Omicron is way down

Beds taken up by covid patients in my hospital are way down.

They were at 42 at the peak.

With 7 intubated.

What makes this different from Delta is the amount of vaccinated people who were infected.

The hospital did have vaccinated people on vents.

A couple.

But they had co-morbidities that pre-disposed them to being ventilated.

Respiratory issues.

Cancer.

Triple P.

I know I have mentioned this before.

But Triple P stands for piss poor protoplasm.

It is a not very nice short hand to say that the patient is sick.

Has been sick.

Will continue to be sick.

Will never not be sick.

And they did not need another insult to their bodies.

Deaths continue to be high.

As expected the death rate is not falling yet.

Because if Covid has taught us anything, it is that deaths lag behind cases.

That being said the American death toll is nearly 925,000.

Where the death toll hit 900,000 only 11 days ago.

I do not want to celebrate prematurely.

Again.

But someday I hope that covid will behind us.

We just have to be smart as we wait it out.

The AORN conference has not been cancelled.

I don’t think it will be.

That will be fun.

And a chance to get away from home and hospital for awhile.

I have the ticket to the expo.

I have signed up with their preferred Clear app to prove my vaccination/boosted status.

At the behest of AORN.

When I noticed something odd.

After I created an account and uploaded my information about my shots, it told me that the information would expire on 3/16/22.

Two days before the conference.

Sigh.

I have also added my vaccine card to my phone’s wallet.

I figure of the two, one will work.

We have a hotel reservation.

We will be driving down.

The drive has been made before.

Fingers crossed that this conference gets to go forward.

Sunday I was invited to speak to the junior volunteers at the hospital.

These are high school students who volunteer at the hospital doing volunteer type things.

There is a comfort cart that they visit patients who have not had many visitors.

They man the desk at the physicians plaza of offices.

They man the surgical services waiting room desk.

They generally make themselves useful and get exposure to the hospital.

These were 9th grade through to seniors.

And a couple of college students who were to speak after us.

I wish that this had been around when I was in high school.

Of course, I lived kind of far away for this to be feasible.

And I worked evenings at Marshalls starting when I was 16..

Back before Marshalls was owned by TJ Maxx.

That is how long ago it was.

I asked Mom to come with me.

We spent way too long speaking about nursing.

The ins and outs.

The different paths that a nurse can take.

The trials and tribulations of nursing.

The highs of nursing.

And why nursing is valuable.

Why education is important.

Mom spoke about being a new nurse in the mid 1970s.

And how different hospitals are today.

With the technology and the pace.

There were some interesting questions.

What kind of surgeon can be mean?

And how to deal with them.

What about deaths?

How can those be managed.

What has changed the most?

We answered them all.

And took up a lot of time.

But the kids were attentive.

I hope that they would have stopped us if we were taking up too much time.

But mom and I were engaging.

And spoke back and forth.

I spoke about the importance of education.

She echoed how far nursing has come in nearly 50 years.

No one asked about the grossest cases.

That was a worry off my brain.

I was sure that it would be a question.

The college students spoke next.

One who was a junior and one who was awaiting admission to medical school.

They did not have the vast amount of experience that we had.

Mom hit it on the head for them.

In front of them was nearly 75 years of nursing knowledge and experience.

My entire take away for the kids was that nursing can be anything they want it to be.

Mom’s take away for the kids was the more technology changed, the focus remained the patients.

I wonder if we should take this show on the road?

The post-it reads ‘At the same point yesterday, surgeon needed something, scrub needed something, CNRA needed something, OR phone in pocket is ringing, wall phone is ringing. Who to answer first?’

Prioritization is a poorly conceived and executed skill sometimes in the OR.

Which of the 5 somethings got answered first?

Always the first consideration, when presented with such a puzzle, is which need is a legitimate need that puts the patient first.

The CRNA may have only needed a bag of fluids.

Or for me to call the anesthesiologist.

The surgeon may have only needed a refill on the suture.

Or something to do with their next case.

The scrub tech may have only needed more laps

Or for me to turn the radio on.

The wall phone ringing may have only been the pathologist with a read on the frozen that was sent.

Or another surgeon with another case.

The phone in the pocket may have only been PACU with a need.

Or the supervisor with a schedule request.

All of the five could have been something that needed immediate attention.

The patient tanking requiring the anesthesiologist.

The bleeding requiring a stick stitch to throw a stitch across.

The laps needed to sop up more blood that was suddenly there.

The pathologist to tell the surgeon that the sample that was sent frozen showed XY or Z.

The supervisor to tell me that there is a courier at the desk.

All of these scenarios could have been true and have been true in the past.

The best thing to do is to walk to where the monitor is visible, to see if there is anything alarming.

To ask the surgeon what he needed.

To look at the scrub techs sign language to see if it is more sponges that are needed.

The pocket phone can be glanced at to ascertain who is calling.

All of this can be done in less than 5 seconds.

And the priority can fall into place.

