, the inmate must be seen within 72hours.
For all non medical requests we foward to mental health or dental.
Is there any accommodation for prisoners who are transsexual (or pre-op)?
I live near a state prison. I was in a liquor store and overheard a conversation between a prison guard working at that prison, and another guard who used to work there with the first guy, but was now working elsewhere. The conversation went something like this:
"Is Frank still working?"
"Oh yeah, he'll be there until he retires".
"Bill transferred to Xyz Correctional."
"How about Ed?"
"Ed works in the east wing with the he-shes."
There are apparently enough people in the transsexual or pre-op range, that they have their own wing of the prison, which is probably a good idea. Does that happen in other prisons?
Transgender inmates are housed with the gender of their anatomy. So if they have a penis they are in the mens unit. If they have a vagina they are in the female housing unit. Breast do not count here.
Transgender inmates almost always scpre extremely high on the PREA questionare, and as a result are usually placed in admin segregation in protective custody due to the high likelyhood of problems that might occur. Self identified transgender inmates are always placed on "house alone" status, regardless of their housing unit assignment.
If you were locked up and wanted to kill yourself how would you do it?
Hmm, all the successful suicide attempts I have seen have been either hangings or cuttings, but niether sounds appealing, as they most likely suffered for several minutes, I would probably get creative, or suicide by correctional officer.
Edit: Don't kill yourself, if anybody needs help or to talk to someone call 1.800.273.TALK or visit r/suicidewatch
You can also text GO to 741-741 to chat with a trained crisis counselor for free!
Good to know! Thanks!
Most suicides I was around for were done by breaking down a shaving razor that is passed out by staff for a few necessary minutes at a time. You're supposed to return it after shaving, but I've seen guys get pretty creative by inserting a piece of tin foil in place of the razor and then hoping nobody notices when it's returned. From there they can do whatever they want with it. Many times I've unsuccessfully tried to shave with a dead razor, wondering what the real thing was being used for elsewhere.
Inmates at my jail buy the razors off commissary. They can buy one per week. Single blade. They are not supervised with them and can keep them as long as they want. They can have no more then 5 at one time however.
Had ever discovered something that a prisoner was hiding in his asshole ? If so what was the craziest objects ?
I already answered this, but a guy was being sent to Disciplinary Seg and when you are sent you cannot take your commisary food with you. So he stuffed a bunch of snack cakes in their wrappers up his anus, he could not get them out and they had to be removed by medical staff.
Do you ever take your work home ?
Nope, when I am at work, I work, when I leave, I am off duty!
Do you ever get any flak from nurses from hospitals for being a prison nurse?
I don't know how I would get flak from them, because I don't really interact with nurses from ofther hospitals in my capacity as a correctional nurse. I do get some flak for only having a 2yr nursing degree though, but whatever.
Getting any crazy good inmate sex?
Haha, NO. I take allegations of sexual abuse extremely seriously. Our facility doesn't exactly have a good track record with inmate staff member relations. . . But we have a ZERO tolerance policy on sexual abuse.
If you had one inch of your penis in your mom and one inch of your dad's penis up your bum which direction would you move in to get out of the situation?
I think I had the same question on my SAT, no wonder I went to community college. I am going to say D. North
How has Trump's "presidency" exacerbated the problem of minorities not only being locked up, but being attacked, injured, and even killed in jail by white supremacist gangs?
Well, there are very few white people in my jail, so, not really. We have only a small population of white supremacists, and they mainly keep to themselves in my dealings with them. We have two major black gangs that dominate the facility.
EDIT: How is stating a fact hate speech?
What is the "butt naked room" exactly?
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