Cookie Thursday 9/29/22-Rosh Hashana inspired cake

Continuing the theme of Baker’s Choice, today I chose to make a Rosh Hashana cake. Well, I have to feed a lot of people and I am adapting the recipe a little to make a very flat cake in a cookie sheet. Everything else is the same.

Rosh Hashana is also known as the Jewish New Year. And New Years are a time of new beginnings. It also marks the start of the High Holy Days in the Jewish calendar. It is marked with prayer, and the blowing of the traditional ram’s horn. And there are symbolic foods.

Being a diverse country, I think it is important to celebrate differences. I am not Jewish, but I know and work people who practice the Jewish faith. And I want to know more. Because I don’t want to make circumstances awkward for them. And they are free to celebrate their religious holidays, no matter what certain facets of our country say

It is important to celebrate these days of reflection and the 10 days of Awe.

And Jewish people are meant to reflect on where the past year has gone wrong, and how they might improve in the future. I think this is a practice that everyone needs to do, regardless of religion, regardless of time. For those of us who celebrate the New Years when the Grigorian calendar flips from December to January, this is absolutely something that we can do.

Today’s bake is a honey syrup soaked cake with cardamon and cloves for spices. And it is cooling in the kitchen on the stove before I take it to the hospital.

Loss of life skills for new generation

I had a friend celebrate her 10 year old son’s learning and maintenance of life skills that are not being taught in schools any longer. And the emphasis on this learning is not being done at home, either.

The life skill he learned and demonstrated was shoe tying.

Apparently, all shoes are slip on now.

Disappeared is the learning to read cursive, or write cursive

And driving a stick shift.

This loss of life skills is not happening only in real life.

Working life has also lost some skills.

Hospital life definitely has lost skills.

No one takes off handwritten orders anymore. No one else is squinting at a doctor’s appalling penmanship and guessing that this order is 200 micrograms of fentanyl, not milligrams. This is also why many systems have moved to pharmacy clearing medicine orders. 200 milligrams is lethal. Layers of eyes looking at orders isn’t a bad thing and might save a life.

Many of the improvements that have been made, looking at you electronic health record and especially computer-based orders, have been done for safety.

There are other skills that really shouldn’t be disappearing.

Analog clocks as the world moves to digital ones. And for that matter military time. Most hospitals run on military time to be able to quickly differentiate between day light hours and evening/night hours.

Calculating medicine drips. Yes, the IV pump will do it for you but what if there isn’t a pump? Or electricity for that matter.

What nurses have forgotten is there is a world out there that does not have the advantages that we enjoy in this country.

Teach children to tell time on an analog clock, to read and write cursive, to drive a stickshift. Someday they may be in a place where they are commonplace.

Teach new healthcare workers and nurses to calculate and hang drips, to take handwritten off and make sure they are followed. To take a verbal order and do the same.

This new technology driven world is exciting and wonderful and new advances are being made all the time.

But what if all of that stopped?

And the kid/nurse/society had to go back to the way it used to be?

Monday’s Musings 9/26/22- The flu is coming- are you prepared?

Apparently the influenza, aka the flu, has been particularly vicious this summer season in the southern hemisphere.

I’ve been seeing article after article warning of an increased flu risk. Sometimes coupled with covid. We don’t know how covid is going to react this fall and winter. How could we? Many states have stopped tracking, and Johns-Hopkins’ Data in Motion dashboard has been rumored to be scaling back.

And the damage that has been done to willingness to get a vaccine will be here for a long time.

A look at the CDC flu vaccination coverage, shows a drop for age group 6 months to 17 years in the 2020-2021 flu cycle. And a slight increase for the 18-48. And a larger increase for the over 49, with the largest increase for 65+. The increases are good, although slight.

But the drop in 6 months to 17 years is alarming. The overall vaccination rate for all age groups encompassed in the larger range dropped from 63.7% to 58.6%. More than 5% points in a year.

Isn’t anyone else alarmed by this?

I find this scary. If parents aren’t vaccinating for the flu, what else aren’t they vaccinating for?

Another thing the articles are positing is the possibility of a twindemic. This means that there will be high levels of cases in both flu and covid.

Because reminder! Covid still kills Americans every day. Over 2,000 in the last 6 days alone.

Is the covid pandemic slowing?

Yes.

Should we still be absolutely concerned?

Also yes.

Does covid had the capacity to come back swinging? BF.7 anyone? Ba.5, which became the cause celebre in the late spring, as well as the most dominant Omicron variant causing most of the infections, is still around but ceding ground to the new variant.

I’m just waiting for the variant one that laugh at the vaccinations and the antibodies.

They’ve already found a coronavirus in bats that laughs at the vaccines.

And we start this entire mess over again.

Clock is ticking.

