Before I get into the meat of this, I'm going to describe what goes into a 'normal' day... with the understanding that there isn't a single 'normal' day to be had in this job. I may have covered some of this before, but I just want to lay it all out here in one go so that you have a good understanding of what made these days particularly frustrating.
There are many tasks to complete in any given day ranging from important 'must do NOW' tasks to lackadaisical 'get to it whenever' style tasks. This list is going to seem quite concrete and set in stone, but the reality is that this list is quite fluid and ever changing. Saving a life is of course always more important than reading emails, but the rest of these tasks can gain or lose importance depending on the situation.
So first up.... Immediately important tasks:
Emergencies: Obviously someone dying or going into a life threatening situation is always important and will override just about any other situation. The only part that makes this even slightly fluid is determining if what is presented as a life threatening event is actually a life threatening event. For instance getting a call from one of the units saying that someone is having trouble breathing can be anything from a heart attack or anaphylactic shock to a mild asthma attack or a coughing fit. Until I determine the actual situation, however, I have to treat it as the former rather than the later. So a call like that will always trump what I'm currently working on.
Other emergencies include practically anything dealing with bleeding or blood, chest pains, abdominal pains, trouble breathing, or broken bones. Non nursing emergencies will also include mobilizations (the prison is practicing (hopefully only practicing!) going into a riot or assaults. Unless I'm dealing with an actual life/death situation, a mobilization or assault will supersede everything else.
Very Important: These tasks are the important ones where someone's life is not on the line, or even potentially on the line. Unless I'm dealing with an actual Emergency of some sort these tasks will supersede anything else. Some things on this list include calls from the units where someone is in distress (massive headache, very sick, hurt limb, can't walk...), direct directions from my supervisor (seeing an inmate that's put a grievance in, preparing for an immediate important inspection...), prepping an inmate for a surgery or other offsite procedure, seeing to an inmate that's just returned from an offsite medical procedure.
Important: Really there are only two things in this category and they are the bulk of my work. Call Outs which are the appointments scheduled for me to handle that given day. Call Outs range from Annual Health Screens (every inmate gets one once a year), Exit Interviews (a final health care related interview before an inmate is paroled or released), and general health related appointments like 'theres a bump on my foot', my feet hurt', 'I think I pulled a muscle', 'I can't stop coughing' and the inevitable follow up visits. The other Important task I do every day is Transfers (also known as Ride Ins).
Not As Important: These are tasks that have to get done, but aren't scheduled. Cleaning/disinfecting the equipment, checking medicines and equipment for expiration dates, performing a count of critical tools and equipment, and reading emails are just a few of these 'not as important' tasks that are expected to be done on a daily basis.
Not Important: These are things that we do when everything else is completed. We don't often get to these tasks as we only rarely get everything else done. Printing up paperwork in advance needed for particular assignments (annual health screens, exit interviews, transfers), organizing often used non medical equipment (pens, markers, highlighters, folders...), taking bio hazard trash out, reading emails (yes, its both Not As Important and Not Important), filling in spreadsheets of tasks done each day... there's a lot to do in this category!
Since my story today involves a lot about Ride Ins, I'll go over a normal Transfers scenario. We normally get between 4 and 9 Transfers a day. These are inmates being transferred into our facility. Its required that they all get a health care orientation within 24 hours of arrival. For the most part they arrive between 3PM and 5PM, but we're notified about 24 hours in advance of their coming. If we're able to, we try to 'prep' their orientation paperwork in advance of their arrival.
Once they arrive and if I can catch them all at one time I'll give them all a group 'Talk'. The talk involves telling them the basics of healthcare without discussing any individual issues. How to request a healthcare appointment, how much a healthcare appointment will cost (yes... they have co-pays!), how the restricted medlines work, how their non restricted prescriptions work, how to buy over the counter medicines from the store, how the grievance (complaint) system works, and a basic rundown of some important health information (Testicular Self Exams, how to avoid HIV/Hepatitis/MRSA/TB...). This 'talk' takes between 10 and 15 minutes so it's quite important to get them all together. If I miss that chance I have to give this 10/15 minute talk to each of them in multiple smaller groups or at worst individually.
After the 'talk' I can keep a couple of them back and finish up their individual portions and send the rest off to their new units, or if time doesn't permit, send them all out to their units. The ones that didn't get their individual portions done have to be called back later to finish up.
