I am a nurse at a prison hospital. AMA

Just a heads up, if a heavily tattooed inmate asks you to leave the door unlocked so he can escape, don't do it

Ha, thanks. If he's not heavily tattooed, is he trustworthy? I don't have any control of the locking mechanisms though... It's all monitored from a central control room.

Ha. For a moment there I read that as "I'm a nurse at a prison hospital. Help."

Some days that's how I feel, ha.

Do you know if people actually get raped by other prisoners who are doing time for life?

Um, I don't know how often it happens, but it does happen, although I don't think it is just lifers that do so. I think it's probably under reported. We have had to stitch up a few rectums.

We have had to stitch up a few rectums

D:

I have read and seen the cumbox story, jolly rancher, dorito, etc etc. But this. This made me cringe.

dorito

?

i know the cumbox and jolly rancher stories.. but dorito? go onnnnn

You've been warned.

It is my professional medical opinion that you should not read this link. It may cause the following symptoms: nausea, vomiting, uncontrollable tremors, nightmares, mania among others. :)

But really, don't do it.

What is the strangest thing ever found inside an inmate?

The scooping end of a spoon, in a guy's bladder. Apparently, he shoved it through his urethra so he could come to the hospital...

Do you work in a prison for wizards or something? The only thing I can think of to explain that is magic.

Never underestimate the crazy.

i cannot imagine the sheer agony that guy faced.

When they reached in to pull it out with FORCEPS THROUGH HIS URETHRA, he was straight faced the entire time. It popped out, he nonchalantly says "Oh, that stung a little." The crazy was strong in that one.

Yea answer this one, they're always good. While we wait I'll tell you a story. I have a.. uhh... friend that works in the DOC. Its not me. So this friend was talking to a nurse and asked the same question. She said she had seen a lot but at the moment the only thing she could recall was an inmate who swallowed a tattoo gun.

So to avoid the shake downs and being caught with contraband, every night before bed this dude would take a glove and wrap up his gun and swallow it. Keep in mind this isn't a high tech full size gun. Just a motor from a Walkman or something. Not sure how the needle situation worked with that. Reason was because shake downs were commonly happening in the late night or early morning hours and he would have no time to try and hide it properly. When asked how he got caught she said that apparently they had wised up to that type of stuff and began wanding them during the process. Of course it was game over then. She asked him didn't it hurt and he said "...well yea, but after a while I got used to it". So she asked him then didn't he know the damage he was doing to his body or the danger he was putting himself in and he replied "its how I pay for the things I need. I don't have any family or anyone on the outside to send me money".

The canteen is what keeps them sane. No money to buy stuff means no contact with some of the things that keep you feeling human. So he traded prison tats for canteen items and thus kept his sanity.

That happens a lot to people without family. Not the swallowing tattoo guns, but contraband trades lol. Apparently drugs are easier to get in prison than out of prison. A while back we found weed in a guy's wheelchair, ha.

As for other stuff found in inmates: cell phones, drugs, drugs, drugs, probably more drugs.

the cell phone shit still amazes me. a simple signal jammer could elimate the need for that. not like the employees even get to bring in a cell phone so who are you depriving? the 10 or so big shots that get to carry one?

i don't know why the inmates want cell phones anyway. they all get shitty service >:)

They aren't in prison because they're smart, for the most part anyway.

I don't have a question, but this was the most interesting AMA I've read in a while. Thanks!

Thank you! I'm glad it was interesting to some people lol.

Do you develop personal relationships with inmates you see on a regular basis?

Kind of...it's complicated. Some of them are there for a long time for antibiotics or whatever, and it's easy to become comfortable with them. At the same time, you have to be on the defense. They didn't go to prison for being a nice guy, you know? You have to wonder whether they're trying to play you. Some inmates stay for a long time and seem to be alright and never ask for anything though.

I've always had the impression that Nurse Barney from The Silence of the Lambs was right on the money when it came to personal relationships. It is okay to talk to the inmates, and even have a friendly and respectful relationship, but you never skimp on the security protocols even for a second, because your prisoner is a dangerous murdering cannibal.

That is absolutely what we aim for, worded perfectly!

Do you get told what they're incarcerated for? Is it in their chart in some way, or do you just learn from guards, or their own disclosure?

