Monday’s Musings 8/8/22- disease round up- now starring 2 diseases of concern

Bump goes bogeyman.

Clutch goes the fingers around the pearls.

Shame, shame, chants the sheep. Only when it is convenient and nothing they think they need to be concerned about.

Hey, in case you’ve forgotten. Covid is still a killer. As of this morning ONE MILLION THIRTY THREE THOUSAND SIX HUNDRED SIXTY EIGHT Americans have died.

Poo, poo go the people who are bored with the pandemic and just want to go back to their lives. Can’t we just go back to our lives?

There is no back to pre-pandemic carefree society. Well, only carefree if you were wealthy enough and lived in a developed country to provide food and medical care. Or, you know, a white man. Then you had it pretty good. Hell, you still have it pretty good. What is happening with woman’s healthcare is the subject of a different post.

People are still getting sick at a high rate. How high? Well. we don’t know because like all of us, the US Congress is bored and sick of talking about that which still kills over a thousand people a week. They’d much rather get back to how to control women even more. Limited people are reporting their at home tests, positive or negative. Some cities are monitoring wastewater but even that does not give us the entire picture. The answer is we don’t know how many people have covid, how fast and wide it is spreading because people, Congress, your school, the community you live in, the state you live in, can’t be bothered anymore. They are bored of covid. It is like Jan chanting in the Brady Bunch when she is sick of her sister, “Covid, covid, covid.”

The ONLY positive is that hospitalizations are down, kind of. I’ve been monitoring hospitalizations in my hospital the entire pandemic, and while we HAD a few days with zero covid patients, the number has been sneaking up since June.

But to many, covid is old news. What is the new sexy disease that wants to hurt us?

Monkeypox.

Terrible name, really. Needs to be renamed. I’m looking at you WHO where it was announced that would be happening in short order. On June 15th.

Monkeypox is not a killer. Yet. There have been 5 deaths associated with Monkeypox in the world in 2022. Zero Americans have died of it.

What makes this a pearl clutching disease that allows people to shame the people who get infected is that this round, because this has been a disease of concern before, most of the infected are those men who have sex with other men.

I can hear the chins wagging from here.

I was a very young child when the AIDS epidemic started. But by the time I was in middle school, the shaming was in full force. There have been great books and plays about it, check it out for yourself. But the shaming energy feels very much the same.

As if those infected DESERVE it.

This is very much bullshit, of course.

Recap:

  1. covid is still killing people
  2. people should still be wearing their mask if the infection rate is high in their area
  3. how do they know the infection rate is high in their area?
  4. they don’t
  5. Monkeypox is becoming a real concern
  6. the US has reported more than 6,000 cases since the beginning of May
  7. sound familiar yet?
  8. don’t worry about not being able to find a vaccine
  9. the US is and has been bungling the response to monkeypox
  10. much like they bungled the response to covid
  11. does anyone else feel a sense of doom?
  12. as if there is something just waiting out there to emerge?
  13. no, just me?
  14. Okay, then, have a good day
  15. wear your mask if your community has a high level of covid, or you know, just wear the mask
  16. wash your hands
  17. stop shaming monkeypox victims
  18. what are you? 5?

But don’t let us stop your cookouts and vacations. Sure.

If something that is trying to kill you could have a bit more of your attention, that would be great!

Post-it Sunday 8/7/22- interdepartmental relations

The gown card reads ‘I am not PACU’s bitch’.

Simple.

Declarative.

Tells the entire story in 5 words.

I was definitely frustrated when I wrote this gown card. I could also probably tell you who I was frustrated by. And why.

But I wrote the card to remind myself to stand up to this person. And their unreasonable demands.

The feeling within the department is I work with PACU for the better of the department.

Yes, individuals may frustrate me and make me want to scream. At the end it is their misfunction that is at play here. Something tells them that I am an easy mark for bullying by yelling at me for not doing their job in addition to my own. Something is wrong.