But for now, we have a new booster that is made specifically for the Omicron variants. And it was just released 3 weeks ago. Get it.

And get your flu shot too. Yes, you can get them both at the same time.

The life you save may be your own.

Post-it Sunday 9/25/22-The post-it vault

The folded paper state ‘Wizard of Oz. Winged monkeys leads to policy and procedure; signatures- winged pens; -paperwork’.

Um.

I write about the first paper/post-it/gown card I pluck from the stack.

And sometimes it doesn’t make a lot of sense.

This one was written in haste. I can tell because it is on a folded piece of paper.

Sometimes you have to be your own diviner of what you meant to write.

To me, this is about 2 separate issues.

That sometimes policy and procedure doesn’t make sense, brought to us by the winged monkeys from the Wicked Witch of the West. You know, the winged monkeys who did the bidding of the WWW? And terrorized Dorothy and crew.

You could assign an identity to the witch, or those who do her bidding. And relate it back to the hospital and it becomes even creepier.

The second part of the note is about signatures using winged pens. Again, this can be related back to the leadership of the hospital. Signing the aforementioned policy and procedure. The pen can be a stand in for the winged monkey. An update if you will.

Or if could be gobbly gook.

And signature?

Could be anything.

Sometimes the post-its don’t make any sense and you have to make sense of scribblings from years ago.

School Me Saturdays 9/24/22-Going back to school

Nurses are always trying to learn more about how to care for patients.

And that looks different for each nurse.

Some want to learn more about how to run the unit, or the hospital.

Some want to learn more about how to run another department.

Some want to learn more about disease states.

Some want to learn more about new treatments and new modalities.

Some want to learn more about getting away from the bedside.

All of these are okay.

And there are different ways to learn about each one.

There are different degree paths for each one.

Some of them don’t even require a degree path.

And some nurses don’t want to get any more degrees than the one that got them their RN.

And that is perfectly fine.

But healthcare is always moving in an outward direction, toward education.

Because we are all here for the patients, whatever that may look like.

You don’t have to follow my path.

Because you are your own nurse.

I love to learn. I have spent the last 6 years on various degree paths.

But that is me.

No one said you had to do as I do. You’re not me after all.

Just to have the same endgame of safe, effective care for patients.

But you will find that you know more than you think you do.

And the patients will still need us.

No matter what form of nursing we take.

Cookie Thursday 9/22/22- butter board

The theme for the month is baker’s choice. I was going to make a standard cookie this week, but something caught my eye earlier in the week.

Have you ever heard of a Butter Board?

It is similar to a charcuterie board. That is a selection of meats, crackers or breads, cheeses, and nuts, and sometimes jellies. All forming a pleasing to the eye and mouth collection of flavors that work well together. Especially in your mouth.

The world became enchanted with the charcuterie board, especially during the pandemic.

I mean, I’ve had a few at parties, and I’ve made a couple myself.

But all that specialty meat and cheeses are expensive. And sometimes hard to source.

I was reading on Monday when I read about a Butter Board. It was in a video made viral by Justine Dorian where she made a butter board, inspired by Josh McFadden’s cookbook titled the Six Seasons. I love cookbooks and I am on the waitlist for the local library for that one.

Justine Dorian begins with a half pound of softened butter that she spreads, in an artistic manner that I don’t have time or energy for. She went on to explain that anything can be added to the butter but her explanatory board had honey, red onions, flaky salt, among other things.

Well, most Cookie Thursday is a Thing bakes begin with a half cup of butter, softened.

I was intrigued. And determined to make a butter board as this week’s make.

It was the simplest and easiest thing I’ve ever done on a Cookie Thursday. And that includes the time I dipped fruit in chocolate.

I added lemon zest, a good balsamic, flaky salt, everything but the bagel seasoning, and Mike’s Hot Honey. You know, just things I had in the pantry.

And I sliced up most of a loaf of 3 cheese bread that I had in the fridge, arranged it prettily on a cutting board, put the cutting board on a cookie sheet and added the sliced bread around it.

And then panicked when I didn’t think there was going to be enough bread and bought a loaf of French bread at the store and added it to the table.

People were already starting to dive in when I left.

My intention was to made the butter myself because have you seen the price of butter these days, using my mixer and cream but I worked ALL last night and thought sleep was more important.

Next time, mixer, next time.

Pagers, medicine’s electronic leash

What is a pager?

For a very long time, it was the only way to get in touch with needed personnel, be they the call team, or doctors. Or, in the late 1980s into the 1990s, to get in touch with family, drug dealers and the like.

This is preemergence of the cell phone to dominate our lives.

The mobile pager allowed for doctors and nursing staff to live relatively normal lives, while on call. Or to allow one doctor to cover the hospital.

There are movies in which doctors are shown flashing their pagers, answering a page and leaving. Kind of like the bat symbol in Gotham.

