Friday Funsies- 6/24/22

I’ve been noticing a trend in my posts. They sometimes can be a downer, with an odd funny one thrown in. I’ve decided to be more intentional with the funny ones. Yes, the world is a bit of a scary place but there is humor to be found, even in healthcare and nursing. This is the first Friday Funsies post.

Of course, my humor isn’t for everyone. It is dark and can be self-deprecating.

Oh, well.

In an effort to learn all the things that I am doing during the run-up to school starting in August, and also learning things I think I need to know prior to school, I’ve been doing classes and webinars. What about? All manner of things.

The use of UV disinfection for hospital rooms. The cleaning of the instrumentation and the special cleaning methods used for high level disinfection things that can’t be sterilized. More about blogging and WordPress. More about writing in general. The funniest one I’ve done is You’re Not a Shitty Writer series. This one is about the self-doubt that all writers have. I finished up the AORN Expo education that I did not get to do in person because of conflicting times. I did investing for dummies (not it’s actual title), and a how to not freak out when the market is webinar.

The point is I do 3-4 hours of education a week. Because if not me, then who?

This last week I was in an Excel class put on by the local library. There are many classes that my library put on; this is the third class I’ve been to. And I know I need a refreshed on using Excel as I will be using it extensively during university.

It was meant to be a class of 5, but just myself and another showed up. A 12-year-old whose father had signed them up and accompanied them to class for half of it.

The instructor was showing us the various bells and whistles of setting up a basic Excel workbook page. And the 12-year-old and I were following along, doing the exercised in tandem with the instructor on the library computers. Until it came time to save.

In Excel there are multiple ways to do pretty much everything. This holds true with saving. There is the menu button, there is the save icon at the top, there is Control S.

The instructor told us to use the save icon at the top left of the screen. This looks like a floppy disc. The 12-year-old couldn’t find it. Said they didn’t know what a floppy disc was.

The instructor and I shared a look. Of course, the kid had never been exposed to a floppy disc as the only world they knew was cloud based.

We did not laugh. It was not the kid’s fault that technology had changed since we’ve learned about technology.

How to get Microsoft to change their save icon? Letter writing campaign? Or a TikTok?

The juxtaposition between generations in using the computer. But I think it is emblematic of all generational push and pull. And this is why the next education I seek out will be about teaching different generations. Because if i am serious about teaching college I must learn how to speak their language.

I almost said cool kid language, but I’ve never been cool.

And I know that learning about generational education styles will let me educate other healthcare workers in the hospital.

Yeah, this was only mildly funny. I’ll try harder next week.

Cookie Thursday 6/23- chex mix

Inflation baking continues.

I ONLY make chex mix in December. Seriously, this is a hard and fast rule in my kitchen. Much to the dismay of my coworkers and friends who enjoy my recipe.

But it is now 6 months to the holidays. And I think we need a little encouragement/fun with the inflation, and price of gas, and pandemic, and war in Ukraine, and… Well, it’s a lot. And I know that out of season chex mix will make my coworkers smile. And none of us are guaranteed another December.

And it has been 95-100 degrees Fahrenheit here in the American South and it is too hot to run the oven during the day. My chex mix recipe bakes low and slow because everything contained in it is already cooked. The oven is set to 225 and I bake it for 2 hours, sometimes less, with frequent stirring. It smells amazing though.

What makes this recipe an inflation baking is the usage of ingredients already in the house. I overbought Chex cereal when it was on sale and I have been storing the excess for this upcoming baking season and they weren’t going to expire until January 2023. Why not use it now?

Also what makes this recipe an inflation bake is the utilization of plantain chips in place of pretzels instead of going out and buying pretzels. I had the plantain chips and I needed to use them so into the mix they went. These are garlic plantain chips. I have no idea how people are going to react. And as this is an experimentation, that is half of the fun.

When I was writing on the board what would be the inflation baking cookie of the week I added a note to remind people that the holidays are just 6 months away. And have they started shopping? Or started saving, although that would be a high bar what with the aforementioned worldly ills.

One thing the slow moving organization frenzy that I am in has been good for is finding presents that I bought and neglected to give to people. Sometimes because I found something better, sometimes I because I forgot where I hid it from myself. Now I have a small pile of presents ready to be gifted at the holiday season. It’s a start. Every little bit helps.