The individual portion of the orientation is setting up their appointments (doctors visits, annual health screens, any ongoing immunizations, offsite procedures), confirming their immunization status, confirming their medications, setting up their insulin schedules if they are insulin dependent, and briefly going over any ongoing medical issues. The biggest variable here, by far, is the ongoing medical issues. Anything that is in progress we continue. For instance they have a new diagnosis of some disease and need to have a nursing or doctors appointment to discuss the results, or they've just had a test done and need to discuss the results. What makes it a big variable is what WE consider an ongoing issue and what THEY consider an ongoing issue. For some inmates this part of the orientation takes a single minute (nothing wrong? ok, lets move on), while with other inmates this can take an hour.
So the first bad day was Friday. I knew in advance that I would be in the clinic (good!), that I would be working with another RN for the shift (good!), that the 'morning' RN would be on for the first four hours of my shift (Three RNs... VERY good!), and that we had 9 transfers coming in. 9 transfers is normally a lot to deal with, but with two of us on for the shift it meant that we'd each have only 4.5 to deal with (whoever got done with their 4 first would pick up the 5th). I also only had 4 call outs.
On the surface, it looked to be a good day. My first call out wasn't for an hour after the beginning of my shift so I started prepping the paperwork for the incoming transfers. About 10 minutes later an officer brought in an inmate in cuffs. An assault. Damn it! As the other two RNs were occupied I picked up the slack and cared for this inmate. As assaults go, he was in good shape. Just a little cut on his hand. I cleaned it up, but a bandaid on it, and sent him back to the officer... who promptly brought me the other guy. Again, not a bad case as he just had a cut on his forehead and a bump on the back of his head. Cleanup/bandaid on the cut and a quick concussion test, and he was sent on his way. But one of the reasons that assaults suck so much is the paperwork.
Every person I see in the clinic requires full medical documentation. There's the (not so) funny joke about how long does it take for a nurse to change a lightbulb? 30 minutes. 1 minute to change the bulb and 29 to document that they did it. The joke isn't to far off. For the 20 minutes I spent with these two guys it took me another 15 to document what I did. On top of that normal paperwork I have to fill out a 'Critical Incident' report as well as two 'Inmate Injury' reports. The injury reports aren't so bad and only take about 10 minutes each. But the incident reports have to match up exactly with the official officer's report so I take the 10 minutes to fill out my portion and then take another 10 minutes to get the rest of the information from the officer (time of incident, inmates involved, officers involved, employees involved, exact location of incident...). So those two bandaids cost me just over an hour.
While I was seeing to these inmates, a call came over the radio that an inmate was having a seizure on the yard. The other two RNs immediatly got their equipment and ran out to offer assistance and bring the inmate back. It turns out that it wasn't a seizure (any time an officer sees an inmate down on the ground and writhing about they assume it's a seizure), but a back injury. The story as told to me was that the inmate was in the weight pit doing crunches with a barbell and collapsed as his back gave out. When I could finally put any attention to him, I noted that he was lying on our gurney, strapped in with a neck brace on. Writhing in 'pain'. I have to put quotes around that as I have no objective way to measure pain. We are taught in nursing school that pain is whatever the patient describes it to be. But this guy would only moan and writhe about when someone was nearby and observing him. When he was alone or didn't notice someone in the room he was quiet and still as a church mouse.
The doctor got involved and ordered a shot of our most powerful pain medication. Being a correctional facility we don't have narcotics available to us, so he got a shot of Toradol. Toradol is an NSAID, and a very effective manager of physical pain. I've seen it used in hospital settings including the ER. Relief from most pains when Toradol is used usually starts in about 5 minutes. It may not eliminate all pains (again, its not a narcotic), but it helps almost all physical pains. It didn't do anything to this patient. Like nurses, the doctor can only define pain by what the 'patient' tells him it is. Without any imaging equipment to see if there was a broken bone or herniated disc, we needed to send him out to the hospital. Being a back injury we couldn't just sit him in a state car and drive him there, we would need to call an ambulance.
The paperwork to send someone to the hospital via ambulance makes the paperwork for an alleged assault look tiny in comparison. If this was a life threatening event we would just call up the ambulance and do the paperwork afterwards... but this wasn't life threatening. We ('we' includes three RNs, the physicians assistant and the physician himself) didn't even believe this was real. So we got all the paperwork together and then were informed by security that it would have to wait until after 'count'.