I remember this. Or, at least, I remember the setup for why I wrote this card. Someone was trying to bully me into doing their job as well for reasons that made sense in their head. I simply chose not to entertain them.

I did not yell. I did not curse. As those would have been counterproductive.

Instead I worked with this person to get the patient to their room. I understood that this person was frustrated by a lot of things outside of work and things they had no control over. I also had no control over these things.

The proverb of you catch more flies with honey than with vinegar is true. And very useful for a harmonious department. Did this person and I have a later conversation as to why what they were demanding was not appropriate for the workplace and that I would appreciate not being bullied? Yes. Simply and without emotion I explained their demands were not going to be met with me jumping to their bark. And they haven’t barked at me since.

The proverb goes both ways. If you want something, don’t tell me I need to do it or make demands. Simply ask.

Having this conversation about tone and timing has gone a long way to calming the waters between that person and myself. They now know I can’t be bullied and I don’t get mad enough to yell. But I will help if asked. And all subsequent times that I was asked to do something for the PACU department I can see the change in the words when they actively think about what they are asking.

Don’t get mad, and curse, and stomp. For pete’s sake don’t run to the bosses and tattle. We are all adults. Ask for a frank and genuine conversation after the current situation has cooled. It will be amazing what can happen.

Gown Cards, if you know you know

The OR being a clean environment full of clean edges, and sterile surfaces during a case, is a dearth of places to write. There just isn’t a lot of paper to write anything. Stacks of paper are frowned upon because they can be dust catchers. And blood can go flying, especially during a total hip.

You could theoretically write on the back of the schedule or the preference card. Those pieces of paper are handy. And since the schedule or the preference card is only printed on one side, the entire back side of the page is empty. Plenty of room to make notes.

The whiteboard is also a place to write. On the bottom, under the patient’s name, birthday, procedure, surgeon and allergies, there can be 18 inches of space. I use the whiteboard to write down things all the time; I note down times, and results from the pathologist if doing a frozen, I write down information while I am on the surgeon’s phone answering a page, I write down the name of the specimens, especially if the surgeon is rattling them off too fast for me to input the orders. If the case is over too quickly and I have not finished charting, I will take a picture of my notes and refer back to the picture when I am finishing charting. I very carefully do not take a picture of the patient’s name or detail and I delete the picture after I am done.

That’s why I don’t like to make important notes that I have to address and complete on the back of a schedule or preference card, there is the potential for too many HIPAA violations. And I’d rather not lose my job for a violation. And it is not appropriate for the patients to have their information bandied about.

Best not.

I am not talking about notes that are about the patient.

I am talking about notes to yourself about future self things.

The to do lists, the next case notes, the reminders about picking up little Timmy from afterschool event. All the things.

There is a dearth of writing materials in the OR. In a pinch, I have been known to write on my scrubs, or on my hand. I routinely keep a post-it on the back of my badge for when I need to take notes.

Another widely used writing paper that all the OR nurses and techs know about is the gown card. This is a 2.5 in x 4.5 in card that is attached to the gowns to allow the wearer to turn in a sterile manner.

These gown cards are useful as hell.

And I cannot keep from collecting them. They are that useful. I have about 10 in my locker at all times, and about 500 at my house because invariably they go home with me.

Things that I have on the gown cards on my desk:

  1. to do list for home
  2. to do list for work
  3. to do list for school
  4. Dispatches from the Evening Shift notes. This comes in handy on Sundays
  5. Cookie Thursday is a Thing themes
  6. Cookie Thursday is a Thing recipes
  7. Christmas list
  8. A reminder for the free library classes I have signed up for

The point is that the gown cards are really useful. And a recyclable resource that is self propagating. This is because there are at least 2 gowns opened per case, more if there is a break relief, or a PA.

I could make notes on my phone but I don’t like to be seen by the surgeon “playing” with my phone. It’s just not a good look.

This makes me analog in a digital world. And that is okay.

