Corrections Nursing: Interview with Marti Sillman, RN
How nursing has evolved and how it is practiced today in L.A. City Jails
What was your early nursing career like?
What was your early nursing career like? I attended a four-year, hospital-based diploma nursing program in Bryn Mawr, Pa. I began my training in 1950, graduated in 1954 and passed the nursing boards in 1955. The program was held in the hospital and our day was divided between clinical and academic work. We would spend part of the day in the classroom and then work on the floors for several hours.
What was the nurse-doctor relationship like at that time?
There was a great deal of etiquette and protocol. We looked to the doctors with respect and were expected to offer our chairs to the physicians or the older nurses and nursing students. We would always hold the door open for them.
As a trainee — and even after our training — we were very solicitous of and deferential to the doctors. We basically waited for them to tell us what to do. The doctors were very arrogant and felt they could not be questioned. For us, it was a combination of intimidation and respect. Smoking was very common at the time, but only doctors smoked in the nurses’ station.
What was it like as you gained more autonomy as a nurse?
I took time off in the 1960s to raise my children and came back to nursing in 1972. When I reentered the workforce, there were new guidelines. Nurses were receiving more clinical education and were expected to do more. For example, prior to the 1970s, only the interns could do IVs, but by then, we nurses were doing more procedures, including IVs.
There was a major cultural shift in the 1970s. Nurses were now seen as true professionals and no longer felt subservient to doctors. We began to recognize and take pride in our level of education and scope of practice. We still took orders from doctors, but our sense of being skilled clinicians in our own right was growing. An increasing number of nurses were pursuing post-graduate degrees, taking part in research and otherwise demonstrating great professionalism and autonomy.
It was also at this time that there were ICU nurses taking special courses and learning more autonomous skills. Nurses who worked in the ER or ICU and had specialized training were not so easily intimated by doctors anymore. At that point in my renewed career, I felt I was taking more responsibility and was more respected as a nurse. As I became more skilled and knowledgeable, I was given more respect by the doctors and no longer seen as a simple handmaiden.
What kind of nursing did you focus on in your career?
I started on med-surg in 1972; worked in the recovery room, CCU and ICU; and was floated to other areas of the hospital as needed. I wasn’t certified in any of these specialties, but was able to work as a backup nurse. I also did a lot of psychiatric nursing at that time.
I was employed through a nursing registry from 1976 to 1990 and worked on a large variety of units in a number of different hospitals. I did a lot of 12-hour shifts. I also spent time as the only nurse in a daycare center for the elderly.
Tell us about your work in corrections nursing.
At a certain point in my career, a nurse friend made me aware of an open corrections position. I then became the evening charge nurse in a correctional facility with 700 juvenile offenders. I worked there for a number of years. I ’ve been with the City of Los Angeles since 1996. The Personnel Department, Medical Services Division is responsible for three “dispensaries” located inside Los Angeles Police Department city jails.
The dispensaries provide services for people who are arrested. Before they can be booked, we triage and screen them for injuries, medication use and medical problems. These individuals are usually in custody with us for several nights — it’s basically a holding area for the court. We coordinate with LAPD and can send arrestees to various facilities for specific care needs. We often have arrestees on suicide watch.
What challenges are involved in corrections nursing?
These arrestees are frequently high-risk, have received little to no medical care and often have conditions they haven’t been taking care of. We can have a real medical crisis on our hands at any time. We don’t know the patients’ history, which is exacerbated by the fact that they’re very poor historians.
When we have a medical emergency, we stabilize the patient and call for an ambulance. We often have patients who experience seizures or cardiac issues; in those cases, we need to transport them so they can receive the best possible care.
Sometimes, a new inmate who doesn’t want to get in even more trouble will swallow a large quantity of drugs before being delivered to us. We then have to race against the clock. We transfer them to the hospital as soon as we see signs of overdose. Some don’t make it, but we do our best. Since we only have our patients for a few days, there’s only so much we can do.
Many of our patients are homeless and have little in the way of support systems or self-care practices. We also work closely with LAPD to provide resources for homeless arrestees upon release. We try to steer them in the right direction and treat them for hypertension, high blood sugar or other acute issues, but we recognize that it’s like putting a Band-Aid on their unaddressed chronic problems.
How do you deal with the stress of your work?
I have a wonderful coworker and we work together as a team. We really support each other emotionally and try to discharge our emotions before we leave for home. There is always a P.A., NP, or M.D. on site, so we know that there’s always skilled clinical backup. The arrestees can be very unkind and many are often withdrawn. When they’re less than kind, we just have to let it go in one ear and out the other. You can’t let it get to you. This population is very manipulative and knows how to work the system. We recognize that they’re in pain and we try to make it better for the short time we have them.
I like corrections because you get to interact with so many different people. They’re there because of the way they were brought up or where they lived — they’re caught in a negative spiral. We even have people from very wealthy homes. I perform a valuable service and I enjoy my work and my colleagues.
What recommendations do you have for younger nurses?
You have to be patient and love what you’re doing. If you don’t love what you’re doing, you just won’t be a good nurse. Nurses are very stressed in the hospital environment now — they’re often forced by circumstances beyond their control to be more concerned with documentation than with patient care. In this environment, you have to do your best to see patients as real people, not just tasks that need to be completed and documented. Yes, you have a technical job to do, but a personal touch is essential.
Your patients have a life outside of the hospital and they’re there to be taken care of. Give them just a little bit of recognition, TLC and personal attention and it will be more healing for both you and them. In the end, you need to always remind yourself why you became a nurse in the first place.
What do you recommend for professional development?
I feel that education is very important. You have to keep learning different things. If there’s something you’ve never heard of, look it up. Keep your education current and stay curious. I recommend getting a bachelor’s degree because the ADNs today have fewer options. With the changes that we’re seeing, getting a job in acute care is more difficult when you have only an associate degree. A BSN opens the door for nurses.
Also, you have to know how to handle different kinds of people without getting too emotionally involved. If patients are being nasty, understand that you have to be patient and listen while maintaining your boundaries.
What are your current plans?
I have some credits towards my BSN, but my career is almost over, so I probably won’t pursue it now. I love my job and will continue going to work for as long as I can and then retire when the time is right.
What is your final advice to young nurses?
I feel young and I behave like a young person. Age is just a number. I’ll never feel old because I love young people and they love me. There’s no point being old — always be as young as you can be.
Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.
This article is from workingnurse.com.