It has been very useful. And convenient.

And lucrative for the people who run the pager companies.

I’ve had a pager in some capacity since 2002. I’ve had a cell phone since 2004.And that’s an entirely different post.

But pagers were created/invented to shortcut reaching out to someone for all sorts of reasons.

In my hospital, the reliance on pagers has been declining for years, matching the rise of cell phones. Heck, I have 90% of the cell numbers of the surgeons I work with. Allowing them to tell me about a surgical case, or me responding to their asks regarding future cases.

And texting. Most of the conversations to be had can be done over text.

Game changer.

But.

What if the surgeon trying to get ahold of you doesn’t have your number and is just on call for the ER that night? And is a courtesy member of surgical staff, solely for call purposes? This is where the pager absolutely comes in handy. Allowing the not our surgeon to reach out to the nurse on call, bypassing the often messy communication with the nursing supervisor. All they have to know is one pager number and it will page all pager numbers associated with that number. This is known as the group page.

Last night I got a call from the supervisor that a PA, who I know for a fact knows the process, called her to book an emergency case. Okay, not the process but I’m on my way.

Prior to the case, I gave the PA a gentle reminder to call the pager and I would answer. He said the number didn’t work. Hmmm. Regardless, I reminded him that I am the call nurse Sunday-Thursday 2100-0700. And to go ahead and call me directly and I would start the cascade of notifications of everyone else. Instead of playing phone tag.

And he told me he never knows who is on call.

Oh, my head.

Prior to this job change the odds were VERY good it was me. And now, the odds are very good that it is me. At least 72% of the nights of the week, and I will re-direct a call outside of those days.

Do I have to wear a tee shirt that says “On call most nights”? Or “FIVE nights a WEEK”!

Maybe.

Do they think it is conversation like Prince Phillip and Aurora? You know when he asks this damsel he meets in the forest “When will I see you again?” To which she replies, “Oh, never!, never!”

Pager, cell, home phone (that no longer exists); there a lot of ways to get in touch with me.

I would much rather not be stuck at home waiting for a page that may or may not come.

You are not going to bother me, promise. I would rather answer a misdirected phone call than a surgeon get frustrated with the back and forth communication, or a patient not receive the care they need in a timely fashion.

Monday’s Musings 9/19/22- end of an era

Whatever you think about the monarchy in England is yours to think.

However you feel about the death of Queen Elizabeth II is yours to feel.

Did I get up at 0500 to watch the funeral proceedings from my couch in the US?

Absolutely.

Whatever you think, however you feel, the fact remains that this is a tremendous loss for England. And it will be a moment for them to get their footing again.

And today, my Facebook memories reminded me that twelve years ago on September 18, 2010, I had an ending for myself. A denouement, a finality to my Air Force years. The following is what I wrote then, about endings.

And today marked the ending of Queen Elizabeth II’s reign.

I found the parallels unique. What has been said about this race and her reign, are similar. Her reign is over, her race is done.

           ‘This weekend finally caps my short lived Air Force career. Never mind that sixteen years has passed and my ROTC scholarship will finally be repaid by December. There was always something missing. There had been no closure. One moment I was in nursing school on the Air Force’s dime and the next I was lying crumpled on some stairs, my shoulder’s inner workings in tatters and my scholarship lost. I got back to nursing school, finally, three years later and graduated to work as an operating room nurse two years after that.

            But something was wrong. I’d intended to be a career officer and that was taken from me. In May 2001, shortly before I graduated, there was a career fair at the college and I asked the Air Force recruiter about reentry, and whether the debt that was hanging over me, nearly twenty thousand dollars, could be dismissed if I rejoined. I received an irrevocable no on that but I was still invited to join the party. I did not.

            So, there it has been looming all these years, all that untapped potential in my life, not to mention all that money they wanted back. When I heard that there was an Air Force Marathon I knew that I had to run the half. This was before I started planning my marathon debut, scheduled for this December. I would run the half for the me that never was, for the chance to run it on my terms and for the medal that will be hanging on my wall.

            When I was in the Air Force the mile and a half we ran every semester was the millstone around my neck. So what if I could do a seventy two inch standing long jump, 20 pushups, seventy sit ups and a relatively fast six hundred meter? The run scared me witless every time I had to run it.

            When I returned to running two and a half years ago it was with that same trepidation but also with a resolve. The run would not get the best of me. Since then I have run seven 5Ks, one 8K, one 12K, one 15K and a single half marathon. Also an adventure race and two triathlons. I’m not the fastest, not by a long shot, but I’m not the slowest. I do, which is what it important. I don’t give up, which is more important.

