Correctional Nursing: Interview with Frank Torres, MSN, FNP-C
Caring for arrestees while they are in custody
Frank Torres, MSN, FNP-C
City of Los Angeles, Personnel, Medical Services Division
Describe for us your place of employment.
I’m a nurse practitioner for the City of Los Angeles, assigned to one of the three medical dispensaries within the Los Angeles Police Department (LAPD) Jail Division. Our medical dispensaries provide healthcare to all arrestees within the LAPD jail system as well as to police and detention officers who fall ill or are injured on the job.
How does the LAPD utilize nurse practitioners?
Individuals arrested by the LAPD need to be medically cleared before being booked into the jail. Medical dispensaries are staffed by registered nurses and medical providers, including physician assistants, nurse practitioners and physicians.
As a nurse practitioner, I’m responsible for the healthcare of the arrestees, treating and managing their illnesses and/or injuries while they are in custody. The medical dispensaries are fully operational 24 hours a day, 365 days per year.
What are your specific responsibilities?
When an arrestee is brought into the station, he or she is met by an RN who then obtains a medical history and vital signs. At that point, I’m informed about the arrestee and proceed to conduct a brief but thorough assessment and examination.
Some of my responsibilities include treating and managing chronic illnesses such as hypertension, diabetes and psychiatric disorders as well as managing the care of arrestees with alcohol and drug addictions. We also treat acute illnesses and injuries such as colds, flu, abscesses, sexually transmitted diseases, minor musculoskeletal injuries and lacerations.
We also conduct a “sick call” once every shift to measure blood pressure and run blood glucose checks on our hypertensive and diabetic patients and then treat accordingly. If additional medical resources are needed, such as X-rays or specific blood work, we arrange transport to the hospital via patrol car or ambulance. Essentially, we are responsible for arrestees’ entire care while they are in custody.
Once the arrestee is medically evaluated and booked into custody, he or she will remain in jail until a court date is set for arraignment. Misdemeanor offenses are usually arraigned within one day and felony offenses within two days. However, if people are arrested on a Friday or over the weekend, they may remain in custody for an extra two to three days. During this time, we are responsible for their healthcare.
Also, if an officer is injured on the job or experiences an occupational exposure of some kind (a needle stick, for example), we provide initial treatment before referring them to Employee Health or the ER.
What is it like to conduct a history and exam on an arrestee?
It can be quite challenging at times since these individuals have just been deprived of their freedom and may be facing a lengthy stay in jail or prison.
Many arrestees present as angry, upset or even combative and many are under the influence of alcohol and/or drugs. That said, it’s important for me to not take anything that is said to me personally. It’s equally important to refrain from escalating with the patient, since this can affect the patient’s assessment and care, and can lead to the unnecessary use of force. I can usually de-escalate patients’ behavior by remaining calm, keeping my voice lower than theirs and being reassuring and respectful in my interactions with them.
When I’m treating or caring for arrestees, I try to see them as my patients rather than as arrestees. This allows me to provide them the same care that I would give anyone else. I’ve always tried to follow my belief that you treat someone in the same way in which you’d like to be treated.
There are times, however, when these attempts are futile and I need to have patients placed in their cells until they can be more cooperative. Once they’ve had time to cool down, they’re usually more compliant with their healthcare.
How do you elicit honest responses in a patient’s history?
This is a challenge. I have to reassure my patients and gain their trust by engaging them in conversation. Part of my job is to convince them that we’re here to take care of their medical needs, not to judge or punish them.
I tell my patients that whatever we talk about can’t be used against them legally. I also tell them that whatever we discuss will help me to take care of them in the best possible way.
If I try to reassure my patients that they’re safe with me, they’ll often open up. As far as believing whether they’re being honest with me, I have to use my discretion along with good clinical judgment.
How do you handle patients who are high or intoxicated?
Arrestees with psychiatric disorders and drug addiction can be quite challenging at times. On many occasions, we have psychiatric patients who weren’t compliant with their medications because they were using alcohol and/or drugs on the street, but now want their medication. Frequently, they don’t know their dosage or they ask for the highest possible dosage in order to stay sedated or high while in jail.
In order to verify their medications, we may contact family members who can bring their medications to the jail or sometimes contact their pharmacy. If these courses of action aren’t available, I use my discretion and clinical judgment in ordering medications.
