The post-it note reads ‘when the EHR goes down you can hear the groans of a thousand nurses’.

The EHR is the electronic health record.

Or computerized charting.

And the one my hospital uses is run out of the Midwest with local hospital based server farms.

It is the life blood of the hospital.

It is where we chart.

It is how we order meds/surgeries/consults/transport.

The EHR runs the hospital.

The EHR sometimes gets a bad rap.

But when it is unavailable it can be catastrophic.

We all convert to paper charting.

With the intent that someone enters all the paper charting into the unit navigator.

Some units have people who do the inputting.

Not the OR.

The OR asks the nurse who circulated the case to copy the paper charting to the electronic chart.

The EHR has to be updated periodically.

Those are called downtimes.

They are scheduled.

And mostly are controlled chaos.

For 4-5 hours.

Sometimes there is a power outage and the EHR becomes read only, if the downtime computer is hooked into the generator plugs.

Sometimes someone unplugged the downtime computer because they needed to charge their phone.

Sometimes people are idiots.

However the downtime happens, it is never very easy for the nurse on duty.

Hence the groaning when the computer goes down.

Last scheduled downtime I was at the hospital for, we were doing an emergency case.

I knew about the coming downtime and I outfitted myself and the CNRA with the appropriate paper charts.

Of course, when PACU nurses got there they did not know where their paper charts were.

Someone had moved them.

Quelle horror.

At 0345 I faced a two way street.

I could go home and get up at 0700 to back chart the rest of my case.

Or I could hang out for an hour and 15 and back chart the rest of the case.

If the downtime was over at the scheduled time.

I went home and went to bed.

And got up in three hours to back chart the case.

Because sometimes the sleep you can get is best.

And now the Covid worldwide death toll is over 4 million.

And there is a new variant; the lambda variant.

India has passed the US in number of deaths.

Of course we will never know the true death toll.

Too many governments are secretive.

Vaccines have been slowing down here in the states.

There hasn’t been a volunteer shift in over two months.

The fully vaccinated number for my state is 43%. On the positive side, the fully vaccinated over 65 is 80%.

For a country who has the biggest stockpile of vaccines the US is not vaccinating fast enough.

Many people are looking at the vaccine and saying, ‘eh, not for me.’

Can you get brain damage from face palming too much?

How long until the variants overwhelm the vaccines?

And these people who declined vaccination will be wringing their hands crying no one ever told them.

sigh

Continuing the Red, White, and Blue theme for the month today’s cookie is a blueberry cookie.

What kind of blueberry cookie?

No idea, really.

But not blueberry and lemon, I did that last month.

As I am looking for a recipe for this week, I am reminded about Willie Wonka and the Chocolate Factory and the little girl who steals and chews the feast gum.

Which is not ready for consumption.

Because the problems have not all been worked out.

This is a good comparison for the hospital.

Some things are tried and tested and never make it to production.

Some things are done because that is the way it has always been done.

The sacred cows of healthcare.

One sacred cow that I lived and worked by when I worked as a night shift CNA in a nursing home, and as a Med-Surg CNA, and as a Med-Surg nurse was that the patients have to be turned every 2 hours.

I thought, at the time, that this was highly scientific and logical because pressure becomes tissue injury become bed sores. It just makes sense.

A couple of months ago I read that patients should be turned every 2 hours because that was how often Florence Nightingale did it.

It took 2 hours to turn all the patients in the ward.

If the ward had been slightly bigger the rule of thumb would be every 2.5 hours.

If the ward had been slightly smaller the rule of thumb could very well be every 90 minutes. Science tells us this is the threshold for tissue injury.

200 years is a long time to do things because that is the way it has always been done.

Now nursing looks for evidence to back up the actions that we do.

We practice evidence based nursing.

I was encouraged to do blueberry lemon cookies.

Because that is the best.

However, I have a fresh lime.

Maybe it’s time to give blueberry lime a try.

Out of nowhere, as I was walking into the hospital today, I was reminded of a surgeon that I knew back in CA.

