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Cookie Thursday 10/20/22- bloody bandages

Spooky Cookie month continues on Cookie Thursday is a Thing. Today’s make is bloody bandages.

These are operating room folks, and it is hard to gross them out.

No ick matter here!

Bloody Bandages

Sugar wafer cookies, the ones with the cream filling between thin crispy wafers.

white chocolate Candiquik. This is meltable chocolate that comes in a variety of flavors and colors and here in the United States it goes by that unfortunately spelled name, or some craft stores carry it for candy making. It melts fast in the microwave and smoothly.

toppings- for effect I used a combination of green sprinkles, and freeze-dried raspberries

I had to experiment a bit with technique. The first tray I laid the wafers out, melted the chocolate, tried to make a square of chocolate with a spoon, put the toppings on

This works but it gets messy as the chocolate begins to dry.

The second tray I had the wafer cookies in a stack, picked them up, spread the chocolate using a knife, added toppings. This worked much better and I was able to get a more uniform square of chocolate

What makes these bloody bandages is the rectangular shape of the wafer cookies, and the hopefully white square of chocolate. And the raspberry “blood”.

On some I added green sprinkles to simulate infection.

I think they are adorable, and they were very fast to make. I barely got through NPR morning edition podcast, which is about 15 minutes long. Seriously one of the fastest makes yet.

Bloody bandages ready for boxing

School Me Saturday 12/3/22-Extra scholarship money goes where now?

I was today years old when I found out that any extra scholarship money, above costs, is refunded to you as cash. At the end of the semester.

My mind is blown.

All my life I have wondered about why people are so excited when they get scholarship money over and above their free ride scholarship. Because they get the money as a pay out at the end of the semester.

I checked in with a student billing officer at a university. And she says this is legit.

Well, hell.

I’ve just been satisfied with my scholarship money, the little I’ve received, and my tuition reimbursement from the hospital. I thought that any scholarship money that was unused just went back to the company that runs the scholarship. I find this very sad that I am just learning about it. I’m on my FIFTH nursing school program, and my sixth college.

Holy cow!

However, this does explain the $995 check I got in September. I thought that was a sinking fund for books. Apparently in my new reality as a Nursing Faculty Loan Forgiveness Program student (they will pay 85% of the tuition cost for school after I teach at the college level after graduation for 4 years), I get $1000/year for books.

The money is on the fridge because I was afraid that they would ask for it back. Tomorrow, I will put it into a high yield savings account.

Of course, the true test will be if I get the $2,000 scholarship that is to be paid out at the end of the semester from AORN. Which would also go into the high yield savings account.

Because I will be holding this money to pay back the NFLFP in case I am unable to fulfill the terms of the contract.

Off to apply for more scholarships. Including the high dollar one from the hospital ($5,000-10,000).

And to finish the statistics final and the 20 page concept application paper for Philosophy.

Because it is finals week!

But if you are looking to go back to school, or have a kid in school, don’t be like me and be ignorant of what the scholarship can do for you, above what school costs.

And there are videos (?) on YouTube that explain more.

I am still flabbergasted.

Cookie Thursday 12/1/22-I bought cookies

The December theme is holiday cookies.

But that is not the story of today.

I was going to make cranberry meringues and peppermint meringues. Two types. Not cranberry-peppermint meringue, I can’t even imagine the horror.

I was going to make them on Wednesday because I knew Thursday would be a rush because of the quarterly awards ceremony at the hospital. These are awards that the shared governance proctors and gives out. The Daisy Award for nurses. The Sunshine Award for auxiliary staff such as pharmacy, or environmental, or dietary. The Rose Award for CNAs.

But there was a banger of a storm on Wednesday. And I knew that the meringues would not dry in such an environment. And I didn’t bake them on Wednesday.