The use of inflation baking as a theme these last two months is to encourage the use of ingredients that already are existing in my house. My baking pantry was stuffed to the gills with Cookie Thursday is a Thing ingredients; it is less stuffed now.

Hospitals and healthcare professionals also suffer from this scarcity mindset or mentality. We are always saving in case a thing can be useful in the future. The sticker is that you have to utilize the thing that you’ve saved, not just buy the newest, shiny sexy thing.

Heal through compassion

As I wait for August because all the exciting things happen or begin in August, I have been doing a lot of continuing education. I mean I have to keep the learning muscles up and ready for school. I get different CEUs from different sources. Or. sometimes, I don’t get CEUs but they are important talks to attend.

Including different avenues from the hospital. This past month I did a research symposium where I learned a lot. And my advisor for university was the key note speaker. And at the end of last month I did a class on the Pause. This was not the surgical time out. This refers to the moment of silence among the healthcare workers after an unsuccessful code blue and the patient dies.

Because we are not going to win them all.

This is an intentional pause.

It is done to acknowledge the patient who has just died. Because they were a person with hopes and dreams and desires in life. And they had every expectation of going forward with that life.

Until they couldn’t.

It is also done to acknowledge the healthcare team who were working to save them. And all their individual effort during the code.

And couldn’t.

The Pause is an international practice. And was started in 2009 by Johnathan Bartels, an emergency room nurse. And has spread since, even to television shows. I think this is something that has always been done, to some extent, but now it has a name. And naming things is influential.

This is a way to acknowledge that with all of our medications, and tools, and machines, this person who had value was unable to be saved. It is a moment to recognize that something momentous has happened. And while momentous things happen every shift, especially in the ER, this was the patient’s momentous thing. And it was also a thing that happened to the healthcare workers.

To me, the pause is a moment to recognize that this has happened, to realize that there will be changes in the survivors lives, and to realize that were will be a change in my own life. Because every death impacts the healthcare worker. The pause allows healthcare workers to realize that something has happened, to acknowledge that it happened, and to set it aside to help the next patient.

This 1 hour webinar was powerful. And made me think about the times I have pronounced a patient dead while working in med surg. And all the times that perhaps went unacknowledged in the last two years as patients died alone in their beds. Except for the healthcare workers who were there. And they just kept giving care to their next patient after pausing to reflect, very briefly, on the one who just died.

I hope that understanding that someone was there when they couldn’t be gives comfort to the families.

Monday’s Musings 6-20-22- covid vaccine roll out for the littlest

All last week I waited with bated breath watching for the FDA to finally approve the covid vaccine for children ages 6 months to 5 years. I have friends who have been waiting for this for as long as their babies have been born.

The approval finally came down on Thursday.

And the CDC followed up on Saturday and voted unanimously to grant emergency status.

Yes, it is true that kids don’t get as sick as adults. But it is still potentially lethal to children, as at least 450 kids under 6 have died.

I know people who have been in virtual lockdown as there is a member of the household who cannot get the vaccine and cannot send their child to pre-school or school in case they bring the virus home to their family member.

Is vaccinating their child a choice every parent will make? No.

Should they consider the options and not listen to histrionics who claim that the vaccine magnetizes your child or you, or has a tracking chip in it? Yes.

People like these who have politicized the vaccine roll out because it suits them and go on to poison others with their warped thinking are the reason covid is still a thing. And still evolving. And people are still dying.

There are new variants I’ve been watching in the UK-BA.4 and BA.5. This variant seems to be able to somewhat dodge the antibodies from vaccination and infection. But if we keep going like we are down this path of variants there will be a variant that can completely ignore the antibody status, regardless of how it is obtained.

And then we will be right back where we started. A virus with no vaccine that can teach your body to attack the virus.

And the hamster wheel would begin again.

Don’t make us go back in time.

Get your vaccine.

Vaccinate your children.

This is the only palatable way of ending this.

And if I have to plan my trip to the UK again for the 5th time, we will have words. And they will not be nice ones.

Post-it Sunday 6/19/22- don’t be the prey

The post-it reads, ‘if you act like prey, you will be treated like prey’.

We have all seen or heard of the attacking surgeon, have we not?

The one who paces.

The one who complains when their case is late.

The one who complains when their case is early, why didn’t we tell them.