It's not in their chart, but we can ask the officers or look them up on the DOC website. It's an if-you-wanna-know kind of thing. If you ask them, they'll likely lie to you, in my experience.

What's the craziest thing that's happened while on the job?

The crazies, oh, the crazies! I've had to give so many shots of psych drugs because someone was having a freakout and seeing elves in their room or didn't like the way they were spoken to and spiraled into a manic episode. Craziest? I'd have to say the guy that bit a hole in his own scrotum...repeatedly.

Multiple bites in one session or multiple sessions?

Both.

Given that you're an LPN and working within an atypical treatment scenario are there more things left to your own judgement about the administration of interventions versus other environments?

Yes and no. I have a charge nurse that is an RN. The RN does admission assessments, identifies the nursing diagnoses for the care plan, and does the shift assessments. If I ever have a question, I can bring it to the RN, but I also have a lot of autonomy. I know more about my patients than the RN that only sees them once in 12 hours. If I feel a need to hold a medication, I do it and report it to the RN. Often the RN will give you feedback, but other than that, as far as medications, it's mostly my call. If I think the medications are ineffective, I can bring it to the RN or the physician on call (who is not in house). I determine whether or not the wound care scheduled is working or not.

Basically, RNs are assessment nurses where I work. My hospital's policy is that if you've been checked off on a skill by staff, you may perform it. I can do anything but hang blood and blood products.

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We defer them, simply telling them they know they aren't allowed to ask personal questions. We did have training, but it was kind of a joke. Apparently, according to the video, inmates can make a shank out of toilet paper! I've learned more from the DOC officers on the floor and from experience.

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That's amazing! I always think about stuff like this, and wonder what those prisoners would be doing if they hadn't had the life circumstances they had.

Have you ever had to help anyone whose crime you found unforgivable? Have you ever considered denying assistance or deferring it to another nurse because you couldn't bring yourself to help the person before you?

Yes. We see a lot of child molesters. I would prefer not to know what the inmates are in for, but people talk around the hospital, be it officers or other nurses. I've never even considered denying care. I've never provided less than the best possible care I could to anyone. That's a controversial attitude to have around our hospital sometimes. You hear a lot of "Oh, he's just a chomo, I don't know why you even bother." and such.

What are your favorite pizza toppings?

Pineapple and cheese! :)

I'm an ER nurse. We get inmates from a nearby prison. The guards request the we crush all oral meds that we give inmates to decrease the chance of the inmate regurgitating the pills, especially narcotics. One guard told me that some inmates practice regurgitating with pill shaped candies to perfect the technique. Have you ever heard of this?

YES! They can sell or trade the narcotics if they get them back to the prison. It's crazy. If you don't crush the meds for some people, they will cheek them and hide them. They'll do it with antibiotics and other meds too if they don't want to get better and go back to their facility. One time, we had a guy on Coumadin therapy whose PT/INR wasn't going up like it should have. The doctor decides to give him a 20mg loading dose and watch him swallow it himself. That night, I put a new hep lock in, noticed a fair amount of blood back up into the syringe when I flushed it, and didn't think much about it. I mean, he's on Coumadin, right? I take out the old hep lock, turn around long enough to get a new piece of tape, turn back....hello, bloodbath. He was cheeking the Coumadin because he liked being in the hospital.

How often do inmates try to hit on you? Also, has anyone tried to escape detainment while in the hospital?

They try to hit on the nurses fairly often, myself included, but there are stern repercussions for that kind of behavior dealt out by the officers. It's usually just a talking to and revoking of tv privileges for a day or too though. That doesn't sound like a big deal, but that's the only activity available to them in the hospital. A lot of inmates try to make themselves seem sick in order to attempt escape en route to the hospital. I've been told it works sometimes, but never personally seen it. Every door on the DOC side has hydraulic locks, so no one has ever escaped from our hospital.

What was the worst condition that someone you treated was in?

There are a lot of cancer patients. Those are probably the worst, because you can literally see them wasting away over time. Mostly, they don't just up and die. It's a slow descent into unresponsiveness, which can last for days. We had a guy whose cancer had formed a tunnel about six inches deep into the wall of his chest. That was the worst.

Can they be treated for cancer and other serious ailments? Do the inmates have access to treatments and treatment programs like chemo?

They do, funded by the state and Medicare. Inmates have complete access to medical care, almost without limits. Surgeries, diagnostic procedures, medications, everything.