I made the cinnamon rolls for the awards ceremony instead. Patrick Barnes, whose death prompted his family to start an international nurse celebration award program, loved Cinnabon. And before he died, he would ask his family to bring some in for the nurses, especially after he became unable to eat. The tradition was born and added to the Daisy ceremony. Well, the local Cinnabon has been closed for months. When I was searching for another one close by, I learned that there were only 16 Cinnabon stores left in the entire state. I didn’t particularly relish driving to the nearest one, the one at the biggest mall in my area, during Christmas shopping season. This led me to make the cinnamon rolls for the ceremony.

Well, I used canned cinnamon rolls from the grocery store, jazzed them up a bit with additions, and made home made cream cheese icing to top them.

They were a hit.

And then we worked all night on Wednesday night.

All part of the gig. You know?

I got home at 0500 and went straight to bed, knowing that I had to be up at 0830 at the latest to buy the flowers that all nominees received, and drive to the hospital to emcee the awards ceremony. It is part of my duties as the chair of the hospital shared governance.

Next I drove over to a local grocery store and bought cookies. I took them to the staff lounge in the hospital and dropped them off.

There was no way I could get home and nap and make the meringues.

And I didn’t.

For the second time this year, Cookie Thursday is a Thing was store bought cookies. And that is okay.

Because sleep.

What do healthcare professional owe when a patient is injured in our care?

This was prompted by an article/news story that I heard listening to NPR while cleaning the kitchen.

In the story, the patient had received a small abrasion on his forehead during a cataract procedure. After napping at home post procedure, he woke up to a bloody pillow case as his forehead was bleeding. His surgeon did not mention the abrasion at his post-op appointment. Upon further investigation, he discovered that was no mention of the abrasion in his chart. Not under the post-op documentation, not under anesthesia notes.

He did not appreciate that much. The entire episode was thought by him to be a reaction to the anesthesia medication.

Wait, let me back up.

This patient was undergoing cataract surgery at a cataract center. While in the procedure, the CRNA asked if he was in pain. He wasn’t, just felt some pressure to the side of the head. They increased his sedation.

The next thing the patient recalled was a bit of a commotion, and the surgeon yelling at him to stay still. In a later appointment the surgeon told him that he had a “adverse impact from the anesthesia.”

He thought to ask for a rebate in recompense for the injury.

The article uses phrases like the jig was up, in ascribing guilt to the surgeon for not mentioning it before. But the surgeon should absolutely have mentioned it when talking to the wife at the end of the procedure.

Oh, this makes me so mad.

Yes, adverse reactions to anesthesia happen. They do. And can run the gamut from allergic reactions to the anesthesia to death. That is quite the range of possibilities.

What I think is that he got a little frisky under deeper sedation.

I see it happen ALL the time in my role as an operating room nurse.

Especially the surgeon shouting at him to keep still while attached to the eye equipment. If the surgeon hadn’t shouted at him, he could very well have been blinded.

And the surgeon should have told the wife immediately. And the circulating nurse should have filled out an internal quality assurance form. That he would not have access to as the patient.

I tell patients after the case when they get belligerent under sedation and their family member. I also warn teenagers, especially boys to age 25, not to wake up like a brat (not the actual word I use). Because teenagers do.

I’ve been slugged, and scratched, and kicked more times than I can count. While patients are emerging from anesthesia. Oh, can’t forget the pinching. That also happens.

Do I think it was a medication reaction like they are purporting it to be? Nope. I bet he got belligerent under deeper sedation. This happens. But this is not an allergy. This is a reaction, probably a one time one..

This makes me wonder if he bothered to ask for and read the nurse’s notes as well. Instead of relying on the doctor’s notes.

The circulator should have note the abrasion on the operative record.

Do you think he even looked there?

I don’t think that this is the whole story. But enough of a story that an article was written and a news story broadcast.

Monday Musing 11/28/22-slippery fallen leaves

There has been such an upswing in the number of broken hips that surgeons in other specialties not orthopedic are starting to notice. Mostly because repairing broken hips clogs up the schedule, but yeah.

One of them asked me during a night case what was up with all the fractured hips.