The one who complains about the team in their room.

The one who complains about the team from two weeks ago.

The one who complains that the scissors are dull.

The one who complains that the light source is not bright enough.

The one who complains about the room being too hot.

The one who complains about the room being too cold.

Okay. I was only kidding with that last one. The room can NEVER be cold enough for some surgeons.

Complaints aren’t attacks, although they can feel like them sometimes. And some surgeons live to complain. This makes their room unpleasant to be in. But they are not frightening.

But some of the OR staff may find them intimidating or frightening. And some staff may refuse to go in their room because of this.

This is the wrong approach.

If staff acts like prey-timid, questioning, afraid to speak up. This signals to the surgeon that the staff are not confident in their skills. Which makes them doubt the staff. Which makes them do all of the complaining above.

If a surgeon is acting like a jerk. Tell them. Tell them exactly what you find objectionable about their behavior.

In my experience, they will back off, if not apologize.

And if they don’t back off, report to management.

Do not act timid in front of them.

If any of the staff would like to borrow some backbone call me and we’ll talk through it.

At the end, everyone in the room just wants what is best for the patient. And if their behavior is causing the patient not to be safe because the staff in the room is too intimidated to speak up, tell them to knock it off. Or find someone who will.

Gurney, not stretcher

Come closer…

Closer…

closer…

So I can hit you over the head for calling a gurney a stretcher!

This literally slays me every time I go to the hospital.

This is what is known as a malapropism.

No, not a prolonged erection, the word for that is priapism.

A gurney has wheels.

A stretcher is two long sticks with a fabric sling between them to carry a patient. Two people are required to carry it. One of each end. Otherwise you’d just be dragging the patient with 2 sticks and some fabric. Don’t do that.

No wheels!

A stretcher is used when it would be difficult or impossible to have wheels. And the patient needs a quick in and out rescue.

As on a battlefield.

Somehow the conversation always wends back to healthcare being a battlefield making the blog’s title appropriate.

I don’t mean to do this.

Yes, I get that the words gurney and stretcher are used interchangeably by most people.

But not by me.

You may even get a lecture from me about the difference if you tell me to get the stretcher when you really want the gurney.

Cookie Thursday 06/16-mini popovers

Inflation baking continues. The ingredients in this “cookie” are simple- eggs, milk, flour. And that’s it.

Popovers are meant to be more of a savory but when I make them I always reserve a couple to have with cinnamon sugar. Because a fried tasting dough that is NOT fried with a cinnamon sugar to dip it in? Yes, please and thank you. Considering how simple they are to make I am shocked at myself for not making them more often.

And today was an experiment. Aren’t they always? I do have a popover pan but that is for big popovers. I honestly had no idea if using the mini muffin pan would work. And it did! Yay, I love it when my experiments do not go awry. I’m looking at you, oatmeal bbq chip cookie. You should have worked.

As always there was a learning curve when using the mini pan. Only half of the batch “popped” over the top of the pan like they were supposed to. I may need to add more to the well next time. Or rest the batter. I’ll find out when I make them again. That is half of the the fun of Cookie Thursday is a Thing, I get to experiment on my coworkers. I wonder if adding a hard cheese, such as parmesan would change the popover. We’ll find out.

Recap: popovers that taste like fried dough but aren’t. A popover shell that can be savory or sweet depending on the add ins. It is hard to beat the yum factor of either.

The reason I have themed this month and last Inflation Baking is not going away.

Sticker shock is everywhere.

I know people who are economizing purchases. I’ve been to the dollar store at least twice this month. And I have been exploring Aldi for food. The jury is still out on Aldi. I’ll see. The cereal is good though.

Last month another nurse gave me $20 for supplies after she heard that Cookie Thursday is a Thing is a self-funded, one woman operation. And it is but it gives structure to my week and a weekly baking experiment. I gave one of my last pounds of butter to my mom so that she could avoid going to the store. I mean, I get food from them at least once a week. I had a pound and a half left that I haven’t touched in 2 months. I mean, inflation baking has been light on butter usage. And butter is the most costly ingredient in this endeavor.

I’ve been stalking the weekly supermarket ads, waiting for butter to go on sale. There are SIX grocery chains in the two towns that immediately surround my own. I am also not opposed to store brand butter. And these things are cyclical. I missed butter last time, about four weeks ago. And last week I missed butter at one of the stores because I didn’t want to drive to the store. It is all about batching the errands, you know.

