Charting or the act of writing down all that has happened on your shift is central to the very core of nursing.

The old saying goes “If you didn’t chart it, you didn’t do it.”

How else is any nurse or doctor who is coming after you going to know what you did?

I’ve used all kinds of charting.

In my first hospital there was a hybrid charting.

We had checklists that we used from our nursing care plans to plan the care for the patient.

We had the very beginning of computer charting.

This was 2001, a very long time in computers ago.

The computers were practically a typewriter with a screen.

We were to do the checklists and a narrative chart note on each patient.

When I went to the OR, the charting was all done on a three fold form, which had a duplicate page.

When I participated as a SME (subject matter expert) when my current organization was working with EPIC to create our EMR, I had to learn computer charting with EPIC.

It is basically a three fold form with check-boxes that are sent in real time to the server farms for saving.

The point is charting is a big deal.

Everything we do as nurse has to be charted, in some form, as proof we did what we did.

The thing about charting is you can be as brief or as long-winded as you want to be.

I had a conversation with the nurses I was relieving tonight.

The primary nurse handed me the card with the written time that the throat pack went in.

I thanked her.

The secondary nurse, who had been acting as a scrub, asked me about it.

The primary nurse and I agreed that we chart the insertion of the throat pack and the removal.

The secondary nurse asked us why.

The field needed my attention at that moment and I texted her later, ‘If you were, God forbid, called to testify about the throat pack being left in you absolutely want documentation.’

If only the insertion is charted, did you really pull it out if not charted?

At its core, charting is about how much liability you are comfortable with.

This is going to be a hard week.

Two of my very favorite people are leaving.

One is my favoritest CRNA.

She’s stepping down from call work to have more time with her young kids.

Evenings won’t be the same without her.

We’ve had some long hard nights together.

We’ve also had some laughs together.

Have fun with the new schedule.

The second is my evening tech 3 nights a week.

He’s going to a different hospital which will set him up better for retirement after they factor in his years in the military.

He’s been the evening tech since before I got hired.

We worked together at a sister hospital before that.

He’s been my movie buddy.

We’ve talked movies and sci-fi and books for years.

He is staying on as a PRN tech. Let’s see how long that will last.

I think it will be mostly call.

Which, as we all know, is my favorite thing.

This week is the end of an era.

There are some big shoes to fill.

The note: Is it weird that I was waiting in line in May of 2021 at the pharmacy and I wanted to congratulate the woman waiting to get her vaccine. Would a hug be out of the question?

The answer is no, it would not be weird to congratulate her.

It would not be weird to thank her either.

I think it is important to reassure people who are getting their vaccines.

This is a BIG step for some.

And that should be celebrated.

I would have congratulated her, especially in the midst of the delta variant.

Any small step will help.

And our state now has one more to add to its 45% of vaccinated or partially vaccinated people.

So much work has been done.

So much work still to do.

Still, a hug would’ve been weird.

The OR is very specific when it comes to the type of power strips that can be used.

Otherwise they are a fire hazard.

It has taken years to get them out of the ORs.

YEARS.

Imagine my surprise when I go to a room to help them turn over and there is a power strip.

An unauthorized power strip.

Behind the back table.

Used to power the flexible sigmoidoscope.

That the MD said he didn’t need power for.

Cool.

The nurse went to the desk and got a power strip from under the secretary’s desk.

And used it.

It just goes to show that everything can be a teaching moment.

And anything is an opportunity for quality improvement.

I educated the nurse that these power strips are carefully regulated because they are a fire risk.

She didn’t care.

I also retrieved one of the 3 long power cords, which are allowed.

And I will be giving it to the secretary to put it under her desk.

After I tell her not to give out the other one.

Two weeks ago I read an article about pistachio cream.

And I was intrigued.

Apparently it can be used savory or sweet.

Since then I am have had pizza with pistachio cream as the sauce (so good!)

Twice.

I knew I had to order some and incorporate it into Cookie Thursday.

After a search of Whole Foods, Trader Joes, Cost Plus, Sur la Table, Williams Sonoma, I admitted defeat and ordered it off Amazon.

My goal was to make a thumbprint cookie with pistachio cream and raspberry jam.

And I did.

The jar of pistachio cream that I got was kinda sweet.

I will be making it in my kitchen with pistachios and olive oil.

And taking my pistachio/raspberry jam cookies to the OR.

I was helping a room move a patient to the bed as the case was done.

When I noticed that the positioner was in a clamp that was, in a word, janky.

It was an ill fitting rusted clamp.

That was on upside down.

I asked the room why this clamp.

Why this clamp that I was pretty sure had been thrown away.

Someone had obviously saved it.

The nurse in the room laughed and said she could not find any other clamps.

I looked at her incredulously.

No other clamps, I repeated.

Um.

I can find 20 clamps in 5 minutes.

No one believed me.

The nurse and the tech trailed behind me as I went to the desk and labeled 6 pieces of paper with the numbers 1-6.

I looked at the nurse who could not find any other clamps and told her to time me.

I went through all of the OR rooms in four minutes and 32 seconds.

I did not find 20 clamps.

I found 30.

At the end, I explained to them the best hiding in plain sight that clamps do.

Time is irrelevant.

Is there a meaning to time?

Time is finite, yes.

However, in the last 18 months time often feels as it is standing still.

Or rushing.

Never just time.

Is anyone else feeling this way?

Today I told my mom that my older cat was 10.

I was TWO entire years off!

She’s twelve.

I’m sure I knew the correct answer.

Before this entire Pandemic thingy started.

But, as time is irrelevant, I was wrong.

I have also heard people refer to 1990s as twenty years ago.

Um, no.

I know that time is out there.

How do we capture it?

Case by case?

Shift by shift?

Add on by add on?

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.

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.”

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