Two words- FALLEN LEAVES.

Lookit all the colors on the leaves!

Isn’t it bootiful?

Yes. Fall foliage is pretty.

The chlorophyll production that the trees live on in the spring and summer is slowing down, preparing the tree for the colder months. This produces the color change, and the leaves dropping as they are no longer useful to the tree.

And fallen leaves are slick. Especially when they have built up into layers.

It’s kind of like being on a sudden ice skating rink.

And gravity wins. Every time.

If it isn’t your hands out to catch you and the wrist breaking, it is the hip hitting the unforgiving ground and breaking.

All the seasons have their own trip and fall hazards. Spring has people newly released from their homes and the yardwork that needs to be done, Summer has garden hoses and gardening mishaps. Winter is what is traditionally thought of as broken hip season.

Not true.

Hazards abound year round. Just do all the ORs a favor and review how to fall. Maybe practice a little in a safe, cushioned environment.

Just wait until the ice comes.

Timber!

Post-it Sunday 11/27/22-call job revisited

The post-it reads “call is my hobby”.

Judging by the handwriting on the post-it, I would say this was written in 2020. Long before there was a call only position at the hospital.

This is the nearly one year anniversary of this gig.

And I love it.

Can I say that, and not tempt fate? Or the red pen in the budgetary process?

I think this is a service to the department and to our coworkers. No one likes call (except me, the PACU call nurse, and the call scrub tech, and the call ENDO nurse), the four of us have done the bulk of the call for the last year. Except for the odd vacation, or holidays, or random days off.

I know that this was started in an effort to attract and retain nurses/techs from going to where there is no call, or the ambulatory surgery centers. Well, I think that was the reason the call position was started. No one has ever came out and told me this was the case.

According to the master list of Dispatches from the Evening Shift posts, yesterday would have been the last day of my old life. The one where I worked entirely too many hours, all the hours that were actually, and took all the call. And did weekly meetings for various committees.

In truth, I had been feeling a bit stale, and a bit put upon by my own coworkers. They just expected me to be able to take ALL the call, sometimes toward the end without asking. I was also feeling hemmed in by changes in the department, changes that I didn’t necessarily buy into. Frankly, it was the call job, or leave the hospital.

And call is my favorite.

And if this ride were to end, I have plans of what to do next. Ideally, it would not end until I have graduated with my PhD. But I don’t know that. I would chose a sister hospital in the system to work for. And find a position that allows me the greatest amount of time for schoolwork. Because positions are still open and departments are begging for staff, especially in those hard to fill shifts. I don’t want to, but I could.

Really, why would it? There is still a nursing shortage. And us call people are the most stable of them all. And the least whiny.

Since beginning the call job, I applied to and was accepted at a state university PhD in nursing program.

I applied to and was accepted to be a writer for a new online publication that will be debuting in February.

I slowed down tremendously in the amount of nurse work that I do. Something had to change in my workaholic ways, and I consciously slowed myself down. Could I have gotten a day shift job somewhere and worked both? Yes, but I knew that would be counter-productive regarding my plans to go back to school.

Call is still my hobby, and my work.

I only wish more people weren’t afraid of it. Perhaps not, it takes a certain personality to do this all the time. I don’t mind the pager, or the unpredictability of case volume.

Call is still my favorite.

And the cats’ favorite too because I am at home more than I ever have been in my working life.

Who knows what the future will bring?

But, I can assure you and myself, that call will be a part of it.

School Me Saturday 11/26/22-scholarships

Let’s talk money, shall we?

I have always said after finishing my masters that I would be interested in a PhD IF I didn’t have to pay out of pocket for it.

Yay! You got into your first pick college. Or second, it’s all to be celebrated.

Now, I am sure you have done the sensible thing and gone to a community college to get the pesky general ed classes out of the way.

No?

That’s okay.

There are still little known scholarships to obtain.