'Count' is when the prison comes to all but a standstill and every single inmate is counted. It happens about six times a day and takes about an hour. So he had to wait on his gurney in our clinic for an hour. As I was walking by him at one point he called out to me and said he needed to urinate ("Hey... I need to take a piss"). Not being my patient and having absolutely no interest in helping this guy 'take a piss' while he's strapped down on a gurney with a 'back injury', I immediately found the RN that was in charge of his care and passed the information on. To perform this task he needed a urinal so I offered to help him get that (hey... points for 'helping' without having to do the task itself!). Sadly finding a urinal was way more work than I wanted. After searching the clinic and our internal storage room (about 20 minutes), I had to trek out into the yard and into our long term storage shed to locate one. When I got back with the urinal the RN asked me to join him while he helped the inmate.
You see, anytime we have to examine or perform a procedure involving an inmates genital area (front or back), we need to have a witness. I guess the department of corrections had a LOT of lawsuits involving nurses supposedly molesting the inmates. So we wheeled the inmate into a curtained area for some privacy and I had to watch the RN pull down this inmate's shorts and underwear (all without moving his bottom off the gurney), and direct his penis into the urinal.
Nothing happened.
A quick aside for a lesson in back injuries. When your back is severely injured it obviously hurts a LOT. One of the reactions to a spinal injury (both bone and disc injuries) is that you will most often lost bladder control. It's not that you CAN'T urinate... you can't NOT urinate. But when your back is in good condition (painful or not) it's incredibly difficult to urinate while you are lying down on your back.
So we chalked this up as another thing under the 'Liar' category, pulled up his pants and wheeled him back into the clinic. 30 minutes later he said that he thought he could actually urinate and would like to try again. At this point the other RN had gone on break. I didn't think much of it as he was under the care of two RNs... neither of them me! So I told the other RN... and she pointed out that the urnial was on the counter and that I could do it with the curtain open and she'd observe.
Grr.
I know damned well that she didn't want to do this particular task... I mean who does? But she also knew that I didn't want to do it. But just because she was shirking her responsibility didn't mean that I would let a patient (even a liar of a patient) suffer. So I wheeled him to the same area as before, closed the curtain enough to give him some privacy while still allowing the other nurse to see in, pulled down his shorts and underwear (a surprisingly difficult task when your patient can't move his butt off the gurney!), grabbed his penis and directed it into the urnial.
STILL NOTHING!! LIAR LIAR FUCKING PANTS ON FIRE!!!
Eventually the ambulance was called and arrived. The last task with him was to get him transferred from our gurney to theirs. This can normally be done with two or three people each lifting the patient up by the sheet under him and moving him across. Sadly we didn't have the sheet positioned and couldn't move him around to put a sheet under him. So it took all three EMTs, as well as the other RN to gently get their hands under his shoulders/hips/feet and me cradling/protecting his head/neck. We all got got into position and.... waited. The other RN snuffed and said "well somebody count it off!"
Why Don't You Count It Off You Non Dick Holding Bitch! Ok... that's just the frustration talking. But still, if you are going to take the effort to complain that people aren't counting off, why don't you just step up and count it off? I looked at everyone quickly and counted it off. We moved the guy who only started groaning in pain halfway through the transfer. Not to completely bash in a point, but if your back is so severely injured that Toradol doesn't help, then getting lifted up in this manner would be extremely painful.... he barely mewled out and only after moving halfway between the gurneys. Even the EMTs were shaking their head in disbelief.
So at 5pm he finally left. We took up an 'office pool' on when he'd be coming back. If this were an honest to God back injury he wouldn't be coming back for days. I picked 9pm as that was both just enough time to get a CT scan and find nothing wrong and it would be the most inconvenient time for us.
By the way... that's halfway through my shift and I haven't seen a single one of my callouts nor have we even started the transfers. The transfers had already arrived and been scattered out to their respective units... so we'd have to do the talk with them in small groups or individually.
As I mentioned, 'Count' is a time where there is no inmate movement. Unless an inmate is already in the clinic (or unless its an emergency), we can't see anybody during count. Another time that we can't see anybody is during the restricted med line. The officer assigned to the clinic has to be outside and monitoring the inmates (looking into all of their mouths to see if they took their pills). With him outside we can't have inmates inside the clinic. So after seeing my callouts the other RN and I looked at med line as the perfect time to get the paperwork ready for the transfers. If all went smoothly we'd have just under two hours to see all of the transfers.
