Post-it note June 20, 2021

The note from this post-it is very long.

‘I definitely feel punked or gaslit.

The call sheet and the board with the call assignments did not match.

So I asked the guy whose name was on the board and he told me, no, it wasn’t him, must’ve been an error, one person was taking the first part of the call and the person on the call sheet was taking the latter portion.

Fast forward a bunch of hours to the middle of the night and I am fruitlessly calling the call sheet person.

After six phone calls, plus the supervisor calling he finally answered and said that he wasn’t on call.

Huh.

I started calling around and no one would answer.

Bear in mind this is 0200.

I called the guy whose name was on the board and he answered.

He also said that he told me that the call was him earlier and the woman who filled out the sheet did it wrong.

I have to say this puts a bad feeling in the pit of my stomach.’

This is where the note on the front and the back of the post-it ended.

This was several days ago and I still have a horrible feeling about the entire situation.

Do I think he lied to me outright?

Yes.

Do I think that he think he was being funny?

Yes.

He has a reputation of a bit a jokester.

But I do not find it funny.

You see, I asked him point blank about it.

And he denied it.

The only reason that came to light was the fact that we have a middle of the night case.

I told our assistant nurse manager about being punked or gaslit by this.

Nothing will come of it.

Which is the worst feeling of all.

Hello, and welcome to call at (hospital)

I’ve been threatening to write my welcome to call at my hospital letter a long time.

I was persuaded against it by my boss and possible call changes coming.

So I desisted.

But recent tom-foolery around call has prompted me to start the letter anew.

In a fit of pique, I finished the letter.

The next day I read it again, to make sure that my anger and disgust didn’t come across on the page.

Good, it didn’t.

In the letter, to be given to new doctors and PAs, as well as existing ones.

I lay out explicitly things the department wants people to know.

  1. the hours of operation
  2. the hours of call
  3. the phone numbers
  4. some helpful hints about calling in the call team, such as there is a 30 minute response time, and then the create the case, pick the case, get the patient, prep the patient before the case even starts time
  5. the fact that #4 may take upwards and beyond an hour
  6. the fact that if their case is in need of a set that doesn’t live at the hospital the wait time for preparing instruments that are brought in from the outside
  7. The fact that #5 may take 3-4 hours from the time the set hits the sterile processing department

My boss read the letter and agreed to give it out at the surgical committee meeting in July.

I told my boss I wanted it given to any new MD as well.

I told my boss I also wanted it laminated and placed at all the nursing stations.

To quote Miracle Max and Valerie from the Princess Bride:

Valerie, “Think it’ll work?”

Miracle Max, “It’ll take a miracle.”

Problem of your own making

Yup.

This is a problem of your own making.

Let me get this straight.

You told me to step back from doing my job as soon as I get in and let the day charge continue to run the desk until they left.

Whenever that would be.

Because you let them craft their own schedule.

While denying me anything less than 5 8s.

Cool.

I did as you ask and let them run the board until the end of their shift.

And it was chaos.

AND you decided to fix it.

But you didn’t solicit ideas of how to fix it.

Or tell me there was a problem in the first place.

Or ask.

You added an additional complication of a second charge nurse that will take care of the new chaos that you created at 1500 by not letting me do my job.

Because of the chaos that you created by having someone who isn’t really committed to the board run the board.

Instead of, you know, letting me do my job.

And you cloaked it in the all the other kids are doing it stock phrase.

Cool.

You should have left well enough alone.

I am more than capable of taking the board over at 1500.

Calmly.

Concisely.

Fairly.

As I’ve been doing for 6 years now.

Instead now I do not take up my charge duties until 1700.

Cool.

And I do not get any say in how the after 1700 rooms should be staffed?

I’ll be on the floor; moving patient, cleaning rooms and hauling trash.

Because there isn’t a consistent ORA after 1500.

Until it is time for the new level of day charge to allow me to take over.

When they want to go home.

Super cool

Cookie Thursday June 18

Today’s Cookie Thursday is a Thing cookie was a cookies and cream cookie.

Confession: I do not care for ice cream. Never really have.

But lately I am crushing cookies and cream by the local grocery store.

And in this month of Baker’s Choice I decided to see if I could put Oreos into another cookie.

You can!

I also added cream cheese because my friend asked me to do a cream cheese cookie as she was out of town when there was a cream cheese chocolate chip cookie.

As I was looking to the past posts I noticed I was remiss in doing a Cookie Thursday post last week for June 11.

Last week I made home made pretzels.

They are super labor intensive.