The pathologist can speak to the surgeon while you are calling the anesthesiologist and getting the extra suture and lap sponges.

Things can be done at the same time.

But happily…

The surgeon needs to tell you about his next case.

The CRNA needs a bag of fluids.

The scrub tech would like the radio on.

The wall phone is a wrong number.

The pocket phone is the supervisor looking for their schedules.

It is knowing how to prioritize sometimes conflicting needs of the room that makes a circulator efficient at their job.

This is something I try to teach people when I am doing education.

Do not let the cacophony ear blind you to the immediate needs of the patient.

Because they are why we are all in the room.

Covid infections are down.

Not to pre-Omicron levels.

But they are down.

Deaths are not.

As has been seen in all the different variants thus far, deaths lag behind infections.

Which is logical.

Because a person has to get sick.

And sicker.

And seek the hospital.

And get vented.

And linger.

Or not.

They could die at home because they didn’t think they were sick enough for the hospital.

And people go to the hospital to die.

Not every patient, but enough.

But for a country who just hit 900,000 dead a week ago on February 4, the US is still averaging nearly 3000 deaths a day.

And the newest death toll number from yesterday is 915,000.

That is 15,000 dead.

In six days.

Yes, covid infections are down.

Although the US fully vaccinated rate is 64%.

And the partially vaccinated rate is 76%.

And there may be an under 5 vaccine announced soon.

States are racing to drop mask restrictions.

Except where there is a high transmission rate.

I know because I follow the news where the high transmission rate areas are.

But I don’t think the average person would.

But they are happy and eager to drop the mask wearing.

We will only have ourselves to blame if cases go back up.

Because we were greedy for this to be at an end.

Let us not celebrate prematurely and it bite us in the ass.

Again.

Dead is dead.

Fayta.

Fehta.

Same cheese.

Same amazing taste.

Salty and creamy.

Surprisingly non melty.

And spinach because feta needs a foil.

Something to play against.

This is the second week of cheese Cookie Thursday is a Thing month.

I’ve baked these before.

And they were well received.

A sconelet is a small scone.

One of my tricks to stretch a batch to feed many.

But today, I made a second, gluten free batch.

Some I will send to my sister, who doesn’t eat gluten.

I will keep a half dozen mixed.

Because I said so.

And I will give the rest to the ED.

They’ve had a rough, rough, rough go of it.

Especially lately with Omicron.

And the usual falls with fracture.

Appedicitises?

Appendicitees?

Appendix patients.

And holding patients waiting for a bed.

I’ve already had 4.

Good thing they are small.

Zoom is amazing.

I get to engage in hospital meetings without leaving my house.

I get to stay in my pajamas.

I don’t have to clear the ice from my windshield.

Zoom is the worst.

There just is not a lot of engagement at the hospital, regional or corporate level.

Take the group meeting I led to today.

Our hospital has Med Surg I, Med Surg II, ICU, IMCU, ED, Women’s (L&D and post partum), OR, Cath Lab, Infusion Services, and Interventional Radiology.

That is 10 departments.

In the past we had a much more robust shared governance council.

There were representatives from 7 of the departments.

Sometimes 8.

There was more multidisciplinary participation as well.

Pharmacy updates and conversation.

Housekeeping updates and conversation.

Engineering updates and conversation.

Public safety updates and conversation.

Electronic health records updates and conversation.

Patient satisfaction updates and conversation.

We helped them, they helped us.

Those are also fading a lot.

Today we only had two.

An EHR representative for a brief 6 minute presentation.

And the patient satisfaction updates.

Shared governance is about leading from the bottom of the hierarchy.

If not leading, then it is about being heard from the bottom of the hierarchy.

What else do we talk about?

Safety of patients and staff and data from those efforts.

And quality of patient care and work life and data from those efforts.

I believe in the value of shared governance.

Very much so.

So much that I am leading these meetings and participating in these conversations inside of my salary.

No longer do I get paid hourly for the hours that I put in.

Today there were 4 people in the meeting.

OR, Women’s, and ED.

Our Magnet coordinator was also in the meeting.

These are the the same 4 people who have been the most consistent for the last six months.

Really great information was shared today in our efforts to elevate staff.

And some things to focus our efforts on.

Both will be discussed at unit meetings.

At least in the ED, OR, and Women’s.

And anyone else I can get to listen to us.

I can’t make nurses care about what the council does.

I can, and do, point out the good that has come out of the councils.

Things like improved lighting in the employee parking lot.

Better signage inside and outside the hospital to indicate to patients where they need to go.

Increased clinical ladder participation.

It is frustrating.

And demoralizing.

But at least the four of us care.

Healthcare is hard right now.

So very, very, very hard.

Nurses are leaving for more money.

Leaving the rest of us to shoulder the load.

And I would rather keep engaging in the conversation.

Than let it die.

And this is the part of zoom that I hate.

The silence.

Are the shared governance faithful screaming into the void?

I’m very much a consumer of the CEU.