I'm sure you already know that not everything went smoothly. Just as med line started and I settled myself down at a workstation we got a call from one of the housing units. An officer told me that he was sending up an inmate. Now normally when an inmate needs to be seen, the officer calls up and asks us what should be done. We can come out and get the inmate, we can have him come up, we can tell him to be sent up later, or we can say that he doesn't need to be seen and to go through proper channels to get an appointment another day. Only rarely does an officer tell us what to do or what is going to happen. My mind started to race... this must be a severe chest pain or breathing problem. Something life threatening and immediate.
Nope.
He was sick. I pressed the officer a bit trying to figure out why he was going to send up a sick inmate as if his life was in danger, but the officer just said "there's something really wrong with him and he's not acting like himself... I'm sending him up to you".
That pissed me off. I imagined seeing a guy with a cold and playing it up to a ridiculous degree. Acting like he couldn't breath, or shaking, or some other over the top playacting. I would take his vital signs (weight, temperature, pulse oxygenation, pulse, blood pressure...), give him some tylenol, tell him to drink more water, and schedule a follow up visit for the sick little boy. And to do this I was going to have to call in another officer.
It started off that way. He was acting like he was out of breath and shaking. His weight was fine. His temperature was fine. His blood pressure was slightly elevated (hey, it takes effort to fake something!), his pulse was.... OMFG his pulse was going about 140 beats per minute. Normal is between 60 and 90. A good workout for most people will take it up around 120 for short periods of time.
140!
And his pulse ox? 87%. Normal is 95% to 100%. Smokers generally get around 93%. If you hold your breath for several minutes you can generally get it down to 90% before you gasp for breath. 85% normally means you are about to pass out from lack of oxygen to the brain.
The thought of him faking completely went out the window. In addition to these two startling readings, he was also coughing and covered in a cold sweat. This guy was honestly in trouble. Before I could randomly act I got more information; He started feeling sick about a week ago with a cough and chest congestion. He got nauseated around 4 days ago and hadn't eaten for the past three days. When I asked how much he had been drinking he said it was a normal amount. I turns out for him a 'normal' amount is about 4 glasses of liquid a day... that included coffee.
A quick word about the amount of water you drink daily. Most of us have heard that you should drink "8 glasses of water a day" to stay healthy. That's not a medical fact, but it hits close to it. Most people should be drinking about 10 eight ounce glasses of water a day, but we get a lot of that needed liquid from the food we eat. Even with that, most people are constantly in a slight state of dehydration. If you really want to do yourself a health favor... drink more. Not matter what you drink now... drink more. Oh... and coffee counts AGAINST the amount you drink. Coffee (and most caffeinated beverages) actually dehydrate you more. When you are sick, however, you should dramatically increase the amount of liquids you intake. So with being sick and not eating at all, this guy was severely dehydrated. That just makes a cold worse and last longer.
I knew I would have to contact the on call physician (the doc and the PA had left for the day), and I didn't want her to have to ask questions. So I gathered up all of his information and also confirmed his pulse (as that was the most alarming number). I know it would seem like his pulse ox is more damning, but we could probably treat that with a quick albuterol teatment... except that an albuterol treatment large enough to increase is O2 stat would also increase his heart rate. So I took his pulse again with the BP machine. And another BP machine. And the Pulse Oximeter. And another Pulse Oximeter. And by counting his pulse at the wrist. And by counting his pulse by using a stethoscope on his chest. Each and every method got me between 135 and 140. Even after sitting in the general calm (and air conditioned) clinic for 20 minutes his pulse hadn't gone down at all.
So I called up the on call physician. I calmly explained what was going on and answered all of her questions. When she asked me about the pulse, I told her all the methods I had used to confirm that number. She then told me to do it again as it had probably gone down. I don't mind a physician asking me to confirm something... but damn it I had taken his pulse eight different times using four different methods already over the period of 20 minutes. It wasn't going to change now. But hey... she's the doc and I'm just a nurse. I asked her if she wanted to wait on the phone while I did it (it was only going to take me two minutes) and she just blurted out "just do it and call me back".
And then she hung up on me.
