5 Block

I haven't talked much about work lately.  It really has become a J O B.  That's both wonderfully good and horribly bad.  Mostly the former.

I just want to catch up on a few things, and before I get into my major grip, I want to look at the good.

The pay is so good.  I can't get into the more soul satisfyingly good things before mentioning that.  I've had better jobs before, but I'm not at them any longer because they didn't pay well.  So the pay is good enough to keep me there and keep me happy.

I work with a wonderful and wonderfully diverse set of co workers.  I'm not sure I would call any of them true friends.  I don't hang out with these people, I don't go over to their homes, nor would I invite any of them over to mine.  There are of course some that I wouldn't want to call friends.  Bitter people that love to bitch and complain and always look for the worst in any situation.  The 'worst' is pretty easy to find when working in a prison.  So those that look for the best in any situation are truly special people.  Thankfully there are plenty of those.  While I don't consider any of them friends, I do look forward to spending time with them.  Talking with them, sharing life and work stories, and just working together.   They are a joy and make the work day go faster.


I'm secure.  In the job sense (a State job AND a union job!), the financial sense (it really IS good pay), and the physical sense.  I know that might be counter intuitive but let's face it... I work in a place where physical security is on everybody's mind at all times.  Yes, I'm surrounded by convicted felons.  Many of which have committed violent and heinous crimes.  But they know where they are.  When they do want to commit violence, it is most often directed at each other.  Occasionally it is directed at the officers.  Very rarely is it directed at the healthcare staff.  If I was in a hospital setting I may work on people just as bad as those I work on now.  The only difference is that here it is a known commodity and it's directly acknowledged.

I'm doing good.  I don't mean that I'm doing my job well, I mean that I'm doing 'good' work.  Yes, sometimes I'm making a child rapist more healthy, or extending the life of a serial murderer.  But the vast majority of those I'm working on are low level criminals and ALL of them are human.  Giving them crutches or passing them medications isn't necessarily a good act, but educating them is.  Many of them need as much health education as they can stand and some basic education can honestly change their lives.  That's good work.

So... there's a lot to love about my job.  But as with any job, there's also the downside.  The bad.

I work on criminals.  Yes, it's good work but even I have my moments where I question who I'm helping out.  Most nurses take great pride in helping good people.  "I saved an innocent child", "I helped a lovely grandmother", "I soothed a teacher in pain".... I don't get to consider things like that.  At best, I help people that may one day be good people.

I work in a secured perimeter.  Yes, it offers me security but it also denies me small pleasures.  I can't take my phone (or any other electronic device) into work.  I had to get special permission just to bring my 'smart' watch into work.  I can't even take in a metal pen.  All pens have to be made of clear plastic.  I can't bring in any food (some nurses sneak in candy), and I can only bring in a single serving of a sealed beverage.  All of the things I bring into and out of work must be looked over by a corrections officer.  I CAN bring in some personal items to decorate my area... pictures of friends/family... but I don't DARE let my patients see my personal life.

I have to constantly second guess any claim made by my patient.  They are looking for trips out of the facility (yes, in their eyes a trip to the local ER is a vacation), they are looking for drugs/medications (even acetaminophen and ibuprofen), they are seeking attention that is not directed at controlling them.  So when they say they are in pain I HAVE to back up that assessment by objective methods.  And even when I KNOW that I'm right in denying them treatment.... well just how often can you say 'no' to someone asking for medical treatment.  I went into nursing to medically treat people, not deny them medical treatment.

I honestly don't believe there is anybody that can't be helped.  But there are those that are incredibly difficult to help and I get to work with large numbers of them all at the same time.  Yes, I'm talking about mental health issues and personality disorders.

There's a part of me that inherently wants to trust people.  That part of me is being chipped away bit by bit each and every day that I work there.

Good.  Bad.  I have both.  Again, the good far outweighs the bad.  But there are times where the bad seems overwhelming.  I'm going through one of those times now.

I've explained about the various RN duty stations before, but here they are again in brief:

South Clinc - My most basic home.  I work on level 1 inmates.  These are inmate that don't life in a cell... they live in a 'cube' with seven other inmates.  These are, for the most part, non violent inmates.  There are several that are in mental health treatment, but they've been diagnoses as health enough to not warrant constant direct treatment.  Most of the job is education.  There's introducing them to the facility, seeing them for their 'once a year' health assessment, and educating them upon their release.  Some of the job is health related... they get sick, they get injured, they need dressing changes and medication administration.  And then there are the emergencies;  chest pain, stroke, seizure.  Some are faked, but some are real.

North Clinic - Mostly like the South Clinic, but here there are level 2 and 3 inmates.  More violent, less controlled.  The education and health treatment roles switch.  There really aren't more honestly sick people there but there are a LOT more claims of being sick as well as injuries and fights.  So education takes a back seat to diagnosing and treating inmates.