You have to make the dough, rest the dough, roll and cut out the dough, rest the dough, boil the dough in baking soda water, bake the dough.

Last time I made these, several years ago, I offered a plain with mustard pretzel, and a cinnamon and sugar one. And people went gaga for the mustard pretzel and ignored the cinnamon and sugar one.

This year I made slightly more plain with mustard and everyone scarfed down the cinnamon and sugar pretzel.

Oh, well.

600,000 dead

That is a stark headline.

And it is meant to be.

600,000 dead from COVID in the US.

Yes, the rate of death is slowing.

Yes, most of the patients who are hospitalized are unvaccinated.

Yes, not everyone can be vaccinated.

Half that number would have been too many.

And the US reached that number December 13-14, 2020.

Let us tease apart what that means.

According to news sites, the first COVID death occurred in February 2020.

The US reached 100,000 deaths at the end of May 2020.

3 months.

300,000 deaths were reached in December 2020 .

6 months.

The US reached 600,000 deaths June 15, 2021.

6 months.

Yes, January and February were grim.

Yet, the numbers are still mind numbing.

I am sure I am not the only one who thinks that the COVID death rate was way undercounted.

In every country.

Including our own.

We may never have an accurate accounting of the COVID deaths.

That is not okay.

Healthcare workers are not okay.

Businesses are not okay.

There has been an unwanted and unwelcome schism in the political parties over this.

I don’t care what you believe.

I care if you are vaccinated.

And I feel for the ones who cannot be.

Who must stand by and watch people say they are not getting vaccinated because X, Y, Z.

COVID doesn’t care.

I have been fully vaccinated since January 25.

My husband has been fully vaccinated since May 14.

This means 2 weeks after our second shots.

I’ve taken my shot.

How about you?

Fake it til you make it.

Newsflash, I’m tired.

Regardless, I had an interesting conversation with a patient I was prepping for surgery last night.

It was so very late.

He was having a surgery that he obviously didn’t want to think about.

So he asked me about how the pandemic had been treating the hospital.

And specifically, how the pandemic had been treating me.

He said that he had been so relived when he got his second shot.

In fact, he had signed up for his first and received it the very first day that his age group was eligible.

I told him that I had never been so excited when my husband got his second shot in the end of April, although I had been vaccinated since January.

While waiting for the rest of the team we talked about many things.

Just not the surgery he was having.

I allayed his fears.

I comforted him.

I laughed with him.

He talked about being excited to get home in time to take the dogs out for their morning walk.

I talked about how exciting it had been to serve as a vaccination nurse.

And he showed me pictures of his dogs.

When the double doors opened, heralding the surgeon come to sign the consent, he turned to me and said that he could never be a nurse.

I smiled, with my eyes of course, and asked why.

He said that he was too much of an introvert.

After the surgeon came and signed the consent, I leaned in close and confessed that I was a huge introvert.

That people are hard for me.

That I fake it.

But everyone needs care.

He smiled at me, with his eyes and said well you do a good job.

Post-it note June 13

I am a note taker.

To say I love to take notes is not an exaggeration.

I take notes during meetings, just to remind myself what was said.

I take notes during classes, again to remind myself what was said.

I take notes to remind myself why a situation drove me a little crazy.

I take notes to remind myself to bring up a situation with management.

I take notes to remind myself that most things are funny, you just have to find the angle.

But today’s note reads,

“awkward conversations: meeting with nurses at a sister hospital with them asking about nurses they “lost” to my hospital. But I don’t know them. Bitten off comment OR nurses aren’t real nurses.”

This is a 200 bed hospital over 9 units, of course I don’t know everyone.

However, the latter half of the comment is what led me to pick it to discuss.

OR nurses aren’t real nurses.

We have patients, we give medication, we chart. What’s not real about that?

Oh, I don’t take care of patients through my entire shift.

I do. It’s just that my shift is a bunch of little shifts crammed into one.

I have patients that I have to care for. Yes, they are under anesthesia but not the entire time.

I also have to make sure that they are safe going under and waking from anesthesia.

I have to ensure that the surgeon has everything they need to operate on this particular patient.

I have to coordinate care across multiple disciplines: radiology, pharmacy, sometimes disciplines in my own department.

Every single patient represents an entire shift.

And the quicker surgeries, that just means that all the different aspects the OR shift have to happen, sometimes within 15 minutes.

Again and again and again.

Unfortunately this is a sentiment that is pervasive in hospitals.

OR nursing isn’t real nursing.