Grrr
I would have felt perfectly justified waiting a few minutes and then calling her back... but I took a calming breath and acted like the professional that I am. I returned to the inmate, put on my stethoscope, took his heart rate again (139), told him that I would be right back, and started back toward the phone. The other RN must have noticed my frustration and offered me the on call phyisian's cell phone number so that I could call her direction and not have to wait to go through the on-call service. I just smiled and explained that even if it took longer, I would most certainly use the service. That way I could inform them that I had to call her back because she hung up on me.
That's me. Pro all the way.
I got her back on the phone, explained (in frustrating detail) how I took his pulse and that it was still incredibly high. I swear I could see her hands go up in frustration through the phone as she said "I don't know, send him to the ER and have them check him out."
I could tell from the tone of her voice that she thought I was making a mistake. She could have easily driven into the prison (she lives about 10 minutes away), but she was instead insisting he go to the hospital. Maybe it was designed to piss me off, but even if she did show up I'm fairly sure the result would have been the same. He needed drugs and treatments that we just aren't able to handle in the clinic. Knowing that this was very urgent, but not a true emergency, I offered to send him via state car. That way the prison wouldn't have to absorb the cost of two ambulances in one day. She said that was fine.
I informed the inmate what was going on and set him back in the waiting room so that I could get all of his 'going to the ER' papework together as well as get the officers working on his ride to the ER. I then went back into the clinic to get back to those pesky transfers When I came back into the clinic the other RN was dealing with another urgent call (another alleged assault, this time with a split lip). He looked up and motioned me over... it seems that the back pain we sent out had returned. I couldn't help but take a moment to myself, look up at the clock and note that I had selected the correct time. 9pm. It was quite literally the worst possible time for him to come back.
So I grabbed his paperwork and read through the ERs report. They did a CT scan and noted several bulging (but not herniated) discs. They also confirmed something that one of the other RNs had thought she remembered... he had been in a very bad fall five years ago. Resulting in.... waitforit....
Bulging Discs.
So the CT scan showed absolutely nothing new. All of the possibilities were still on the floor. He could honestly be in horrendous pain with a new injury that will take months to fully heal. He could have re-injured a previously bulging disc and be in pain (easily manageable pain) for a week or so. Or he could have done nothing at all and be faking it all. I'm still thinking that he should be on the burn unit with all the pants on fire he's been experiencing.
They did prescribe him some muscle relaxants and some pain medication. Sadly, they prescribed him a narcotic that just isn't allowed in the prison. We actually have the muscle relaxant in our stock of meds, but I couldn't just leave him with no pain medication. So again I charged into the lions mouth and called the on-call physician. I explained the relevant parts of the report and got her to confirm the muscle relaxant prescription. I then offered the option of changing out his narcotic prescription with our strongest pain med (that is also available in our stock). She agreed (wearily) and I ended the call (politely... although I really wanted to hang up on her!).
I brought the inmate into the clinic and told him what was going on. I gave him a 'no work' detail, an 'ice' detail, a follow up appointment with the doctor in three days (as suggested by the ER), and told him the new meds he would be on. He was just smiling the entire time and nodding his head. Of course he was... he was as high as a kite on pain meds.
It took me a good 30 minutes to write up all his details, give him a hand full of tylenol, and get him back out into his housing unit. When I walked back in I saw that my previous sick inmate was still in the waiting room... lying down and struggling to breath. Not struggling as in 'oh my god, he's going to die, call 911', but having more trouble than he was in the ER. That was the last piece of the puzzle as far as I was concerned. The waiting room is the same temp and humidity as outside, while the clinic has AC. The extra effort he was experiencing was almost certainly a sign that he had pneumonia. But more importantly than confirming my thoguht process... what the fuck was he still doing there? He should have been gone about 10 minutes after I put him in there. So before getting to my first transfer I asked the officer in the clinic what was taking so long. He didn't know directly, but he guessed that they were trying to find someone willing to go to the ER. It was near the end of their shift as well and they probably didnt' want to volunteer for what could be between a 2 and 8 hour assignment.
I fumed on that for awhile as I pulled him out of the waiting room and sat him up in the clinic. At the very least I knew he would be under observation there as well as breathing easier in the cooler drier air. I got my transfer in and 20 minutes later got him back out to his new unit. Sicky was still waiting in the clinic. So I sauntered off to the officer again and asked for an update. He told me that he was informed that they didn't have a volunteer to take him to the hospital, so he would probably be waiting for a few hours until the next shift came in and got settled.