Cookie Thursday 8/4/22- no heat month begins with fudgy cocoa no bakes, with coconut

August.

Much has been written about August. According to the Farmers’ Almanac, July 3-August 11 are some of the hottest days of the year. The dog days, where colloquial wisdom explains that is because the dogs are panting in the shade because it’s so hot.

I mean, yes, but wrong.

Yes, these are the hottest days of summer.

No, that is not why they are considered the dog days of summer. The ancient Greeks noticed that the hottest days of summer coincided with the rising of Sirius, the dog star. Hence, these are the dog days of summer. Am I Sirius? You bet, and don’t call me Sirius. (Any Airplane! fans reading? just me, okay)

In my house the cats do not lie panting in the shade. They do, however, lie on the floor, eschewing the cat beds and furniture.

Yes, I don’t want to turn on my oven to bake cookies. It is too hot to add more heat to our house.

That is the origin story of No Heat August, a Cookie Thursday is a Thing exclusive. (I mean, I think)

Every week will be a different no bake make. Today’s cookie is the fudgy cocoa no bakes. I know I had these growing up, did you?

Of course, since Cookie Thursday is a Thing is about experimentation, I wondered a couple of years ago if I could add unsweetened coconut to the cookies. Would they firm up as much? Would there be any substantive change to the cookie? The answer is yes, they firm up just fine, just a little softer, and no there is no real change to the texture of the taste. There is a very slight coconut flavor to them.

There is another meaning to the word august. It doesn’t mean the 8th month of the Gregorian calendar. It also means marked by majestic dignity or grandeur according to Merriam-Webster. For men I think it is a double-edged insult. It sounds majestic, I mean that is in the definition, but I think it is as much an insult as calling a woman’s features handsome. This is done in many 19th century books and if you read between the lines the woman is to be pitied for not being pretty. Saying a man has an august bearing belittles them for not being handsome. At least it does to me.

Okay, tangent city.

The bake of the week is no bake cookies with peanut butter, oatmeal, cocoa. No flour or eggs required. Or oven, which is the point of no heat theme for August.

A nurse is a nurse of course, of course

Before I start back up in school I’ve been reading and watching videos, I came across and I watched a video where a nurse was denied a continued discount being offered to nurses from a store. She got the discount at the time but was warned that she was not eligible for it in the future. She had her license pulled up from the stateon her phone, and her badge and these were both showed as proof that she is a nurse. Her takeaway, and mine really, is that because she is an LPN, and licensed by the state, she is a nurse. This is absolutely true. And enraging that she is second classed because she is an LPN, not an RN.

The definition of nurse, according to Merriam-Webster, is a ‘licensed health-care professional who practices independently or is supervised by a physician, or dentist and who is skilled in promoting and maintaining health’. The Licensed Practical Nurse (LPN) is a person who has undergone training and obtained a license (as from a state) conferring authorization to provide routine care for the sick. The Registered Nurse (RN) is a graduate trained nurse who has been licensed by a state authority after qualifying for registration.

This is a very dry way of saying that both are real nurses. Both take state licensure exams, both care for the sick and injured. From what I read when researching this topic, the LVN requires less education; an RN can have a diploma of nursing, an associate’s degree in nursing, a bachelor’s degree in nurse, or higher. For some people the education to be an LVN can be less daunting. Of course, others view it as a stepping stone before they continue their education.

Organizations also have to watch for classism, or othering of the LVN. In the hospitals that I’ve worked in, some in leadership look down on the LVN because they “don’t have the degree”. So what? They are caring for those who need help. There will be some things they are not qualified to do, and that’s okay. Trust me when I say every hand on deck is a release of the pressure on the unit. Clear roles and responsibilities go a long way for this. Just because the nurse is an LVN does not mean that they are not smart enough.

I’ve heard jokes that being an LVN means that they are not smart enough for an RN program.

Egad! Do you hear yourself?

