Have you heard the one about the two types of people in the world? There are many versions such as “There are two types of people in the world: Those who see the glass as half full and those who see the glass as half empty.” Or how about – “There are two types of people in the world: givers and takers. The takers may eat better, but the givers sleep better”. Well, I think there may be two types of correctional nurses in the world: Those who borrow and those who hoard. Which category do you fall into? Maybe both!

In the resource-scare correctional healthcare environment, savvy nurses are always looking for ways to deliver needed health care. Unfortunately, this can lead to poor professional practices that end up actually resulting in clinical errors. Practices such as borrowing or hoarding medications and supplies can also lead to licensure and employment issues.

I recently came across a posting by a nurse lawyer about the dangers of borrowing medications. The actual case came from a long term care facility, but there are commonalities and implications for correctional nursing practice. With the limited pharmacy support and isolation that is a part of many correctional settings, nurses look for ways to deliver ordered medications and treatments. When an important medication for a particular patient is not available, it is tempting to take the same medication from another patient’s supply to meet the immediate need. Most nurses do this with every intention of returning the medication to the original patient before it is needed. However, more times than we desire, in the chaotic and distractible world of correctional nursing, this does not happen. How can the temptation to borrow be reduced in corrections?

• Have available a reasonable stock supply of medications to accommodate unexpected needs. Depending on your facility, this supply can include antibiotics, insulin, standard antihypertensives, and inhalers.
• Keep medication carts organized and a patient’s medications grouped together. When carts are disorganized even available medication can appear to be missing.
• If you administer medications in the housing areas, check your supplies, especially for new admissions, before you leave the medication room. You may be able to solve a missing med problem before it becomes an issue.
• If a medication on the Medication Administration Record (MAR) is not found, check the medical record. It may have been recently discontinued or the dose changed.

Another temptation in correctional nursing is hoarding. Like missing medications, it is amazing how often supplies are not around when needed. Therefore, it is tempting to create a personal ‘stash’ of necessary supplies such as alcohol wipes, gloves, and even syringes or IV fluids. As with borrowing, keeping a personal supply can lead to error and injury. Supplies expire or products change. Multiple collections of various items squirreled away by staff members only compound the difficulty of keeping track of what is available or switching out expired or no-longer-approved items. Instead, work with your supervisor and team to develop a consistant process for re-ordering and re-stocking needed supplies.

So, do you see yourself in this discussion? I do. I am more of a hoarder than a borrower, by nature, but the challenges of working behind bars can tempt us into either type. Do you have a story or a tip about borrowing or hoarding for our readers? Share your thoughts in the comments section of this post.

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