Done with being polite in any way to anybody I leaned in and told him that I was fine with that.. but he should call the lieutenant on duty to get approval for staying after, or at least find out what officer would be staying in the clinic. When he gave me a confused look I told him that I was not going to medically clear him from the clinic until he was transported to the ER. And if an inmate is in the clinic then an officer MUST be in the clinic. He tried to worm his way out and said that he could wait in the ER... to which I corrected him and told him that in no way was this inmate to return to the waiting room or any non air conditioned area as his health was currently relying on that.
I knew that under normal circumstances that this wouldn't do much to speed things up, but I had a couple things working for me. First, the officer that I was speaking to has been with the department of corrections for a long time... i.e. he knows that they can't just overturn a nurses order when it's spelled out like that. If he went against my commands and anything happened to the inmate, it would be solely on his head. His seniority also meant that he could refuse to stay over himself, forcing the current shift lieutenant to mandate another officer to stay over and watch him. That wouldn't go over well with the oncoming lieutenant. So without another word I walked away.
5 minutes later two (unhappy looking) officers walked in and escorted the inmate out to a state car and onto the hospital.
Just afterwards, the night shift nurse came on. I hate leaving transfers for the night nurse as it's not as though they have a ton of time to devote to this extra work. But when it took a good 20 minutes for me and the other RN to give him report (it normally takes all of 90 seconds) because of all the urgents we'd had, he completely understood and just took over.
That was ONE of my bad days. Writing all of this out has left me kind of... blah. It's my day off, so I'm going to pause and post this as is. Sometime soon I'll update this post with the past two days which were just as frustratingly bad.
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They say that time heals all wounds. Well that's certainly the case here. I remember feeling really upset at this trio of bad days, but in all honesty it's all but worn off now. They WERE bad days, but the salient details have all but left me. I'll try to recap the days but they won't sound AS bad as that fist days.
After that bad Friday, I had the weekend off. Monday at work wasn't bad... then came Tuesday. It was jut me in the clinic and the two LPNs in the med room. I believe we had 8 transfers, and I had something like 4 call outs. But where Friday had several large urgents and two hospital visits, Tuesday had around 6 small urgents but no hospital visits. We still didn't have our regular CO so I was also breaking in an officer that hadn't worked in the clinic before.
The first ugent of the day really set the tone. An inmate had hurt his ankle and was unable to come down to the clinic under his own power. So I had to grab a wheelchair and go get him myself. We had several inmates in the clinic, so my officer couldn't travel along with me. I never realized how comforting it is to be accompanied by an officer when traveling through the yard. It's not as though our regular officer is an imposing person. He's around five foot four, in his sixties and not in really good shape. At six foot three (when standing up straight) and 270 pounds, I'm far more imposing. But that uniform... the inmates have it deeply imbeded into their psyche that you don't fuck with the uniform.
Getting the inmate into the chair and back to the clinic wasn't a problem. Thankfully nothing was broken and he was just dealing with a severe sprain. Assessing him, getting the things he needs (ice, crutches, ace wrap, details for those things), and getting him back to his unit still took about an hour. While wheeling the chair back to the clinic I saw all of my transfers heading out of the medical building and out to their units. That meant I'd have to hit them up in small groups or individually again. Fuck.
I got a couple call outs done and then came in the next urgent. His complaint was that he was urinating blood. Under normal circumstances I would take that claim quite seriously, but this inmate has a history of making stuff up. He's currently being disciplined and can't leave his bunk for anything other than an hour outside and meals. And medical. He's even pulled this same claim before. So even before I saw him, I knew I was dealing with a false claim. I had no doubt that he would have some bit of evidence to back up his claim, but that at the end of the day he couldn't fully confirm it.
When he got to the clinic he was all eager to show me the spot of blood in his underwear. I immediatly took it to the next step and asked him for a sample of urine. If he truly had blood in there, it would shop up with a quick urinalysis. Of course he claimed that he didn't have to go and couldn't force even a few ounces out. So I had him drink about 6 glasses of water and had him wait for 30 minutes. Surprise surprise... he still couldn't go. So I sent him back to his unit with instructions to tell his officer when he had to go so that he could come up and give me a sample.
Now to most people, it's neigh impossible to fake blood in your urine. But to an inmate that's seeking medical attention (by that I mean attention from the medical staff and NOT medical treatment!) it's easy. All you have to do is get your hands on a paper clip, staple, or anything you can stick up the end of your penis. Stick it in, rip it around a bit... and Voilà; blood coming from your penis. The big problem there is that the blood won't last long and will be gone after the first urination.