Similarly, drug addicts will display drug-seeking behavior by repeatedly requesting high dosages of narcotics. I’m aware that patients may have a history of drug abuse, whether cocaine, crystal meth, heroin, ecstasy or PCP. So, it’s important to look for signs of the patient’s being under the influence, such as dilated or pinpoint pupils, elevated blood pressure and heart rate, droopy eyelids or a slow or unsteady gait. If I determine that a patient is under the influence, I may refrain from administering narcotics, relying as always on good clinical judgment and discretion.
When arrestees are very intoxicated or grossly under the influence of drugs or alcohol, we can place them in a “sober cell” where they can be observed closely for changes in their behavior or condition. After six hours of observation by officers, the patient will return to the medical dispensary for reevaluation.
I’d like to add that we have an alcohol and drug abuse protocol wherein the nurses assess addicted arrestees every four hours and provide medications to prevent or lessen the severity of withdrawal symptoms.
Do you feel safe at work?
I always feel safe. There’s always at least one officer in the exam room in the event that the patient is aggressive or upset. The officers are there for our safety and for the safety of our patients.
To be honest, I feel safer in my present workplace than I felt when I worked in the ER as an RN. The emergency room is full of angry people in pain and there isn’t always someone there to protect you. I was swung at and hit in the ER, but I’ve never been attacked or hurt while working in the jail.
How does working in a prison differ from what you do?
Having worked as a deputy sheriff, I understand the world of the prison system. When arrestees get to prison or jail, they’ve actually calmed down to some extent. Prison clinics and hospitals are also very safe places to work and medical and nursing staff are afforded constant protection by corrections officers.
When arrestees come to us, their frame of mind is impacted by the acute grief of losing their freedom, so it’s quite different from working with inmates who are more or less acclimated to prison life.
In prison, clinicians have the opportunity to establish a rapport with inmates over time, which allows for trust to grow. Additionally, since we have arrestees in our care so briefly, there are many tests and procedures that we generally don’t utilize, whereas patients in prison receive much more robust long-term care.
How did you choose this career path?
After working as a nurse for a few years, I studied law enforcement and became a deputy sheriff with the L.A. County Sheriff’s Department. I simultaneously worked as a nurse in one of the busiest ERs in the country, so I had a foot in both worlds. Following my stint as a deputy sheriff, I worked as a helicopter flight nurse for 10 years, studying to be a nurse practitioner during that time.
Since 2003, I’ve worked as an NP in urgent care and family practice, finally settling in my current position with the City of L.A. Having a background in law enforcement has really helped me to understand various aspects of working with arrestees in a clinical capacity.
Are any certifications required for working in corrections?
No. However, I know that the American Correctional Association offers nurses a certified corrections nurse certification based on experience and an examination.
What do you love about your work?
I’ve been with the City of Los Angeles for six years. As an employee, I love the benefits, including having a pension plan, comp time, 401(k), sick leave, adequate vacation time and holiday pay as well as a uniform allowance and discounts on tickets and events. Working 12-hour shifts allows additional time off and there are bonuses for working the night shift and for having your national certification.
Our managing physician gives us a great deal of latitude in how we manage our patients and I really enjoy that autonomy. Clinically, we have a set of protocols, but they’re really just guidelines. I have access to excellent medical supervision and support and the Los Angeles Fire Department is right next door in case we have a medical emergency.
I have a great working relationship with the police and detention officers and with the nursing staff.
What would you say to a nurse interested in correctional nursing?
When you first think about working in corrections, it might scare you, but like I said, it’s actually safer than your average inner-city ER. If you have respect for law enforcement and its purpose, working clinically within the corrections milieu could be very rewarding for you. It’s a form of public service and the benefits of working for a large city or county can be enticing.
Do you have any future plans for your career?
At 52, I’m content with where I am at in my career as a nurse practitioner. As a city employee, I’m working at one of the finest police departments in the country and I find my work challenging and meaningful. I’m also very happy with my working relationships with my colleagues, the nursing staff and the police and detention officers at LAPD.
Most importantly, I’ve been blessed with a wonderful family, including three grandchildren, so my time off is very precious to me. We have many family get-togethers and my wife Jeanne and I love to travel, hang out at the beach, ride bikes and, best of all, surf!
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.