But this week another grocery store had butter on special, and it was on the way home. I got 4 pounds of a chi-chi butter as it was on sale, and cheaper than the store brand, and a pound of another brand I have never tried. 5 pounds of butter for my $20. Not too shabby.

What does it mean to be called in? Part 10-PACU

This is the concluding part of the what does it mean to be called in journey.

But all call cases are not lap appys.

True.

But a case, any case, follows the same steps.

  1. there is a call/page
  2. you answer it and take down information on the case
  3. you call the supervisor to inform them there is a case
  4. you head to the hospital
  5. you schedule and pick the case
  6. you go to the ER to pick them up
  7. you do all the preop checklist with them for surgery
  8. the surgeon arrives, they and the anesthesiologist talk to the patient
  9. consents are signed
  10. patient enters the OR and undergoes induction of anesthesia
  11. the patient is prepped and draped
  12. pre-incision timeout
  13. incision and beginning of case stuff
  14. the object of the surgery is identified
  15. you pour the medications on the field
  16. the surgeon begins to close the surgical incision
  17. the patient emerges from anesthesia
  18. you take the patient to PACU
  19. if there is another case, rinse and repeat

Delivering the patient to PACU means that I am handing the patient off to another nurse. There is information that I have to impart to the PACU nurse that sums up the entire case in an info dump.

The PACU nurse needs to know who the patient is, why they have had surgery, what the surgery entailed, where they are going after PACU, and any concerns that you have about the patient and their expected course.

To report off on Patient A, I would start with his name and birthdate. I say that he has appendicitis, and which surgeon performed the case. I discuss the dressing, dermabond in this case, and the three port sites on his abdomen. I say there is no drain and that 30 cc of marcaine 0.5 % was injected to the port sites. Finally I say that Patient A is going home after PACU. By this I mean that the patient is not being admitted and, after the acute PACU phase, the nurse should get him ready for discharge.

All of this info dump is being performed while we are hooking the patient up to the monitors: blood pressure, cardiac waveform, and pulse ox.

After asking if the PACU nurse has any questions I pick up the specimen to take it to the lab. Specimens are not to be left in the PACU, except during the day when the lab rounds on the specimen holding area. I check the holding cart whenever I am at the hospital, and take specimens I find there to the lab.

And I log out of my OR phone and hang it up at the desk.

And prepare to go home myself.

Monday’s Musings-6/13/22-Inflation Bites

Inflation is on my mind and weighing down my wallet.

Yeah, yeah, inflation of basic goods and commodities hurts. Especially when costs are carried over to customers.

And gas prices. Yikes!

Contrary to popular belief this is not the fault of the current administration, or the previous one. This is the fault of the pandemic. Oh, yeah, there are mitigating circumstances that do not help. I’m looking at you, invasion by Russia into a neighboring country and blaming it for being invaded. Because your mad tyrant wants to get the band that was the USSR back together.

A pointless war that is killing civilians and uprooting scores and scores of Ukranians from their home is not helping inflation. And, in fact, is a contributory cause.

The supply chain crunch that is causing panic buying. Again!

The shipping woes of the world.

The covid woes of China’s strict zero covid policy.

The refineries not being able to keep up because they laid off people due to the decrease in demand during covid and, gee, can’t ramp up as quickly as they ramped down. I wonder why that is (sarcasm).

The baby formula factory that was shut down because of baby deaths. Which led to a massive shortage of needed formula. And the panic that ensues in parents. Because babies gotta eat and they are not ready for solid foods. Or are medically fragile and how they thrive is a certain type of formula. And there is a shortage of that formula and most formulas. And parents are desperate because they just want to feed their children. I could go on about the dangers of having a very small number of companies in an industry and what happens when one falters and brings the entire industry down.

The needed wage pressure from jobs that haven’t had an increase in the minimum wage since 2009. Workers are burned out from the last six or so years, especially the last two and a half. And are leaving jobs to seek better paying jobs; sometimes in other workplaces and changing industries altogether.

Even if there is pressure from the housing market and the rental market and the automobile market.

It’s the ginormous, bubbling vat of all these problems that is causing inflation.

And everywhere there is suffering.