So they day progresses. I get my call outs done and handle a few other urgents, and it's finally med line time. So long as the med line goes smoothly, I'll have two hours to get my transfers done. I have a sinking feeling that I WON'T get a full two hours, so I only prep five of them. Just as medline is finishing I call out those five transfers so that they'll be ready as soon as my officer gets back into the clinic. I also get a call that Mr 'blood in my urine' is ready to come up and provide me with a sample.
So medline finishes and I wander past the waiting room. I see my five transfers, I see my urination guy... and someone else. At this point in the day I'm the only person in the clinic that should have anybody to see... but I didn't call this mystery guy out. So I wait for the officer who should be back any moment.... and wait... and wait... and wait.
She doesn't come back in. It seems that when she finished up the med line she hung out outside chatting with her fellow officers, not realizing that I needed her INSIDE. No officer inside, no seeing inmates inside. I finally buzz her radio and she comes scampering back in. She promptly tells me that the mystery man in the waiting room is another urgent that was sent to the clinic. An hour ago. He got hit in the face with a volleyball and his sunglasses cut his cheek.
Fuck.
So I pull him back knowing that my night is ruined. Even if he's quick (and i know him from previous visits... he won't be quick), and Mr 'blood in my urine' is quick (he's not), I still won't have time to finish with the five transfers I had already set up. As soon as I'm finished with 'cut on my face' who was also trying to play up a concision, my officer heads back out to do the last call for med line. While she's out Mr 'blood in my urine' tries to head back to his unit. I knew he'd try that as he undoubtedly put something up his penis to cut it and couldn't hold his bladder for as long as he'd been up here... so he used the bathroom. From previous times using this complaint he knew that he wouldn't have any blood left in the next sample. Thankfully I had already called control and told them that he wasn't to leave.
So when the officer came back in I had Mr 'blood in my urine' give me a sample. Surprise surprise... no blood. I'd say that he lost... but really he was just looking to get out of his unit and get some attention. He may not have earned himself future attention from follow up visits or a visit with the doc, but he did get out of his unit for several hours that day.
Anywho, with him sent out I got to my transfers. I had about a half hour left in the day and could only get three guys done. When the night nurse came in I had to pass off five transfers to her.
Again, what on the surface looked to be an easy day turned out to be anything but. It was nothing but a series of semi stressful events that prevented me from getting everything done. Stress adds up and I was incredibly pissed off on my way home.
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The third day was Wednesday. I was scheduled to be in the med room while another RN was in the clinic. At this point I was more than happy to leave the unpredictable clinic behind and head into the relative boring and predictable med room. That morning I checked my work email as I hadn't had a chance to do so while AT work. I saw email that would include the list of incoming transfers and opened it up. I really didn't need to know how many there were as it wasn't my job that night... but I wanted to see so that I could kid the RN with the 'small' amount he had compared to my night of 8.
25.
There were 25 transfers coming in.
Twenty Five!
TWENTY FUCKING FIVE NEW TRANSFERS!!!!!!
If both I and the other RN were BOTH in the clinic and had the help of no call outs, AND the transfers got in early enough we might.... MIGHT... be able to get that many processed. Oh, and we'd have to have NO urgents.
Of course, there's no way that was going to happen. So when I got in, I already knew that I'd be helping with the transfers before heading into the med room. One of the LPNs had already taken most of my call outs, while the morning RN took my remaining ones. The transfers had actually come in before my shift started, and the RN was already setting them up. I picked up where he left off as he brought the first transfer in.
After laying out all the transfers' charts and meds, I noticed that I had four extra guys without charts. I quickly looked them up and found out that three of them also had meds. So if they weren't located somwhere else, someone woudl have to make a run to the pharmacy. I called over to the North Clinic (all the paperwork gets filtered through there), but they didn't have them. So I called over to control.
Now obviously getting 25 transfers in is stressful for the medical staff, but it's just as stressful for the officers. They're tasked with finding beds for all of them, and giving their own orientations. So when the guy tried to blow me off I understood his frustration. I just didn't care enough to let him blow me off. I informed him in no uncertain terms that someone needed to check the intake area for these charts and meds or my next call would be to the captain to whom I'd explain that one of his officers was preventing me from providing medical care to several inmates.