Alicia Silverstone said it best in Clueless.

As if.

Yup, yelled at a doc today

Yes, I yelled at a doctor today.

No, I do not regret it.

The number one thing I say over, and over, and over, and over.

And over.

Is move the bed away from the table when you are sitting up a patient.

We had moved the patient.

The tech and I were conferring near the end of the bed about troubleshooting the table.

I stepped away, after putting the side rails on one side up.

To turn off the table.

I look back and the anesthesiologist is trying to sit the patient up.

My hands flew out.

I called out loudly, “(Name), stop!”

He did not.

The bed clunked as it strained against the hundreds of pound bed.

I could see the table trying to move.

The bed clunked again as it was straining against the bed.

I repeated my warning.

He looked at me, wide eyed.

Rather an Alfred E. Newman look.

I scolded him.

“The one thing I repeat every FUCKING day is to move the bed away from the table before sitting up.”

He put his hands up and stepped away from the bed.

“You can flip the table and damage the bed.”

He carefully didn’t look at me on the way to PACU.

I mean, what the actual fuck?

Never written up an MD before, perhaps I should

And the struggles with no doctor call continue.

Last night I got a text from the supervisor about a D&C on the floor who was bleeding.

I replied no doctor had called me, texted me, smoke signals.

Nada.

I texted the CRNA and told her there was an imminent urgent case that I knew nothing about.

She texted back that she had called in her OB back-up, as she was stuck in endo.

I texted the surgeon that I heard there was a D&C, care to share?

I got an immediate call back.

She said there was a bleeder on the floor who needed to come down urgently.

She said that she had called the anesthesiologist.

I reminded her, gently, that the first call should be to the OR charge, so that I can get the ball rolling, the patient sent for, and inform the anesthesia team.

She pushed back, telling me she had been in the room with the patient.

Um, yeah, but nothing happens until you call the OR charge.

I don’t care that you told the anesthesiologist, who, it turns out, gave you incorrect information.

I don’t care that you told the floor nurse.

You have to tell the OR charge.

Which is me, hello. (waves)

Already behind the 8-ball, I got the tech to pick the case and set up the room.

I got PACU to call for the patient and put a fire under transport.

I finished setting up the room, offered to help with the quick prep.

Reminded the doc again when she came down of the proper procedure for scheduling an add on, emergency or not.

I was hopping mad.

Because this entire circus?

Cost us about 30 minutes in preparation time when we could be getting the patient down, prepping the patient, making sure that the blood that had been ordered was ready and beginning the blood.

And when you’ve already hemorrhaged for five hours, thirty minutes can mean life or death.

I hate beginning already thirty minutes behind.

To do:

I will finish the welcome letter to MDs about add on process.

I will get it blessed by surgical committee.

I will get it posted in all the units of the hospital.

In the midst of the chaos the general surgeon called with another add on.

A lap appy.

Because of course he did.

Prepare before case ends

I have heard it from many surgeons.

“I want an evening shift turnover.”

For a long time I thought that meant that evenings could skip from room to room.

However, we usually stay in the same room and just turn it over.

Monday, I relieved in a case that was finishing at 1500.

There was a case to follow.

When I relieved the day nurse, I looked around.

There was trash everywhere.

The irrigator had not yet been taken down, although they were past that point.

The bovie was still plugged into the generator, although they were past that point.

A trash can had not been readied to receive the drapes and back table supplies.

I set about picking up the trash, taking down the irrigation, emptying one of the large barrel trash cans, putting a new liner in the same large barrel trash can, unplugging the bovie.

Just, you know, generally tidying up the space to make turnover easier.

And it hit me.

One of the reasons that evenings has such a fast turnover has everything to do with the fact that I begin preparing for the next case while still in the previous case.

Trash is picked up.

Equipment that is no longer in use is pushed aside.

Furniture that is no longer in service, such as prep tables and basin holders are placed to where they will be used for the next case.

There is always a trash can that has enough room for the drapes and back table supplies, even if I have to empty a trash can and put a new liner in.

The suction canisters, if no longer in service, are taken off the suction tree and treated with thickening agent to thicken the suctions.

This is done as the surgeon or PA is finishing closing.

At the same time I am making sure they have their dressings, and that PACU has been called.

All that remains is to wake the patient up.

Finishing getting the trash together and taking it out.

And turning over the room after they have left the room.

As we were wheeling the patient to PACU I looked at the CRNA at 1510 and told them, “The wheels in goal for the next patient is 20 minutes. Which makes it 1530.”

And we were.

Huh.