I am also a prison nurse (at a women's prison), I have always wanted to do an AMA, I guess I didn't jump to it fast enough.

Have you worked with male prisoners at all? We treat both, and I find that the women always seem to be crazier! I have a whole lot of respect for what you do every day.

Wierdest reason a prisoner has had to come to you?

Vagina problems....they're always disgusting. Uterine prolapse, man. The weirdest was actually a private patient that came into the ER. She was having a psychotic episode, calmly walked in, sat down in front of the triage desk and proceeded to tell me that she had run of her medication a few days before, and now little red demons were jumping on her bed while she was trying to sleep.

Happened to my parakeet :(

The demons or the uterine prolapse?

Are there many injuries due to fights/shanking or is that an urban myth?

Totally not a myth. We see a fair amount of knife wounds, head injuries, and occasionally someone injured so badly they have to stay in the hospital for months. We won't take critical patients, but as soon as they are stable, we accept them. I'd say maybe 1 in 15-20 patients is admitted due to assault.

Wow, i'm glad im not in there. Do you know what the primary start of the fights are?

Gang violence, drug deals gone bad; the others are mostly due to the aggression of a thousand angry criminals being caged up together.

How safe do you feel when on the job?

Really safe! We have officers that will go in a patient room with you if you feel uncomfortable around that inmate, and all of the inmates are cuffed to the beds, minimum security or not, for our safety. The officers also monitor what is going on via camera, and they can see into all the rooms.

Is it true that some prisoners will stab themselves in the gut in order to have a colostomy bag so that other prisoners can have sex with their stoma? I've heard this from a few nurses but I am positive it can't be true.

Mmmm, I haven't heard that before. I have heard of inmates having intercourse with colostomy stomas though...

have you ever felt you were in danger? could you describe any of those situations?

Yes. Some patients get pretty intense sometimes. I was trying to hold down a tiny guy, maybe 120lb, 5'4'', while we put in a urinary catheter that he HAD to have. He went retard strong! Morphine 4mg IV, Ativan 2mg IV and neither had any effect. He was flailing around, and finally, with four people including myself, we restrained him physically. I was at his torso, and he came up lightning fast against my grip and tried to bite my forearm. The DOC officer in the room with us slammed him down on the bed. It was pretty scary, and that inmate had hepatitis C, which I could have contracted if he had bitten me.

What is the pay like? Roughly what salary bracket would you be in?

I make approximately $45,000-$50,000 annually before taxes. That's calculated on 50-60 hours/week, but because we work 12 hour shifts, that's only four days a week. I also work nights, so I get a sweet differential, and anything after 84 hours in a two week period is double time. Also, I'm paid more than the average LPN in this area, which is about $25,000-$30,000 before taxes.

How many butt secks?

Many, many. Mostly consensual though.

Do treat them like humans? I've been to jail in my experience medical treatment of any kind is treated with suspicion.

There's a saying at my hospital that the inmates we work with are patients first. That is to say that they are human, they are ill, and they should be treated as such without regard to their criminal history. The rules change a little if they actually are playing you, but innocent until guilty. Labs and diagnostics usually will detect when something is wrong. There are times that they don't. I'm sorry for the way you were treated. Personally, I always treat my patients as humans. The hospital is basically seclusion for them. I may be the only person they see in a day that is polite to them. I know how the DOC officers are with them a lot of the time, and it can be unpleasant. I don't ask what they are in prison for, or look it up even though I have the ability to. That doesn't matter. What matters is that they are sick, and that's what I am there for, not to judge or look down upon them for being in the position they are in. I don't know their life or circumstances, so who am I to pass judgement?

Did anyone try to escape through the hospital?

Tried, but not succeeded. I wasn't there, but there was tackling involved. Some guy took off running down the hallway, and a DOC officer took him down. There are so many locked doors, there's no chance in hell he would have gotten out though.

How did you get into nursing in the prison system and how long have you been there?

I just kind of fell into it. I didn't know this hospital was DOC when I applied, but they were going to start me out at a higher rate than anywhere else. I'm glad I did it, though. There's a lot of diversity in the disease processes we see because we are the only hospital of its kind in my state, so we get everything.

And I've been there for about six months. For some reason, it wouldn't let me edit my previous post...

How do people generally wind up needing medical care?

