You want a third break?

I received an electronic copy of my performance review.

I’m still trying to process this.

It reads like it is two people.

She is willing to do all the jobs in the department: cleaner, circulator, scrub.

She does not go into the rooms enough. (while doing all the jobs in the department)

She is very helpful and willing to work extra to get the job done.

She does not offer a break after 1700. (all afternoon breaks are done before I get there)

She does not ensure that the late people (1900) get off on time. (I’m usually in a room myself.)

She catches problems for the next day and works to solve them.

She sits too much at the desk. (I am adding cases and working on getting things for the next day.)

I got the sense as I read this that my lunch, that I try to take at 1620 at the latest so I can be free to relieve someone at 1645, is not appreciated. It has been so hard to carve out a lunch time that does not interfere with the OR cases. And next to impossible to take a lunch or a break after 1900 when everyone leaves, which is what I think that they want. This leads me to going without.

Sometimes I have to give unsavory assignments and I try to be fair and not always have the same people do them.

Sometimes I take the unsavory assignment, especially if it is going to go past 1830, and leave the late people out to do the stuff I do. Unsurprisingly, this is not popular either. And can double my workload as I still do all the stuff after the case, or between cases.

One of our late OR assistants quit, someone has to take up the cleaning and moving slack.

Again.

If the writing is on the wall and I have to keep a nurse or a tech to finish at 1700 or 1900 (and I’m talking 15 minutes at most) I ask/tell early. This is not an everyday or even every week occasion. And if someone offers to stay because they also see the writing on the wall, I sometimes take them up on it. Only to hear them complaining the next day that I kept them late.

Say it with me now!

PEOPLE!

Spreading kindness

Wednesday marked the beginning of Lent, my personal favorite liturgical season.

It is the beginning of spring for me.

It is a time for renewal.

It can mean whatever you want it to mean.

One thing I do during Lent is to do acts of service.

Again, this can mean whatever you want it to mean.

This year, to me, it means I go out of my way to say kind things to co-workers.

I mean, who else am I going to see in this year?

(Covid numbers are down, please don’t be stupid.)

I perceive myself to be severe.

I am no one’s pick for the popular squad.

However, I am everyone’s pick for trivia.

I know I have a tendency to get wrapped up in my brain.

Thinking my thoughts.

Making my plans.

Thinking of all the thousand of details that encompass a shift in the OR.

This allows me to get out of my head for a little while.

To really focus on others and what I can do for them.

Why be kind?

Why not?

Pearl clutching at its best.

I know, I know that evening shift and day shift thinks differently.

I know.

Day shift wants to do their cases and finish their shifts and go home.

Evening shift want to make sure that day shift has all the instruments and tools needed for their next shift, doing cases all the while.

Day shift’s patients are 90-100% tested for Covid, before the day of surgery.

Evening shift’s patients are not tested.

Okay, to be fair, rarely tested.

I mean really rarely.

Sometimes there is an overlap to where day/afternoon shift ends and where evening shift takes up the mantle.

I thought it was understood, like months ago, that ER patients are not tested prior to surgery.

Today, there was a late afternoon case.

I didn’t think I had to tell my coworkers that this is an ER patient, there has not been enough time to test them, therefore they have not been tested.

But, apparently I did.

I will try to do better last time.

Doc-blocked

Doc-blocked.

Simple enough phrase.

When your doc (or surgeon) has been blocked by another department or case.

*cough, cough, OB*

When a phone call occurs and it is a surgeon telling you about a case, that starts the clock that all other add ons will be after.

Regardless of department.

Regardless of details by the surgeon. Those can be gathered later.

This is one of the foundation stones of scheduling for the OR.

Other cases may trump urgency, but the steps still need to be done.

If the other surgeon feels their case has precedence, there is a bumping protocol that has been established.

Or, you know, the anesthesia department can call in their call person if the case is OB related.

There are some questions to ask yourself instead of blindly acceding case priority out of turn.

Is the case for the OR urgent?

Is the patient for the OR urgent? Say, bleeding profusely, with a low blood pressure?

Further conversations need to be had when calls come in practically simultaneously.

Or, as my surgeon said when he had to wait two+ hours to start his urgent case, someone is going to get hosed.

Or, to use my new phrase, doc-blocked.

Have a little empathy

We have a new doctor.

She is efficient.

As the nurse who has worked with her the most, I recognize that she has been gifted the black cloud for the group.

This is something that gets passed around to ALL the new docs.

Her cases are harder, her patients sicker, the diagnoses are odder.

Guys, we go through this every time with a new doc in that group.

Remember how horribly the last new doc got beaten up by cases.

Oh, that’s right, you can’t.

You weren’t here then.

To date she has done 3 impossibly hard cases in the middle of the night, one retrocecal appy in the evening.

And 2 horrible gall bladders on a weekend shift.

And she and I have started building her preference cards; so far we have an appy, a gallbladder, an open belly case, and the start of an ex lap card.