I may have told this story before.

I was a newer OR nurse and I was assisting with a manipulation of a shoulder.

The surgeon did the manipulation and then barked for the medication.

‘What medication?’ I asked, innocently.

‘You know the medication, the epi, to inject this joint.’

I had been an OR nurse for about three months as I recall.

I dutifully went to the pyxis and pulled out an entire bottle of epinephrine.

I knew it was not correct.

But no one else corrected him.

Not the scrub tech.

Not the anesthesiologist.

It didn’t even phase the PACU nurses when I pulled out a ginormous bottle of epi.

Okay, no one was going to help me.

The surgeon was waiting, impatiently, for a syringe of medication and a needle.

I put the epi in my pocket and walked back to the room.

He put his hand out.

And I refused.

He looked at me as if I was less than nothing.

Me? Denying a surgeon.

He looked at the anesthesiologist who was maintaining the airway, probably hoping I’d get a move on.

He looked at the scrub who was leaning against the wall. They don’t have a role in manipulations.

I pulled out the brown 20 ml bottle of epinephrine and I showed it to him.

‘This is not the medication you think it is.’

‘Never mind,’ he growled, hand still out.

‘This is epinephrine. This is a medication that is given during codes to restart someone’s heart. I will not be giving you a 20 ml syringe of this. It would kill the patient.’

He blinked and looked at me and then at the bottle and then back to me.

‘What can I give then?’

I pulled the second bottle out of my pocket and showed it to him. ‘This is marcaine with epi 1:200,000. This is what you want.’

He made a gimmee motion with his fingers.

I drew it up, put a new needle on it, and handed it to him, telling him in a closed loop communication although he had just seen me draw it up, ‘This is marcaine 0.5% with epinephrine 1:200,000.’

No further mention was made of his nearly catastrophic medication error.

No further mention was made of how it was good that I stood up to him.

Nurses don’t do this kind of thing for recognition.

We do it to keep the patient safe.

And that was the first time I stood up and defied a surgeon.

It has not been the last.

I gave up television years ago.

Many, many years ago.

I watch things like the Marvel shows on Disney: Wandavision, Loki,

But besides that I listen when my husband watches television while I read.

And there has been a commercial that has been playing seemingly nonstop.

Tylenol has declared it a no limits pain medication.

Um.

No.

That is exactly opposite of what has to happen with Tylenol.

To a layperson watching the commercial they may get the idea that they can take as many tablets as they want.

Definitely not.

There is a limit that the liver can safely metabolize per day.

This is not exactly limitless.

Please stop before people need new livers.

There aren’t that many to go around.

Traditionally parts of the hospital are closed the day after a holiday if that holiday falls on a Saturday or Sunday.

This is to make sure that the different parts get the same holidays as everyone, such as those who work Monday-Friday.

For example if the fourth of July is on a Saturday, the observed holiday would be the Friday before.

And if the fourth of July is on a Sunday the observed holiday would be that Monday.

This is the way that the hospital I have worked at for years handled it.

Since yesterday was the 4th, today should be the observed holiday.

Scheduling is off

Administration is off.

Some doctor’s offices are off.

Not after a pandemic apparently.

Have to make the hay while the sun shines.

The hospital made an announcement in the beginning of the year that observed holidays would not be happening going forward.

Because the healthcare appointments and ORs were still “catching up” from last year.

This was kind of unpopular.

Some of us need the 8 hours off so that pressure can be taken off our PTO balance.

And then last week there were daily reminders that the administration office would be closed on the 5th of July.

I haven’t had a moment with the leaders to tell them that this is tone deaf.

No one got the memo from the MD’s offices.

There are TWO cases on the board for today.

TWO.

A bunch of day shift got flexed.

I guess they got their observed day.

The evening shift will be expected to show up and work the entire shift.

If you need administration you will have to wait for Tuesday.

If you need me, I’ll be at the hospital, along with other departments working.

Happy 4th everyone.

Why, yes, I’ve been to the hospital already to do a laser case for a cysto.