Did you know that Mashalls, before they were owned by TJ Maxx, used to be owned by a pharmaceutical company? Definitely. Do I remember which one? No. But they gave me a $4,000 scholarship to start my college journey with.

The first tip is to ask your employer about scholarships they offer. And follow up that question with when is the application period open? Don’t ask how much, that is gauche. Any scholarships are a gift.

If you are a teenager looking toward college, ask your parents if the company they work for has a scholarship program for dependents of employees. They might, but not advertise it.

You can google scholarships and there are many clearing house type of companies who can help you tap into scholarships. These tend to the younger crowd, high schoolers, first time college students, minorities, perceived minorities (such as men going into nursing), military. You get the idea.

It isn’t a bad thing to join one of these sites. Be prepared for a LOT of email queries. In fact, use an alternate email and check it often. An example of these sites is Scholarship Owl. I’ve not gotten any scholarship money out of them, but I recognize that I am not their target audience. Someone, presumably, is getting the scholarships, it is just not me.

You can also search scholarship on Pinterest. There are many other sites that are not Scholarship Owl.

If, like me, you are a nurse looking to go back to school, apply at the state level Board of Nursing. Can’t help.

Or apply to the professional organization scholarship that you belong to. I did, and I am anticipating $2,000 at the end of the semester.

And the last tip, which should be near the beginning, is ask the college that you will be attending if there are any scholarships that you qualify for. They want students, and some make it easier for them to attend. The university I am attending now has a scholarship that, if I agree to teach on a collegiate level at an accredited school for 4 years, I will get 85% of the tuition cost paid for. This is the best deal that I have found. There are many, many, many accredited nursing schools. And they are desperate for instructors. There is a nursing instructor shortage, which is compounding the nurse shortage. Can’t graduate nurses if there is no one to teach them.

Apply early, apply often for scholarships. You never know when your number will come up and you are the new recipient of money for college.

Medical Mnemonics-IYKYK

Medical terminology is sometimes shrouded in veils of mystery. Because, you know, we have our own language. And when studying in nursing school or medical school it can be useful to use mnemonics.

These are the letters that spell out a meaningful phrase. At least meaningful to the medical type people.

When I was at Creighton at 19, the boys would giggle at the mnemonic for naming the cranial nerves.

  1. Olfactory
  2. Optic
  3. Occulomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Auditory
  9. Glossopharyngeal
  10. Vagus
  11. Spinal accessory
  12. Hypoglossal

Not very giggle worthy, but if you took the first letter from each to make a new word to make a sentence. Oh, Oh, Oh, To Touch And Feel …

This would end in something naughty, or not. You get the idea.

Medical Mnemonics, helping teenagers study for anatomy tests since the dawn of anatomy tests.

There are others in the medical field.

There is the 8 letter mnemonic for the bones of the wrist.

Not all of medical mnemonics are anatomical.

Sometimes they are used in different contexts.

ABC- for the steps of CPR, which is another one.

APGAR, used in maternity wards.

SOAP and SOAPIE, which is how I learned to write a nursing diagnosis.

SBAR which is used to get information out in a systematic manner.

These are very useful, and intentional communication aids.

That most medical type people will understand.

This was a texting language before texting was a glimmer in Friedhelm Hillebrand and Bernard Ghillebaert’s eyes. These men are inventors of texting in 1984. You can thank them later.

Or Samuel Shem who wrote about tongue in cheek mnemonics for House of God. That is the O-sign if you want to know. There’s a post about that sometime in Dispatches’ past.

All the way back to the 1920s and Otto Neurath and the Isotype Pictograph language.

I bet this was the modern beginning of emojis.

If there is a way to shorthand information, nursing and medicine have found it and utilized it. Because it is a way to disseminate needed information in a rapid manner. To be understood by people who need to know.

And it isn’t just medical mnemonics, the military have been doing this for years.

Did you know that the original Jeep stood for general purposes? Or Gee Pee.

If we didn’t have a way to explain complex, emergent situations, we, and the patients, would be FUBARed.