North/South med rooms - this is mainly an LPNs job but RNs will often be assigned to them.  The biggest part of this job is taking care of the medicines and handing them out to the inmates.  Get new meds in, ensure they are correct, sort them and file them away, have the inmates line up and hand out their individual pills.   There isn't much time for anything else and even if an inmate has a question I have to direct them to the clinic staff (which by the time they get there, may well be me).  It's dull tedious work that doesn't require a lot of thinking.

4 and 5 Blocks - These are the level 4 and 5 inmates.  They are very violent, uncontrolled, or in residential mental health treatment.  The blocks are the worst combination of the clinics and med rooms.  It's a massive med pass with almost all of the meds being for mental health.   Haldol, Lithium, Prolixin.  Anti-psychotic medications.  When someone in the blocks says the voices in their head are getting bad, you have to take it extremely seriously.  Almost every single inmate there has a major personality disorder, meaning that they feel a need to manipulate people.  Forcing a corrections officer to discipline them is a way to manipulate the corrections officer.  The throwing of feces is a reality here.  Medical treatment (i.e. bandages, vital signs, wound assessments...) are almost non existent.  The medical treatment that is most often completed is from self inflicted wounds.    Education... yeah that just doesn't really happen here.

Since I've already said that education is my favorite part of the job, you can imagine that my least favorite areas to work are the blocks and the med rooms.  Those areas just don't have much opportunity to provide that service.

Now that's not to say that every nurse feels like I do.  There are dedicated nurses who have a calling to help those with mental health issues.  Ideally there would be a group of about 6 nurses with that calling.  One for each shift on each block, and one to bounce between the two blocks and cover days off.   Even if it's only 4, the other RNs like myself could come in and cover the days off as we'd only be out there for a day or two at a time.

The problem is that right now we have 3 nurses that prefer to work in the blocks.  1st shift in both blocks is covered.  4 block has a regular 2nd shift nurse, but 5 block doesn't.  That's where my personal hell comes in.  I, along with 3 or 4 other RNs make up the 'regular' 2nd shift RN position.  None of us want to be out there.  On the last few schedules I was out there for a few days at a time.  Mostly on weekends.  It wasn't too bad... I stepped in, did what needed to be done, and got out.  I didn't have to maintain the position as the 'regular' nurse would be back in a day or so.  But now that I'm one of the regular nurses, I have to do everything.  Process meds, maintain the stock, and monitor patients over the long term.  These are patients that REQUIRE long term monitoring.  If their mood goes down for any reason, then it needs to be addressed.  Their down mood isn't just them being sad, it's them possibly becoming violent or self injurious.  If those moods can be caught and treated/reported, then those serious conditions can be mitigated.

One problem I have with being a regular nurse out in the blocks is that it is SO different than the clinics.  First and foremost, you work alone.  In the south clinic the minimum staffing for nurses is three.  Two LPNs and one RN.  In five block it is just one RN.  Yeah, there are correctional officers, and mental health staff, but the RN mainly sits in the med room and works alone.

So shifting between the blocks and the clinics isn't something that happens quickly.  It takes a few days to really adjust to the change and get 'good' at the job again.

Last schedule I was out in 5 block for three weeks.  That's one week in 5 block, two weeks in the South Clinic, then back to 5 block for a week.  And by a week, I'm not talking about 5 days straight.. it's my normal 3 days on, day off, 3 days on.  I barely feel like I get comfortable there then I'm moved back to the South Clinic.  Coming back to the Clinic isn't a walk in the park either.. I have to re-adjust to that work environment and that takes a day or two.  So I told the scheduling supervisor that if I"m going to be out there on a regular basis that it's in everybody's interest that I get put out there for an extended time.  3 weeks straight.

I'm right now in the middle of those 3 weeks.  And oh dear God I just don't know if I can make it to the end.   I HATE this part of the job.  It's all the BAD and none of the GOOD.  The pay is still there, but I don't work with my colleagues, it's far less secure, I'm helping the worst of the worst, and there is almost NO educating going on.

Good days are when I can get in and get out as fast and easily as possible.  Good days are the rare ones where the inmates don't hurt themselves or others.  And I DO mean rare.  Bad days are when they cut themselves and require surgery to fix it.  Bad days are when they hang themselves.  Bad days are when they collect enough medication to kill themselves.  Bad days are when they take entire bottles of over the counter medications.  Bad days are... almost every day.

I got the next schedule in email the other day.  I'm not sure if the scheduling supervisor forgot what we talked about or just figured it's too hard to maintain that type of scheduling, but I'm out there intermittently.  Only 10 out of the 30 working days, but it's a few days here and a few days there.  I know damned well that I won't be able to do my job well in that circumstance.  But I don't know if I want to question her on this.   I might not do the job well, but I'll be in and out.  I'll be able to come in, keep my head down, and get out of there without letting any of them die.  If they don't get the best healthcare from the staff RN (me).... if they have a higher chance of hurting themselves or other inmates... if they have a higher chance of dying... well that's the price THEY'LL have to pay for MY  sanity.

God forgive me, that's a price I'm now willing to pay.