Please respond within 30 minutes

When you are called in you have 30 minutes to get to the hospital.

Not 40.

Not 50.

Not 60.

Thirty, 30, 3-0.

Do not pass go, do not shower, do not go out to eat, do not walk the dog.

Unless you can get it done and still report to the hospital within the 30.

I think people have gotten spoiled because I live so close to the hospital.

I’m there usually within ten, fifteen with traffic.

This leaves me time to grab and sign into a phone.

Schedule the case.

Pick the case.

Call for report for patient.

Arrange transport for patient.

Put the pick in the room.

Pre-op the patient.

Tell anesthesia the patient is in PACU.

And you are still not there.

That’s assuming you’ve answered your phone at all.

If not, and this has happened several times recently with a certain tech, I start the phone tree looking for a replacement tech.

And I stall the doc until a tech arrives, without letting on that we are waiting for a tech.

It’s getting old, people.

It’s FIVE feet away!!!

Um, so I was rounding to make sure the rooms were picked up and the stirrups away and the rooms set back to neutral when I noticed a nurse was still in the department.

She was cleaning and organizing room 5.

She’d spent a bulk of the day cleaning and organizing room 6 for the advent of cases.

She asked me to approve of her changes and I did.

In room 6.

In room 5 she put unsterile specimen containers above the computer in the computer station.

Because the room might need them.

I looked past her to the substerile room that was 1 door and 5 feet away and asked, “Like the ones in the substerile cabinet. That is 5 feet away.”

She said yes, and sometimes people didn’t like to leave their rooms.

I repeated, “5 FEET away is too far?”

She didn’t speak to me the remaining 4 minutes of her shift.

I felt like the little kid who was collecting money for the newspaper and all he wanted was 2 dollars.

Sheesh.

Five feet away and it is too far to walk.

Tightening the belt

I thought I was done with this since I left California.

But no!

My hospital is tightening the proverbial belt around budgets.

I have no quarrel with this.

I have no objection.

What I do object to is cutting the staffing so deep that we only have enough people to do the cases.

That means nothing gets stocked.

That means nothing is checked for expiration date.

That means we are running cases until the wee hours of the morning because they told anesthesia that of course they could run five rooms that day, not six and the add-ons backed up.

This leaves evening shift to not only clean up after days, but to run the rooms until way past dark.

I am tired.

Growing our shifts

It was decided that my OR would add a weekend shift.

0700-1900.

A nurse and a tech and Pacu team too.

We’ve hired the tech.

There hasn’t been a good fit for the RN role.

But the tech has been training during the week on the evening shift.

And tonight I laid it all out for her.

How to prioritize cases.

How to get an emergency case done.

What kind of emergency cases that are done in our OR.

How to utilize the laser call person.

How to find out information that is needed.

Because her orientation will be over.

And, until she has a nurse, she’ll have to forge ahead.

She is motivated.

I think she’ll do fine.

 

All the things have an expiration date

Time has a funny way of affecting a budget.

Not only return on investment.

Not only asset capture.

Not only surgical time versus man hours.

But the expiration of surgical supplies.

These can be many things.

Sponges.

Mesh implants.

All the implants.

Dressings.

Staplers.

Suture.

The list is as long as the supplies for the OR.

99.9% of our supplies/implants have an expiration date.

If the department doesn’t use them within the time frame, the department eats the cost.

I am sure some of the depreciation is calculated into the cost of surgery.

But.

I train people to always look at expiration dates when opening supplies.

Most especially for implants.

And if there are two of an item in their hand, they should open the one that will expire first.

It just makes sense.

 

I’m not always the best judge of character

When I was living less than a block from the hospital, my husband and I explored buying the townhouse duplex we lived in. Someone scooped it out from under us. No matter. I still lived less than a block from the hospital.

We lived in the bigger half of the duplex. A three bedroom, two bathroom open concept place. I loved it there. I was a new nurse, working evening shift on a Med-Surg floor.

The people in the other half had moved out and a woman and her daughter moved in. I soon saw her orienting on my floor. She was a fellow nurse!

She was fun.

Always laughing.

Always open to doing things out of work.

She had been a nurse for ten years, and she’d been working at several hospitals before she moved to our little town.

I was none of these things.

I have been called severe, too serious.

I laughed but usually at myself.

I had been a working nurse for three months and my only experience was a CNA in a nursing home and several different jobs at the hospital.

I thought she could teach me a lot of things, like time management, and how to address scary situations.

And then I noticed some things.

She was always behind on her evening med pass.

That some of her patients had fallen.

That she always worked later than me finishing her charting.

That she always was laughing, sometimes at the patients.

She was always flirting with the doctors.

I did learn from her.

I learned when to keep my mouth shut.

I learned  how to time my evening med pass so none of the medications were late.

I learned when to pay extra attention to symptoms the patient was having.

I learned to be succinct in my narrative charting.

I learned how to talk to doctors.

I learned how to be respectful to patients, because they were in our care.

She didn’t last long at our little hospital. She and her daughter moved away after six months.

 

Nuclear Edition

There is a newish tech at the hospital.

And he’s scooping up all the tech weekend call.

And he’s obnoxious.

He’s a know it all and not in a good way.

He won’t answer his phone.

He won’t answer his pager.

I am disgusted.

I have two options as I see it.

  1. grin and bear it until the weekend tech is ready to go live on her shift
  2. stop taking all the weekend call from the nurses

The second is the nuclear option.

I enjoy call.

I’m good at it.

I do not enjoy shepherding a know it all through his paces.

Every weekend.

I’m leaning toward 1. However, I heard about him telling the new weekend tech that she’s going to get tired of working every weekend, inferring that she should not.

As I did not hear this myself I can’t report off to my boss.

However, I can tell her to pay no attention to him.