Being an LVN does not mean that! It means that this is what they wanted, maybe because the nurse in question didn’t have the opportunity to do an RN course, which can be longer than an LVN course. I know lots of nurses who started as LVNs, went back to school for their RN while working as an LVN.

This is not a Pinocchio moment. The LVN is not waiting for a visit from the Blue Fairy for an enchantment so they can be a real nurse. They are a real nurse.

So sorry your narrow-mindedness and ignorance has got in the way of your recognizing an LVN is a real nurse.

The woman in the video seemed genuinely distressed over this encounter. And I hurt for her, and am mad for her and other LVN that are confronted with this every day.

Say it with me, everyone, PEOPLE!

(reminder that people IS a swear word that can mean many things, but most commonly it is a derogatory term when used in the correct context)

Monday’s Musings 8/1/22- Yup, still pissed

Yes, I am still pissed about the Dobbs decision to overturn Roe v Wade. My husband keeps bringing it up, asking me if I am still mad. And I have lacked the language and the words to explain why, exactly, it is so troubling to have a precedent where woman’s rights to bodily autonomy are summarily stripped away. This decision robs a woman of bodily autonomy and the right to make decisions over her body that are best for her.

Yup, still pissed.

And then we were having a conversation about it last week and I had a thought, after watching an erectile dysfunction medication ad during a newscast.

I turned to him and remarked, kind of in an off-hand manner, “Well, what if men were no longer guaranteed access to ED meds. Because it is God’s will not to have an erection in some men.”

Oh, boy. You’d’ve thought I had just kicked him where it hurts. Right in the babymaker.

He spluttered, incensed, “They can’t do that! This is my body, and I can choose not to have a limp dick!”

I considered this reaction to be a little extreme. And I told him so. He kept going on and on about ED is a medical process and nobody can tell him what to do with his, and other men’s, theoretical erectile dysfunction.

And celebration bells started going off in my head. I mean, ring-a-ding-ding! His reaction, I can use to explain why the Dobbs decision is so disturbing for women. He’s a man, he doesn’t understand, not really.

Next I asked him if a man can choose to have self-determination over erectile dysfunction, I could no longer be guaranteed the same protection over my own body. And is self-determination okay unless a woman is of childbearing age?

Watching realization dawn is a wonderful thing. Even if it is in a man who is very opposed to the Dobbs decision, just not as mad about it as me. At least, until I corresponded the thought that I am still angry to a thing he could understand.

Eureka!

He’s still mad I brought that up and used the argument to explain why I, and millions of women, are still so very pissed, even 5 weeks out. But I think he understands why now, a little bit better.

And he has yet to ask me again if I am still mad about Dobbs. Because he remembers the conversation and knows the answer is yes.

On the subject of men and Dobbs decision, more men are opting for permanent sterilization. I mean, it can theoretically be reversed. I read that a urologist has had an uptick in inquiries about vasectomy, it has gone from 15 a week, to a high of 72. Per week.

This opens a wider conversation about a man’s role in pregnancy as 1/2 half of the equation that makes a baby. And how, for years and years and years, the responsibility for reproductive planning has fallen on women.

It is about time that men realize that they have a stake in this entire baby making process. Welcome, boys, better to be late to the party than not come at all.

And some men are choosing vasectomies because they can conceive (see what I did there) of a time when even that will be taken away from them. Although there are no plans to attack a man’s right to choose or bodily autonomy, I can see extremists thinking that is a mighty fine idea in the future.

Nah, probably not because the conversation has never been about control over men.

This is a reminder that the entire construct has been a method of control over women, wrapped up in baby bunting and using a pacifier.

As always, this does not impact me, being a married woman of 47. Those days are over for me. This impacts all the other women in the country of childbearing age. Our nieces, our daughters, our young friends. I consider all of them under threat, regardless of where they live. Yes, I’m still pissed, and afraid for them.

Sunday Post-it 7/31/22-The Worst Day of Your Life… and then?