Even the countries with different leaders. Don’t let some people hear you say it though.

It is a scary time in the US. But I’ve lived through that before. To borrow a British WWII slogan- Keep Calm and Carry on.

A Cookie Thursday is a Thing consumer handed me $20 for supplies two weeks ago. I purposefully held on to it because I knew what the pantry needed. I am down to my last pound of butter, and although inflation baking as a theme for 2 months is helping, I still require more. I was able to get 5 pounds of butter for $19.00. Yes, that is an entire dollar more a pound than I had been paying but still less than the $5.00 a pound or more that some brands are charging. I did this by watching my grocery store sales and buying when the butter was BOGO or buy one get one free. 1 pound of the grocery store brand is $3.69. I got 4 pounds of Land of Lakes extra creamy butter, kind of like European butter, for the price of 2. And a new brand that I had never heard of for $3.50. We’ll see how that brand bakes up.

Overall, this reminds me of when my husband and I were newly married and poor as hell. I am leaning on some of the tricks I learned then. Buy off brand, look for sales, have a list and strictly stick to it, consider substitutes if exactly what is required is not available, eat less meat, protein substitutes such as beans and lentils, and count every penny.

And gas prices. Dear me.

Thankfully I only fill up once a month due to the new shift and not leaving the house if I don’t have to. I cluster errands, only go grocery shopping once a week. And drive at 60 mph, to the consternation of the gas guzzlers that everyone just had to have in the last decade. I realize that this is a position of privilege and not everyone can do these things. But they work for us.

And, for pete’s sake, keep your tires properly inflated.

These are all lessons I learned living in CA.

I’m a wee bit concerned about starting at a university that is 74 miles away and having to be at the campus at least once every 2 weeks, if not every week. I hope inflation and gas prices will ease by then.

Be well.

Don’t be stupid.

Keep calm and carry on the best you can.

Post-it Sunday 6/12/22-scripting the OR

The post-it reads ‘using scripts with patients’.

This is something that healthcare has been doing for years. And not just at my hospital.

Scripting is when you use words that you did not write, even if you mean them.

Healthcare providers as a whole are not eloquent. We use jargon too much. We forget to dumb it down for non healthcare people. Not that non healthcare people, aka patients, are dumb, but they don’t know the lingo. And they sometimes feel they are drowning in the alphabet soup that healthcare uses as a shorthand to get a lot of information across to someone who knows and can interpret the lingo. So ixnay on the lingo in front of patients and families.

Sometimes the patients think they know the lingo. This can lead to misinterpretation of the facts when they try to be hip and cool like the healthcare personnel. And cause a headache for the healthcare provider trying to be clear and concise when they are speaking to a non healthcare type person.

The worst kinds of scripts are the ones that are tailored to the patient surveys they receive after care. These scripts use the exact words of the survey questions in order to trigger a memory when it comes time to fill out the surveys. These are not bad on their own merits but feels like cheating. In fact the hospital has told us not to use exact wording from the survey questions. It seems that patients are figuring out that is what’s going on and leading to a mild backlash. They know they are being programmed, in a way, to respond to a certain question in the manner the provider would like. And if there is anything that has been made absolutely clear in the last couple of years, patients do not like to be told what to do. Even if it will save their lives or someone else’s.

Scripting is in fact a programming language that is used to interpret and execute one command at a time. Kind of like healthcare worker trying to get through to their patient the importance of this one little thing. Like the dangers of smoking. Of taking their medication as prescribed. Or avoiding covid.

When I tell you that the patient is an LOL, NAD, CAD, DNR, that may mean nothing. Or it may mean that the patient is an elderly woman, in no apparent distress, with cardiac arterial disease who is a do not resuscitate. Or, where it is dangerous and misinterpreted, when the family decides that all of that means we do not care about the patient, that she should just die. And instead it means that we will treat the patient, take care of her ills, until the time that her heart stops. Because there is a lot of things that can be done until then to make her comfortable.

I’m not sure how I got on to the alphabet soup from scripting conversations that healthcare providers have with patients that mimic the survey questions they will fill out after their care but here we are.

If you get a survey, fill it out. Be honest.

Healthcare entities use these surveys to fine tune care. But don’t let a bad day or a bad experience that is outside of the care provided, such as you got cut off by a driver leaving the hospital, color the survey.