There's a lot of infection in the prison system. We see a lot of staph, cellulitis (which is just a blanket term for any skin infection), and tuberculosis. Also, a lot of lifers are aging and have chronic disease that requires frequent treatment.

any idea why?

Some facilities don't have the most sanitary conditions. Inmates are given the "jobs" of cleaning, etc and it doesn't get done properly. Medical care in the facilities is limited and often understaffed. Inmates called orderlies provide medical care in the form of changing dressings, emptying catheters, basically the work of a CNA. They do this without adequate training, IMO.

Does the stereotype people have for prisoners hold up in the prison you work in?

Somewhat. The guys with 10 prison tattoos are always the ones afraid of needles. Many beg for more pain medication ALL THE TIME. Interestingly, all of the really nice, polite inmates are murderers. They say it's because they have no chance of getting out, therefore no incentive to cause trouble since it would just make it harder on them.

What do you deal with more inmate on inmate injuries vs officer on inmate injuries vs self inflicted injuries? ratio would suffice.

Hard to know. In an injury like that, we get a report from the facility. Number of reports that say "found in cell unresponsive by officer/cellmate" to number of reports that say what really happened: 100:1

It's also just downright amazing how many people receive head injuries by "falling off the top bunk."

Have you ever turned a prisoner away because you/superiors thought they were faking, only to have something worse come about?

Not yet. If anything, we tend to keep people too long sometimes. If we can't figure out what's wrong we keep them for observation for a few days and repeat labs and diagnostic procedures.

What is your favourite part about your job?

Honestly, I love everything about nursing, except for the "customer service" part of it. At a private hospital, you have to cater to that patient who lays on the call light because he/she wants her blinds open, then closed, then pull their blanket up to their chin, then it's too hot, etc. when that patient is perfectly capable of doing all those things on their own. Not to say I mind doing those things for patient's who need it, but when you have six other patients who need medications and wound care and a bed bath, that one patient becomes a real pain in the ass. With DOC patients, they aren't allowed to do that! It's great. I don't have to take any crap! Although we're still nice to them. They're patients before inmates. Sometimes they have pretty cool stories too.

Are you ever scared while working?

Sometimes. Mostly just if an inmate gets angry. In emergent situations like codes, my instincts kick in, and I just do what I have to do. Dat adrenaline.

What drew you to prison nursing? pros/cons? RN or BSN?

I'm a nursing student, considering psych nursing, not interested in med/surg whatsoever. My mom says I should look into prison nursing when I graduate.

LPN working toward RN, actually. I don't actually work in a prison. I work on a med/surg floor for inmates. From what I hear, prison nursing in completely different. The pay is what drew me in, and it's a definite pro. The diversity of conditions, not having to play nicey nice all the time with the ass hat patients, those are pros. Cons: I kind of miss being able to sit down with a patient to comfort them and talk about what's bothering them; I think this job has the propensity to make you a hard person if you let it.

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Why, thank you. :)

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Thank you for the frankness in this reply. I work in a rural private hospital with a contract to treat DOC patients. I've never been in a prison, nor do I know anyone with experience in prison. I too hope that all facilities are not run like the one you were in. Thank you for the perspective.

How often do you get attempted suicide patients?

Surprisingly, not very often. I think once you've been in prison for a while, that's the only thing you know and are comfortable with, and it becomes a separate world for some inmates. The ones with longer terms thrive there. The ones with shorter terms have no reason to harm themselves.

Are any inmates on dialysis? How is this handled, procedurally? I.e. is there a facility on site, are they bussed somewhere, etc.

I'm not really sure. I haven't encountered anyone on dialysis. I think they do everything to manage renal failure that they can without dialysis. I've seen people with shunts. We don't do dialysis at our hospital.

Do prisons cater to peoples dietary needs/philosophies?

We do, and I think the prisons do. You can get a kosher diet for example. They also have diabetic meals, I believe, but those are largely ineffective since they don't put a limit on the number of Ho-Hos you can buy at this commisary.

Did you ever watch Prison Break? And are you as hot as Sara Tancredi?

I've never seen it. I googled her though, and she's pretty hot. I don't think I quite measure up to that, but I do alright, ha.

Do you have any really sad, heart-wrenching stories? Do you ever pity the inmates you work with?

One guy was in for manslaughter. He was driving drunk and hit a little girl. He broke down crying when he told me the story. It was pretty sad.