I use them for renewing my nursing license every 2 years in my state.

I use them for renewing my CNOR every 5 years.

I use them for maintaining my clinical ladder.

But, I also really enjoy learning.

And teaching to others.

One of my most frequent question is where to find CEUs for any of these purposes.

And every year I compile a list for nurses, departments, and professional practice binders that we use in our hospital units.

I get the list from a variety of sources:

1. Conferences
2. Online modules/seminars
3. Board of nursing in my state
4. Offerings from the various organizations I belong to- AORN, ANA, my state nursing council, the organization I work for
5. The honor society I belong to- Sigma Theta Tau
6. My current favorite is the Beyond Clean offerings about the sterile processing department

Kind of like the clampy project.

CEUs are everywhere.

Or, to horribly misquote Cole Sear from the Sixth Sense, “I see CEUs everywhere. Hanging around in the the internet, from accredited sources, they won’t be counted until they are found and watched or tested.”

I have got to re-watch that movie.

Right after the CITI training module I am on.

You know the one, about research ethics that are required for the research council. and various shared governance councils.

Okay.

Just me then.

If you want a 2022 updated CEU list, reach out to me and I will send it to you.

There is a legislative movement afoot to wage cap travel nursing.

In many states.

And many urging the federal government to move in the same direction.

This is an example of the free market.

And we all had to take economics in high school and many in college.

Oh, your school didn’t require it.

And you didn’t think you’d need it.

There is a meme that is going around attributed to nurselex.

A nurse in full PPE is embracing/supporting a clearly suffering patient.

The text underneath read

“If a lawyer can make $300/hour to defend violent criminals

and therapists can charge $250/hour for their work

and housecleaners can charge $100/hour

and tattoo artists can charge $150/hour

Then some nurses** making $100/hour should not be a concern of CONGRESS”

Nurses number 4 million in the US.

And we are expensive.

And a big part of hospital payroll.

Because the hospital is staffed 24 hours a day, 7 days a week.

In case you need us.

We’ve been at the hospital throughout this ENTIRE pandemic.

Tending to the dying.

Cheering those who are getting better.

Taking care of those who cannot wait.

And if nurses want to leave to get a slice of something they think is better…

I’ve worked enough places to know that the grass is not greener on the other hospital.

And it is free market to pay nurses what they can get.

And now people in power are clutching their pearls and bleating out ‘wait! that’s too expensive’.

I know of managers who used to tell staff if they didn’t like the changes to go ahead and leave for another job.

I’ve heard from friends that this kind of behavior is still going on.

From hospitals big and small.

I’ve worked for a barely scraping by hospital and I’ve worked for a big corporation.

The poor hospital will have a problem with this.

Several poor hospitals in parts of the country have closed during the pandemic and before.

Because they could no longer afford to stay open.

That is another side of the economics discussion.

Instead of a blanket cap that will never fly because, as a group, we are not willing to be pushed around.

There can absolutely be a conversation about why you feel the need to take such steps.

And can we also talk about your salary?

And by you, I mean the executives, the lawyers, and the legislatures.

And safety?

Of the nurses who have too many patients to handle and care for during their shifts.

Of the patients who have overburdened nurses.

Of the rest of the sick people who need care.

Is this a conversation you are willing to have?

I thought so.

The post-it reads ‘crushing management’s ideas by telling the truth. Would not recommend.’

Can anyone else hear Jack Nicholson’s character in a Few Good Men screaming on the stand?

You can’t handle the truth.

Management used to ask me questions about different matters that came up in the department.

Why?

Because I would always tell the truth.

But sometimes the truth is not what they are looking for.

I don’t care if they don’t want the truth.

I will not sugarcoat my response.

If I think an idea is terrible or has been done many times before and abandoned, I will say so.

That is the problem with being long lived in a department.

And having a good memory.

This kind of response is not very popular.

And, I imagine, gets me a debbie downer reputation.

You want to try the bright shiny idea that has been done before?

Oh, so many times?

Because maybe it will be different this time?

Knock yourself out.

However, you have to be careful of crushing their ideals too many times.

They will stop inviting you to the table for discussion.

And do the terrible thing anyways.

And when it fails, replace it.

Not with the non-terrible idea that came before.

But by something else that is even more terrible.

And non-sustainable.

You’ve heard the adage the road to Hell is paved with good intentions.

Similarly the road to not-happy employees is paved with bad ideas with good intentions.

Because someone did not think it through.

Or ask if there could be any downsides.

Or asking if there could be any downsides in their echo chamber.

No, no, don’t ask her.

She’ll say no.

What could go wrong?

According to the Johns Hopkins Coronavirus Resource Center, my go to for information covid information, the world had crossed 10 billion vaccines administered.

It is not nearly enough.

But it is so very exciting.

The world has come so far in so little time that it is mindboggling.

But, those of us who are living this in the real world, and watching the hospital numbers go up.

And the deaths go up up up.

This is a relief.

It is not nearly enough.

But it is a start.