The gown card reads ‘what happens the day after the worst day of your life?’

Kind of a downer question but very relevant to today. As always.

I really need to start dating the post-its when I write them so I can see when this was written, and remember the details of why I wrote this. That’s a tomorrow Kate problem, although I have been dating them for, checks notes, since November of 2021.

What makes this day the worst day of your life is a valid question. There are podcasts, and Reddit forums, and Facebook posts aplenty. This can also be a rhetorical, throw down with the universe existential question. I’ve heard it referenced when someone misses out on an opportunity. Of missing the callback at an audition, at being overlooked for the big promotion. I am sure that someone said it about losing the 1.2 billion Mega Millions jackpot.

In my experience as an OR nurse, it usually refers to a death. A death of a loved one, a death of a child, a death of a patient.

Saying that a certain day when shitty things happen the worst day of your life is valid. Only you know your life and where this particular day ranks.

But happens the next day?

That is the question that the gown card was trying to prompt. What happens after you don’t get the job, or the part, or the promotion? What happens after someone dies?

Life must go on.

The bereaved have to eat, and function, and sleep. Although they cannot fathom doing so with such a new hole in their life, a new reality of their life.

Someone somewhere is looking a positive pregnancy test in a state that does not support abortion and has to figure out next steps.

Because tomorrow will come and it will no longer be the worst day of your life. It will be a new day, with new opportunities and new griefs and grievances to weigh on you. The old adage is pull yourself up by the bootstraps. This is ascribed to a piece of fiction by Rudolph Raspe where the character pulled themselves out of a swamp by their hair. A task that seemed impossible, but was overcome by the characters grit.

Tomorrow will dawn, and it will no longer be the worst day in your life. How you react will be up to you.

Not to go full Pollyanna Puke on the blog, but Annie said it best ‘the sun will come out tomorrow!’

Shift work, and why 12 hours is not ideal

When I was a new nurse doing my year on medsurg the hospital I was working in starting “experimenting” with staff mix. And not for the better.

To set the scene, this was in late months of 2001, I had been a nurse for 4 months. I was a newbie, wet behind the ears, still afraid to confront doctors. Oh, how times have changed.

The first thing they did was go to ‘team’ nursing. I had an LPN, and 1.5 CNAs, and 20 patients, which was half the floor. I was expected to assess all the patients, give all the IV medications, and oversee the LPN and the CNAs. You know what is troubling in that set-up? One patient going south, and by that I mean coding, or falling, or pitching a fit and holding the other nurse who had the other half of the unit at knifepoint.

That really happened. The patient was psychotic and threatening to jump out of the window and threatened the nurse with the knife that had been in their bag from home. They wanted the window opened and they were not going to take no for an answer. Never mind that the unit was on the second floor of the hospital. Not a lethal distance. This is also when the hospital developed the code gray around threats from patients. Security and the police came, and the patient was disarmed and put back to bed in a room closer to the nurses’ station where there could be many people watching them. It was a tension filled evening. And charting happened until way after midnight because no charting got done during the crisis.

The point is that the entire evening was wrecked in terms of patient care. The LPNs and the CNAs had been medicating, and positioning patients, and getting them ready for bed; in other words, keeping them calm and unaware of what was going down in room 201. The other RN and I were trying to de-escalate the situation, struggling to assess our patients, making sure that all the orders were carried out. It was a mess. But funnily enough, not the shift that sank the new program, or not the only one. I had a patient who was a self-harmer for attention, a patient who had Munchausen’s. They were in their early twenties and had a self-reported history of cancer, a central line and they would pull blood from the central line and have “bloody emesis” to cause a ruckus and many phone calls to the doctor. This was witnessed and the patient referred to the local psychiatric hospital.

The RNs had been complaining for days about this new team nursing paradigm and several shifts that went sideways in a week was the impetus to change back to the normal workload of 1 RN for 10 patients. This is not the workload of nurses today, thank goodness.