Monday Musings 11/21/22- imposter syndrome

Help!

There’s an imposter in my house.

My mental house that is.

No, not really, but imposter syndrome is a real thing that impacts many people daily. So many people, maybe even you. Probably you if you are in healthcare.

According to the American Psychological Association, it is the chronic feeling of inadequacy, despite being a high achiever.

To put simply it is the incorrect belief that you do not belong there. No matter where there is. It might be a corporate office, or a hospital department, or, oh I don’t know, a grad school.

Despite the hours you’ve worked to get to the office, or the hospital department you want to work in. Or the application process for a grad school program. All of that says you belong here, otherwise you would not be there.

But our gut tells us that we do not belong. That all of the accolades, and praise, and maybe high grades that got us there, were lying. Or misrepresenting us.

Because we are not a person who deserves to be where we are.

It is the ultimate mind-fuck.

But, Kate, if I feel I don’t belong even if I do, what can I do about it?

Lie to yourself. After all, your mind is lying to you.

Act as if you do belong. Because you do.

Be confident that you belong where you are. See above point.

Be aware that your brain is lying to you. You do belong.

I could be glib and tell you to keep reminding yourself that you do belong.

And, maybe, eventually you’ll believe it.

Stop wasting the mental and emotional energy on thoughts and feelings that you don’t belong. Someone obviously thought you did.

Believe in yourself and your abilities.

It is best to have yourself in your own corner.

You have this, you belong, you are not in the wrong place.

Most importantly, it will be okay.

Post-it Sunday 11/20/22-Finding that engagement spark

The post-is reads ‘finding that spark for engaging with patients, especially young adults’.

All ages can be difficult to engage with, but the young adults from 13-22 are especially hard. It is like a forcefield of apathy.

Recently I had a young adult patient who was scared out of their mind about the impending surgery. No conversational gambits worked. Not even the usual: school, pets, siblings. Nothing, they just sat their, unmoving. Except for their eyes that saw everything.

I usually talk school; what grade, favorite subject, exams.

Nothing.

For the younger crowd I try siblings, or pets.

Tried those too.

Nothing.

I made a comment to the surgeon, away from the patient, while they were being interviewed by anesthesia. A comment about the soon to be released newest Marvel movie. The surgeon and I are big fans, and always talk plot points, and acting choices, and actor critiques.

To my surprise, the patient turned their head toward us and blurted out that they wanted to see that movie too!

Completely different patient, with one stray comment that wasn’t even directed at them.

Two lessons reinforced

  1. patients are ALWAYS listening
  2. Marvel transcends fear

We spent the next ten minutes talking superheroes until it was time to head back to the OR.

And picked up with the conversation after surgery was over and they were a bit more awake.

And chatted happily about heroes, and villains.

Oh, my.

There is always a lever to get a patient to talk to you.

It is just a matter of finding it.

School Me Saturday 11/19/22- end of semester nears

The semester is drawing to a close.

And you know what means.

End of semester tests.

And papers.

So many pages.

It seems like we had just gotten through midterms.

But where there is a midterm, there will be a final.

Kind of like peanut butter and jelly, they apparently go together. I tried.

How to support your student while they study for the end of semester tests.

Be patient.

If the test in in-person, consider driving them to the test. If you have time to spare and want to wait around for the test to be over.

If the test is a virtual one, essentially an open book test, give them space and time to work on the problems. And encouragement to work on the test a little bit every day.

Otherwise their head may spin on the due date; obviously because they did not work on the test in a timely manner.

Reassure them that it is going to be okay.

Do not let them obsessively add up the semester points to see what will be required for the grade they want.

Caffeine will probably be key.

And sleep.

And if they are hip deep in reference books, and bunches and bunches of notes, muttering to themselves as they tear the paper with their erasing, take a deep breath yourself.

And remember this will pass.

And hopefully they will pass.

The test, of course.

I had to amend that because so many people use pass as a synonym for dying.