National Nurses United

performed by an LVN. Nursing policy touches on the issue of clinical supervi- sion of an LVN by an RN. However, in the organizational charts of nursing services and in reality, MTAs are super- vised by senior MTAs who work under the Supervising Registered RN II. Pris- oners' complaints that they need health services remain largely ignored and unreported to RNs by MTA/LVNs. The focus of MTA/LVNs remains punitive, i.e. their efforts are enthusiastically exerted in discontinuing medications and appli- ances for inmates who, in their LVN view, are noncompliant; complaining to MDs about the amount of medications being ordered; delaying or discarding inmate healthcare requests for medical care; coercion with custody personnel to discard or discourage inmates' writ- ten 602 appeals regarding healthcare; and many other practices too numerous to list. Nor is there a system in place to audit the delivery of medication admin- istration or documentation of patient care by MTA/LVNs, even though it is written in their "post orders." There are no nursing competencies in place for RNs or LVNs. Despite the new, written nursing policies HCSD established to direct nursing practice within the scope of practice for respec- tive licenses for RNs and LVNs, little has changed in the actual practices of nurs- ing. Plata requires monitoring by fed- eral court experts of the implementation of these nursing policies (among other areas) over a period of time (approxi- mately six prisons per year until 2008). The auditing system by federal court experts is being illegally subverted by custody and nursing staff in a multitude of ways, and statistics reflecting the implementation of healthcare are skewed. The "face-to-face triage" by RNs implemented under the Plata agreement as part of the healthcare tracking system is being subverted. Some MTA/LVNs pick up the healthcare requests, some don't. RNs who have had "Plata training" as to how to implement this tracking and pri- oritizing of inmates' needs as emergent (now), urgent (within 24 hours), or rou- tine (seen by a provider within 10 days) are skewing the tracking statistics imple- mented by the court experts. Most healthcare requests are not listed in the tracking logs by RNs. Inmates that are to be seen by MDs within 24 hours are being seen up to five days later or not at all. Logs are being altered from "urgent" by RNs and medical records clerks to "routine." Nursing triage is not being done face to face, it's being reviewed by RNs on paper and then determined to be urgent, routine, etc. There is no consis- tent direct RN assessment of an inmate's/patient's needs. The underlying intent within the healthcare system has been to placate Plata until the court monitoring period is over, and then alter what has been implemented according to what suits CDCR at the time. Prisons under review in 2003/2004 failed to meet the 85 per- cent minimum requirement by the fed- eral courts to achieve the establishment of basic humane care in prisons in chronic care. In the meantime, RNs have been brought into the system in large numbers due to the federal court mandated implementation of Plata but RNs have continued to resign their jobs at CDCR in large numbers, sometimes within months of hiring, and the system is not asking why, nor has CDCR even begun to work on any real retention of competent RNs. Competent RNs are actively sabotaged by MTA/LVNs, who not only resent their increasing pres- ence, but also continue to undermine efforts within the HCSD to ensure that LVNs practice within the scope of their licensure. MTA/LVNs have set themselves up as the monitors of RN practice and decide whether RNs are doing what the LVNs think they should. They have become the line staff interpreters of what RN nursing practice is or is not and, accord- ingly, undermine good nursing practice. The practice of nursing within the scope of licensure basically exists on paper only. This is a primary reason that com- petent RNs attracted to working within the prisons are resigning in large num- bers. Contract RNs and MDs (registry) have exerted a good influence in the delivery of competent healthcare within the system, but are railroaded out due to budget reasons or rumors, or being set up within the system to be fired. They are afforded less rights than even inmates, including the right to due process when their good reputations and work records are tampered with within CDCR. C A L I F O R N I A N U R S E J A N U A R Y / F E B R U A R Y 2 0 0 6 25

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