And then administration glommed onto 12-hour shifts. Who doesn’t want two more days off a week? The units could be run with less staff. Think of the savinge!

This ended up happening. Two extra days off a week is not a gift. It is recovery time. Nursing is hard and physical work, not to mention the mental work.

However, this was not created with nurses in mind. It is, and has always been, about saving money by requiring less staff.

Cookie Thursday 7/28/22- baker’s day off

No cookies this week.

I have seen the wrong side of morning from the night way too often this week as I watch my 3rd sunrise taking a patient to the ICU after doing surgery on them all night. And it is only Thursday! This baker needs a week off from baking.

Because I’m tired.

I had a plan. I had a recipe all ready to go. But three-hour of sleep segments BID (that means twice a day) of sleep is not very conducive to wanting to bake. I’m afraid I’ll burn the batch because I am no paying attention.

This is the value of this call shift becomes even more glaringly obvious. Instead of staff having to work their shift and take night call and work all night and work their next shift, the burden is on the call team. But the team member could go home early. Yes, IF the schedule allows for that, and no one else has called in sick. Shockingly it transpires that the staff member who has worked all day the day before, had the evening off, working call cases all night, and is expected to work their normal day shift. Medical personnel fatigue is a real thing. And is against policy. And AORN standards.

I had a good friend die in a car accident after the end of a night shift while she was driving home. She fell asleep at the wheel on a winding mountain road that you need your entire attention on.

The call shift is a good thing. It allows for consistency for the surgeons 5 nights a week, and night rest for the regular staff 5 days a week. Now if I could only get a certain CRNA to show up on time after I text them that the patient is in PACU and ready to be seen. There is nothing I hate more than inefficiency and making the sick patient and the rest of the team wait for the CRNA clocks high on that scale.

No Cookie Thursday is a Thing this week. If you want to call it a week in the continuing one woman protest against overturning Roe v Wade, you may. But that is just a side benefit and not accurate. Because women in the 18th century didn’t get the day off because they were fatigued. Someone has to cook the meals and clean. Hell, weekends weren’t a thing until the late 19th century. The Oxford English Dictionary clocks its first mention of the weekend to 1879.

I am going back to bed to have the second 3-hour segment of the day.

AORN Expo and conference 2023 thoughts

All podium presentation applications are due on Sunday.

I have 2 ideas that I am considering.

Number one is the the phoenix rising of shared governance in a corporation. I am on that committee. It is very important work. I think I would have to get permission from the C-suite though. Or I can spin it as the using whatever the corporation comes up with in my home hospital as a test case. I don’t know, maybe. I like the imagery of the phoenix rising from the wreck of the last two and a half years.

Number two is Don’t Mind the Pager; or how to stop worrying and love the call. This would be soundly in my wheelhouse. Call should not be scary. I have a project going around call bootcamp in conjunction with my Call Preserver tip book. I am proud of this book, and for the unit for not getting rid of it when I started the call shift and stopped being the evening charge nurse. I know it has helped people and I show every new nurse when I am doing the call bootcamp. I just need to formalize it into an actual project. I wonder if I will need IRB.

Or I am just a unicorn who likes call.

All poster applications will be due at a later date, probably October. Okay, I quick checked the website, October 2. I will be writing up both these ideas for poster abstract. I’ve had two in one conference before, why not try both.

But the big question mark of the entire AORN conference for me is the location of the 2023 conference. The conference will be held in San Antonio, Texas.

I am of 2 minds about going. Yay! Conference. Boo! Texas and its extreme limiting of women’s rights. I have negative desire to go to Texas in this political climate. However, I am beginning a project with other AORN members regarding a novice OR nurse publication and I wonder if participation will be highly encouraged, if not mandatory. I can also get ideas for further projects of my own, this may be useful for school.

On the third hand I do not want to be a second class citizen and give money to the state that acts like I am less than.

Because I happen to have 2 X chromosomes.