I was putting the frozen groceries away when I got a call from the call nurse that there was a patient on the table and they unexpectedly needed laser.

Off I went.

It’s a good thing I live 5 minutes from the hospital.

But that is not the post-it note for today.

Today’s post-it note is brief.

Very brief.

But I know what it is referencing perfectly and try to live it in my own shift life.

‘Word to the wise, when offered take the fucking break.’

I know this one very well.

When I was in my first hospital, as a new OR nurse, I was scheduled to work the day after Thanksgiving.

My tech, the anesthesiologist, and myself.

Everyone else had been let off.

Due to lack of volume.

There was a back surgery that was on the books.

It was scheduled to only be three hours.

Fine, I thought, I can do anything for three hours.

My manager had stopped in to do paperwork and offered me a break before he left.

I declined a break, citing the 3 hour case.

He smirked at me and said okay very sarcastically and left.

7 hours later the case was finally done and the patient was in PACU.

This was a hard lesson to learn.

When the break is offered, take it.

Otherwise it can be hours.

It is not often that the stars align and it is the perfect time to offer a break.

Always take the break.

It may be the only one you get.

And eventually you will have to pee.

I do not regularly visit the email address what this blog is linked to.

I have it linked to my phone.

I do not remember the last time I checked it on my desk top.

Not sure what prompted me to check it last night.

In the spam folder there were emails about someone liking my posts.

1. I had no idea why that is not on the dashboard when I sign in to write
2. I also had no idea that I was not shouting into the void. So thank you.
3. Sorry, Sebastian.

And Yahoo, what the fuck.

I have regular correspondence with WordPress about my account.

That I read on my phone.

And this is what the mailbox does to half of my emails?

Apparently I have to check this email address more frequently.

Which I will do.

Now that I know that it is an issue.

However, if you are reading.

Thank you.

Most people want to go to lunch during their shift, preferably before they are set to go home.

Especially as there is a moratorium on working the shift straight through and clocking out with no lunch.

The corporation wants you to have a break.

What happens if it is lunch time 1100 and you have one lunch to give?

You either let the person out first or you go to lunch first.

And then switch.

What happens if it is lunch time 1100 and you have one lunch to give, and a case that is due to start at 1300?

You give the lunch at 1100 and take your own after or vice versa.

And it is now 1215 or 1230 and you go to set up your 1300 case.

What happens if it is lunch time 1100 and you have one lunch to give, and a case that is due to start at 1300.

And your MD shows up an hour early, ready to cut at 1200.

And the desk says that absolute we can start as soon as we can.

You’ve given your lunch and now your case is at 1200, not 1300.

With cases still to follow.

But you were supposed to give yourself lunch after or before you gave the other lunch.

Ideally, the desk would ask if you in fact took lunch, because there was a lunch to give, and a case to start.

Ideally, the desk would practice closed loop communication and ensure that you got lunch as well.

Sometimes that does not happen.

How mad are you allowed to be?

It is Thursday.

Again.

And I worked in the middle of the night.

Again.

And it is the tech’s last evening shift.

So I made him his favorite cookie.

The Jalapeno chocolate chip.

I figure half of the batch to him and the rest to the followers of the chocolate jalapeno cookie.

For everyone else welcome to July!

The theme for July is Red, White, and Blue.

Whatever I choose that to be.

Could be a surprise.

Today the cookie is maraschino cherry chocolate chip.

I haven’t made this one in at least a year.

Maybe two.

But the funniest part of my baking today is the fact I laid out all of my ingredients.

Because I know I am sleep deprived.

Due to a text I got at 0820 from day shift charge.

14 minutes before my alarm was set to go off!

I could have used that 14 minutes!

Ahem, so I am sleep deprived.

And I had laid out all the ingredients.

Including a new bag of chocolate chips.

As I am sliding the 1st cookie sheet out of the oven I spy the unopened bag of chocolate chips.

<face palm

The first two cookie batches do not have chocolate chips in them.

It’s an experiment?