Continued from Page 2

Wanted: RNs

Like other medical facilities in the state, the California Medical Facility is battling a severe nursing shortage. The greatest shortage is of MTAs, Sherman Champen, RN, MSN, FNP, said.

The facility has openings for more than 40 MTAs, Constance Gibbs, RN, a nursing supervisor, said. The prison’s 60 RN positions are almost filled, but it needs to hire 30 more nurses to comply with recently enacted state-mandated nurse-patient ratios, she said. The ratios require a registered nurse for every six patients in noncritical areas.

Because of the ratios and the MTA shortage, “we’re all doing a lot of overtime right now,” Gibbs said. The prison also is using registry nurses to comply with the ratios, Champen said. “We’ve used registries a whole lot and then we’re killing our budget,” he said.

Last year, the prison shut down one unit of its 63-bed hospital, but has reopened the unit when the inmates need it, Champen said. The alternative to treating an inmate in the prison, Champen said, is to take him to a community hospital under guard, which costs more than reopening the unit.

The surgery unit, which used to do some major surgeries many years ago, now is in its second year of limited operation for minor surgeries, said Noel McGarter, RN, a post-anesthesia care unit nurse. “We wish we could do it every week,” she said, “but there’s such a shortage of nursing staff, we can only open every other week.”

Au, the dialysis nurse, said her unit is growing and needs to expand. But she’s short of space and nurses. “We have the same problems they do on the outside,” she said. “We’re short-staffed. There are not enough dialysis-trained nurses.”

On a particularly busy week, Au may work six shifts, she said. The nursing department is trying to find alternatives, she said, and is considering offering 12-hour shifts as an alternative to the eight-hour shifts that prison nurses now work.

Hiring new nurses and MTAs is not easy, Champen said, especially when hospitals around the state are competing for RNs and medical staff. Although state employee benefits are among the best in the industry, RN salaries are lower than what nurses can make at many other hospitals, he said. Nurses at the California Medical Facility make a maximum salary of about $4,800 a month, he said, plus an $800-per-month recruitment and retention bonus.

It also takes time for new prison employees to obtain required clearance. Red tape and paperwork are particular obstacles in hiring MTAs, he said. Because MTAs are considered correctional peace officers, they must go through training and a security process that used to take a year and now takes about nine months. Few people are willing to wait that long to start a job, Champen said. “We lose them in the interim.”

Security issue

Many nurses — or their families — also feel uneasy about working in a prison, Champen said. “This is not for everybody,” he said, although he added that most nurses are pleasantly surprised after they actually visit the prison and see its services. “Very few people end up saying, ‘I don’t want to work here, I’m scared.’ ”

The prison clinical staff is about as safe, or safer, than the staffs of any inner-city emergency department, Bick said. The greatest risks are for MTAs who escort inmates and deliver medications. MTAs sometimes get gassed — hit with a bag of bodily fluids from infected patients — or stuck with needles or scalpels that an inmate has stolen from a sharps bucket.

Charles Humphries, RN, BSN, a public health nurse for infection control at the prison, said he did not know of any incidents of inmates passing infections to staff in the 10 years he’s worked at the prison.

“I don’t know why, but I’ve never felt scared,” said McGarter, the recovery room nurse who has worked in the prison for 14 years. “These guys are human and they need the care.”

Au, the dialysis nurse, said she never feels frightened because so many correctional officers are around. “You have to remember where you are at all times,” she said. “You have to always think custody. Safety, safety, custody.”

But she has never felt conflicted by the need for security vs. the need for medical care, she said. From the time she arrived at the prison, she knew her first priority was care. “That goes for everybody who works here,” she said. “I was hired to administer medical nursing care and that’s all I do.”

Au said she was apprehensive about working in the prison at first. “But once I got here, my perspective changed because they deserve the same kind of care as anyone else. The inmates are really nice people.” When she hears about their crimes, often she is shocked. “But here they are in a controlled environment, so their whole demeanor changes.”

Bick said one of his goals is to create “zero tolerance” for disrespect, whether from patients to staff or from staff to patients. Many problem patients have horrendous stories of abuse and mental trauma, he said. They’ve grown up in a world with different rules, different ways of dealing with anger and pain. “You have to set very clear expectations and show them another way,” he said.

McGarter said she has always treated her patients with respect and has received nothing but respect from them in return. “I have a good rapport with them,” she said.

Recently, as she was picking up a chart, an inmate she had never seen before approached her. “I have a problem,” he said, “and I think you can help me.” He was trying to get a lower bunk and needed to show proof that he needed it for medical reasons. McGarter was hesitant. It didn’t sound like her area of duty, and she knew inmates could be manipulative. But the man was so nice, she decided to see what she could do.

She did some research, but when the answer came back, “it wasn’t the result he wanted to hear,” she said. He was denied the bunk. “But he was still very polite to me,” she said. He thanked her for her help, and she felt glad she had helped him.

“These guys know me,” she said. “They tell me I’m a good nurse. They feel comfortable to know I will be here when they wake up after surgery.”

That relationship is the reason she doesn’t want to work anywhere else. “I love this,” she said. “I really love it.”

To comment on this story, send e-mail to editorca@nurseweek.com.