Okay, it takes time, depends on the case.

When I got to work yesterday to do a diagnostic lap with her I got an earful from the CRNA, telling me she was reserving judgement on this doctor based on the two horrible gallbladders.

And a corrected preference card at the desk.

I reminded the CRNA to please have an open mind, see the above black cloud she has been gifted.

The diagnostic lap, although strange and odd diagnosis, went well. The CRNA said she was pleased it had gone so well.

I looked at the preference card corrections.

Every single, blessed thing that was written down to be added WAS ALREADY ON THE CARD!

Sigh.

Overstocking, I’m on the case

There I was, minding my own business, in a very long case that had converted to open, making it longer still, when I thought to myself, “I’ll do one of my favorite long case distraction techniques.”

Not my phone.

Checking for outdates.

After the counting and conversion was done, I went to the cabinets and began going through them, looking for outdates.

I found the outdates, many of them, up to $500 worth.

What I also found was the cabinets stuffed with supplies.

I had to closed my eyes and breathe deeply.

The thing that really frosts my button, besides inefficiency, is waste.

So may things were stuffed into these poor cabinets, often in two places.

I pulled out an entire bin of overstock, always leaving 2-5 of a supply, depending on the kind.

Bovie tips, and dressing supplies, and more bovie tips, and extra chloraprep (hello, it comes in the packs, you do not need 15 in a room). Gelfoam of all sizes, and surgicel of all sizes. Excuse me the most common sizes are 4×8 and 2×14, why do you need fifteen 0.5×2?

When I was done, there was entire bin of extra supplies, the cabinets still looked full, and I had removed 30+ pieces of expired things.

The oldest expired item was from December.

Of 2019.

As this is 2021, I think that is excessive!

And I also think I need to retrain my coworkers on stocking and expiration date hunting.

Monday, I think I will do room 5.

Perfect Covid metaphor

I was talking to my nursing supervisor this evening and in doing so I struck upon the perfect metaphor for the Covid winter, autumn, summer, spring, winter we are stuck in.

I know I have written before about Covid being the grindstone and healthcare workers being ground down and we have to be careful that we are not ground down into nothing.

But this metaphor is even more perfect.

I wish, I wish I could draw.

I wish, I wish I could protect my idea.

I wish I knew an artist.

Here is the metaphor:

Have you heard of Sisyphus?

The Greek king who was sentenced by Zeus to forever roll a large rock uphill in Hades.

The king could never get the rock up the hill.

For healthcare workers the rock is our patients and society at large and the hill is Covid.

And we are forever rolling and supporting the rock up the hill.

And never getting anywhere.

I could expand the metaphor and say there are obstacles in our way.

The obstacles of denial, of mask refusal, of anti-vaxxers.

The obstacles of the economy and the political climate that makes the obstacles even harder.

I think that is the perfect metaphor for healthcare workers.

We are supporting the rock, who may not want to be rolled up the hill, against the hill that is the Pandemic.

And the hill seems like it will never end.

And the rock never gets any lighter.

Grossest case list keeps getting longer

Look, I’ve been a nurse for nearly 20 years. And an OR nurse for 19 of them.

I’ve had my share of gross, how are you still alive cases.

I keep a ranked list in my head.

The guy who lost his buttocks, and rectum to necrotizing fasciitis.

The woman who lost her leg and nearly her life to necrotizing fasciitis.

The men who’ve made me believe the 90% fatality rate that happen with scrotal abscesses.

The men and women who have had plastic surgery cheaper abroad.

Hint, it’s never cheaper when you come home and nearly die of sepsis.

The sweet lady on the floor who the surgeons were waiting to see demarcation of the necrotic limb before amputation who died of sepsis before the amputation could take place.

And there is a new contender for not the grossest case ever but high on the list.

This past week we had diffuse necrotizing fasciitis through an entire segment of a person’s body.

As the surgeon kept doing sharp debridement and continuing to find the black/gray tendrils and liquifying sub-q, the patient kept losing more and more area.

It is now 2nd on the list of the amount of tissue taken off a patient.

But they clearly needed it.

Because necrotizing fasciitis can kill.

I hope they do okay.

Continuing Education?

It has been a full year since I paid for college courses.

I paid for my last 2 classes just after New Year’s last year.

In this past year I have paid more for membership in various nursing groups.

I joined my state nursing association and do education through there.

I paid for an education membership to a group that does continuing education.

I paid for my Sigma Theta Tau membership.

I paid for a nursing membership to a group that is going to be important to a project I am working on with another nurse.

I paid to go to a virtual conference through my state nursing association.

I take free classes when I can, especially those surrounding the Coronavirus and the response therein.

I take free classes through AORN.

But my AORN membership allows for monthly free CEUs through their journal.

It is part of my New Year’s resolutions to fully engage with the AORN CEUs.

And read all of my nursing education.

Because I have 3 years to earn 125 hours to retain my CNOR.

All the while, in the back of my head, I think PhD, Maybe?