Being a Medacs Healthcare custody nurse presents its challenges, and also has its rewards. Whether it’s assessing a detainee for fitness to interview, taking samples or writing up statements for court, there’s never a dull moment.
We asked Jane Burns, Custody Nurse, to give us an idea about what a typical seven days looks like for her.
Day One: Sexual offence suspect sampling and beans on toast
“Today was my day off to recover from my birthday celebrations - not that I needed the whole day, which turned out to be a good job. I was called into a custody unit to take some samples along with our new nurse, who was about to do his first observation after his training day..
“The suspect has learning difficulties and is a juvenile, which makes life more challenging. The preparation takes longer than the actual process, including cleaning the room, setting up the sampling kit etc. After arriving home at 21:40, I find out the kids have decided to have beans on toast for tea and not what I’d made them. The joys of juggling home life and work eh?”
Day Two: A hostile lady in her mid-60s and a familiar face
“My first case is a very hostile lady who has given a positive breath test so a blood sample needs to be taken. The officer hasn’t done the blood procedure before, which isn’t uncommon – we are often much more experienced than officers at this kind of thing. I show him how to fill out the relevant paperwork. Everything goes smoothly with the procedure and she is soon on her way home.
“One of the custody suites I work with is closed to new detainees thanks to a major incident, meaning it’s going to be busier than usual. My first case is a familiar face – a drug user who has pinpoint pupils, is drowsy, slow to answer. He tells me he hasn’t used in four hours and says that soon he’ll be ‘rattling’ badly. I respectfully disagree and put him on 30 minute rousals, 15 minute observations and declare him ‘fit to detain’. The Sergeant will review his fitness to interview in a few hours. Despite his ‘rattling’ claims, he settles down to sleep and stays that way until morning.”
Day Three: Continuity of care is so important
“I’ve met today’s first client before, and he looks much better than the last time I saw him when he was sent to hospital where he stayed for five days. He gives me his assurances he has not touched a drop of alcohol, but he’s shaking and anxious. He smelt strongly of alcohol and I believe he had been drinking. Declared him fit to detain and interview.
“Another familiar face follows, but this time he has been sticking to his preventative medication and has been dry since May. He seemed well. Appointments booked for both before they go to court in the morning. Handover to the day nurse before leaving – teamwork is such an integral part of this role between the day and night staff to make sure we have continuity of care.”
Day Four: Photocopying and rota nightmares
“Today I thought I had broken the photocopier in custody when it started bleeping madly at me. It was just politely letting me know that it had finished its job. The officer sat at his desk laughed so loudly at our momentary panic!
“A call comes in to see another regular client – an alcoholic with a fit to detain needed. I arrive to find he’s not as intoxicated as he can be - a relief for me. Short lived though, as it’s clear he’s unhappy with me for not giving him medication immediately, despite me explaining he’d only been in custody for an hour and is still clearly under the influence of alcohol. He storms out and advises the Sergeant he wants to make an official complaint about me. This isn’t an unusual occurrence, but whether it will actually come to anything is another matter. I advise to book him in a withdrawal assessment in four to six hours depending on how he is, and ethically he’ll have to see the Forensic Medical Examiner. No further calls for me today so a chance for me to do some of the computer based learning and education modules available.
“Spent the evening doing the rota for next month. Ended up re-doing it all and sending it out to the team with offers of extra shifts and a grovelling apology and request to be forgiven. I’m sure my apology was accepted.”
Day Five: Two DPs (detained person) in different stations
“Nothing booked in first thing, but at handover the night nurse informs me of two detainees I may have to see later, one at each of the stations I am covering.
“My first detainee finally wakes up and is immediately withdrawing badly. During his assessment he rocks constantly – until he thinks I’m distracted by the computer I’m working on, and then he sits perfectly still. Strange that! I agree he is withdrawing, but not as badly as he would have me believe. A quick chat with the doctor follows as he’s undergoing tests for another condition, and we agree he can have his medication.
“We frequently have scenarios where detained people state they’re on medication, but are not registered with a GP. This indicates the medication is street bought and not prescribed. This is the case with the second detainee. When I ask if officers can go to get his prescribed drugs from home, he gets aggressive and walks out. He also complains he hasn’t been able to have a cigarette!”
Day Six: Signs of feigning unconsciousness
“We hear on the radio there is an expected positive breath test, and I see him staggering when getting out of the police car. Bloods will not be needed that’s clear. He does have health problems and does need an assessment. It’s at this point that his demeanour changes – he becomes evasive and gives silly answers and decides to discontinue within ten minutes because he is ‘really ill and in absolute need for medication’. I advise him that he needs to fully participate in health assessment before he gets any medication.
“Suddenly he collapses in his cell. I go to see him and find him ‘unconscious and unresponsive’, however he is in a seated position and his eyelids flutter when his eyelashes are touched – both signs of feigning unconsciousness. He is clearly faking it, but an ambulance has to be called.
“He returns five hours later, more sober and upset because he has to have eight hours rest before being interviewed. He admits to faking his condition and is rewarded with the knowledge that his 8am interview is now more likely to be lunchtime.”
Day Seven: Close, constant watch
“Once again, it pays to listen to the radio – we hear that officers have arrested a well-known epileptic, who is always aggressive and abusive, and usually intoxicated when he arrives. True to form, he’s shouting, swearing and threatening on arrival. He’s taken straight to his cell and I’m asked to see him straight away as he has head injuries which he didn’t have when officers had moved him two hours prior. He was originally at the hospital with his injuries and was arrested when he became abusive. I get him to calm down and he is sent back to A&E with some advice on how to behave. He obviously adheres as we don’t see him again.
“A fit to detain causes me concern – a young man had been stopped driving and given a positive breath test. Drugs were found in his car. He’s very calm, very quiet, very intense and has the knowledge and skills to harm himself. For the first time in a long time, I insist on close constant watch until he has a mental health assessment in the morning.”
This is a typical seven days in the life of a custody nurse. Along with the day to day role, we do forge great relationships with our colleagues, often being asked personal advice on health issues and potentially uncooperative photocopiers!
If you would like to know more about working as a custody nurse, please email firstname.lastname@example.org.
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