            I didn’t realize the mythology of this race to me until I was running down the chute toward the finish line. At the far end there were Air Force personnel handing out medals, actually placing them over people’s heads. I almost cried when the medal was put in place, there were tears standing in my eyes. The female officer embraced me by the shoulders and told me I was done, that the race had ended.

I was surprised by the wave of emotion. It had been such a difficult race for me. Unfamiliar territory, the unrelenting sun, the GU mishap that made me ill, the hard concrete of the roads that pounded my calves and feet for all those miles. But I finished it, I was done. And I felt lighter, freer.’

Post-it Sunday 9/18/22- When the lift is just that good

The gown card reads ‘when the patient lift is so good it sets off the bed alarm’.

This actually happened last week and made me laugh.

This happened when I was being the second PACU nurse which I do as part of my new job role. If there isn’t another case, I stay in recovery with the patient and the primary PACU nurse, just in case there is a problem. Safety in numbers.

The patient had woken up and was in the PACU. Since they were being admitted to the hospital overnight, we placed them on a hospital bed after surgery, not a gurney. They had woken up a bit antsy and had squirmed their way down the bed.

As a result, their oxygen saturation wasn’t ideal. And they were uncomfortable. This is because they were so far down the bed that instead of bending at the waist when the head of the bed was raised, they were bending in the middle of their chest. This is uncomfortable. And some people even wiggle down further so that the bend is at their shoulders and neck. It isn’t ideal.

Well, this patient was bending uncomfortably in the middle of their chest. This does not allow for optimal lung expansion, and their oxygen saturation becomes compromised. Sometimes this can lead to air hunger, or the decreased oxygen saturation can affect their mentation. The best thing to do is to lift the patient bodily in bed so that they are no longer bending in the middle of their chest and their lungs have room to expand and contract and they can breathe better.

This particular patient, while not small, had wiggled their way down and was in the situation. The real PACU nurse and I decided to lift them in bed leading to better gas exchange and a more comfortable patient. The head of the bed was lowered and the PACU nurse and I lowered the top head rails and grasped the sides of the lifting sheet. We reassured the patient that the head of their bed would not be down long and instructed them to bend up their knees and push on the count of three.

One

Two

Three

The PACU nurse and I tightened our grasp, lifted the patient slightly, and pulled toward the head of the bed. This is all one motion. The patient pushed up at the same time.

And the patient got pulled up to the head of the bed.

Up went the side rails. Up went the head of the bed. Up went the knees of the bed as a speed bump to help them not slide down again. Covers were pulled taut again. A successful lift.

We were so successful that the bed alarm went off, thinking that the patient was trying to get out of bed. Even the though the patient had not left the bed.

A bed alarm is necessary, and it alarms when there is a pressure change on the mattress. This is a safety feature that notifies the staff on the unit that the patient was getting out of bed. We don’t want patients to get out of bed without permission. This can lead to a patient falling.

The patient had not left the bed, but the alarm was still going off. This lift was that smooth.

I had to make a note on a gown card, knowing that I would make it a Sunday Post-it post. When things work in healthcare, it can be a thing of beauty.

School Me Saturdays 9/17/22- Where have all the teachers gone?

America is in a nursing shortage.

It’s been talked about for literally as long as I’ve been a nurse.

21 years for those playing along at home.

The warnings started as I was preparing to graduate. They might have existed longer, but I just wasn’t paying attention.

Why?

The retiring Baby Boomer generation of nurses is a big part of it.

The covid pandemic did not make it any better. 90% of current nurses are considering leaving the profession. There are a lot of reasons but the most current one is the blatant disrespect of the public around covid precautions and vaccinations. At least that is what some nurses I work with are telling me.

And the side gig life is real. And lucrative for some people.

Online schools have also joined the playing field. There are many ways to go about getting an RN. There is the traditional 4-year college. There are community colleges. There are online schools. All graduating as many as they can to hold off the crisis.

And nursing schools have been limiting enrollment in nursing programs.

According to the American Association of Colleges of Nurses 64,000 qualified applicants were turned down because of class size limitations. Nurses that very much are in need in the current climate.

Why?

Because there is a lack of nursing instructors.

Again, there are a variety of reasons, including retirement of current instructors. And the budgetary constraints of the schools feed into it. Don’t forget that nursing instructors are nurses too and have been impacted by the pandemic.

Heck, I was headhunted by a nurse educator at a college fair at the hospital. It’s a bit too far for me to drive to teach there, and I’ve got this PhD program I’m in right now. But, when I graduate, I will definitely be finding a job as a nursing instructor. Because that is part of my nursing endgame, and one of the reasons I am back in school and in a nursing faculty loan forgiveness program. I have to teach nursing after I graduate, and 85% of my schooling will be forgiven.

But there are many nursing schools within my metro area at a glance. Over 10 within thirty miles. And you can’t have a nursing school program without teachers.