Control called back and told me that they found the charts and stuff and would drop it off at the North clinic. I thanked him and promptly left to go pick them up. Once I stepped outside to get into my car (it's a short drive, but still a drive to get to the other side of the prison) the skies opened up and wept. It was a downpour and I was soaked before I was halfway to my car. The rain continued on for my short drive and stopped just as abruptly... just as I was walking into the other side of the prison.
Thank you for that weather Gods. Thank you for bringing the rain only while I was outside. When I got to the North Clinic they were busy and simply pointed out the charts that an officer had just dropped off for me. School charts. Not medical ones.
Grr.
I grabbed the charts and drove back. When I walked into the clinic, soaked to the bone, I noticed a new pile of charts. The very charts that I had just gotten rained on to pick up. It seems that the officers had decided (without letting anyone know) that they would be nice and drop them off at our clinic.
Grr.
So, still wet, I set up the charts and pulled in one of the transfers to do his orientation. I expected that I could probably get through five or even six inmates before I had to stop and get into the med room.
The first guy was a doozy. Just before coming into prison he was diagnosed with not only one new disease, but two. He hadn't even started treatment. So what should have been about a 20 minute orientation took me about an hour and a half, mostly just comforting him and letting him know that he would be taken care of.
The second inmate I got (still time for three or four inmates if I hurry) was a real piece of work. It seems that had been in prison before and immediately started demanding the things he wanted. A prescription for tylenol (he didn't want to buy it from the store for $2), an athletic shoe detail (his feet hurt), a bottom bunk detail (he had surgery on his knee 20 years ago), to see the doctor immediately (not later today, not tomorrow and certainly not at his appointed time in two weeks), his lab results (for blood taken that morning), a special diet (one that we don't offer), and on and on and on.
Needless to say, I only got the two inmates done. The medroom was a nice respite, but I couldn't really relax knowing that the other RN was getting run over. I tried to hurry through my tasks after the med line, but the room was a mess and as much as I wanted to help I just couldn't leave it that way for some other nurse to care for. By the time I got out of the med room it was 10 minutes to shift change. I helped the other RN with some random 'end of shift' tasks, but at the end of the day we had only got through 12 of the transfers leaving 13 for the night nurse.
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When I started this post, I had intended on just venting about these three days. But as long as I'm doing this later than expected, I should go ahead and go over the past few days. Friday was a breeze... I was in the med room and it was a quiet day overall. BTW, we actually avoid using the word 'quiet'. When 'quiet' is spoken, it seems to ensure that the remainder of the day will be anything BUT quiet.
Saturday should have been a good day. The scheduling Gods had moved me from a day of 4 Block to a day in my home (the South Clinic). We have an RN that works every other weekend. She has a full time job at a large prestigious university hospital but still picks up these shifts because it helps out and it's a breath of fresh air for her. It seems that years ago she had made an arrangement that she would ONLY work in the South Clinic. And while I had been moved there, she had been moved over to the North Clinic. She threw a tizzy. I tried to calmly explain that I would be more than happy to go over to the North Clinic, but wanted to hear that it was OK from a supervisor first.
She didn't want to hear about it and headed off to the North Clinic muttering that she didn't need this kind of shit and probably wouldn't be coming back. I ended up with only a few call outs, no transfers (no transfers on the weekend), and 6 urgents. To be honest, it wasn't a horrible day as I didn't have anything to do beyond the urgents... so I didn't mind them.
Part way through the shift, my supervisor called and asked me if I'd be willing to work Sunday in the North Clinic so that the other RN could work the south side. I of course agreed. I'd much rather work the South Clinic as I know where everything is, but I can bend and accommodate another RN. Even when it's for an RN that WON'T bend to accommodate me.
Sunday was.... oh god it was the opposite of the three bad days. That's not to say it was a glorious fun day... there was nothing to do. I had NO callouts and there were NO urgents. 8 Busy hours fly by. 8 slow hours feels like DAYS. From what I heard at the end of the shift, the South Clnic was hopping busy all day including being called out to a unit to perform CPR. I never want to wish ill upon someone.... but at least a small part of me is glad that she didn't have a good day in my home.
Anywho... I really just wanted to vent. These bad days in no way make me hate my job or make me regret working there, or make me want to find another job. It's just the way the dice roll in this job. There are good days and there are bad days. But at the end of every day I know I make a difference and that I really REALLY enjoy my job.
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