You, the surgeon has been forced to wait because another surgeon has overstayed their case. You are definitely mad about this

Day shift charge, oh we’ll just do a superfast turnover as soon as that case leaves the room.

You, the inconvenienced surgeon are slightly mollified.

Day shift charge, who has circumvented a tantrum, breathes a sigh of relief.

Um, no. There is no such thing. The room is either clean or it is not.

Do not give the rampaging surgeon false hope about super fast turnover.

Why? This is a slippery slope.

1. There is no such thing
2. The surgeon will expect it every time from now until the end of time
3. When the surgeon doesn’t get it every time from now until the end of time, there will be a threatening tantrum
4. rinse, tantrum, repeat
5. Please don’t set up evening shift this way, there is a reason our turnover times are so fast

Why are the evening shift turnover times so fast and without the benefit of a cleaning person.

Preparation.

Turnover should start way before the end of the case, before the patient leaves the room.

During the first case, thoughts should be had about what instruments/equipment is needed for the next case.

During the first case, the floor should be policed and all the trash picked up off of it.

During the first case, all extra stuff not needed for the second case, and has reached the end of its usefulness should be put back in the cabinets or taken out of the room.

After need for suction is over, the suction canister should be removed and solidifier introduced into the liquid, so that you don’t have to do that after.

All equipment that is no longer needed should be turned off and pushed away from the field.

As the patient is wheeled out, the bed should be stripped and the instruments taken out.

The circulator should give report to the PACU nurse.

The circulator should interview the next patient and return to the room to finish cleaning.

While the circulator is gone the scrub should take their instruments out and commence wiping all of the tables and OR bed.

The circulator should mop the floor while the scrub is taking a prep table and loading it with the next case instruments.

The circulator should make the bed, while the scrub is wheeling in the prep table and spreading the case.

New masks should be donned and the opening commence.

That is how evenings gets a 10 minute turnover.

One of my favorite scrub techs has a saying she got from her dad, “Chores are very loyal, they wait.”

One of the things about evening shift is if we are not doing cases, we are working on chores. Chores that happen every day are bringing up the cases for the next day, picking instruments for the next day, stocking rooms and carts in the core, and preparing rooms for the next day after they have been terminally cleaned for the day.

Evenings can break down at any point in the night.

Some nights we can get the cases up and everything else on the chore list is completed.

Some nights we do the bare minimum.

Some nights I don’t get to eat lunch before everyone leaves for the night.

Some nights I get to do my paperwork and my e-mail.

It just is up to the luck of the draw.

But I would like to know how to motivate people to do any of the chore list before they leave for the night, say at 1700 or 1900. This is harder than it seems.

Recently, I heard someone say to leave the chores for evening shift, they’ve not much to do anyway.

Really?

It just so happened that after they left a doozy of a case came in and NOTHING on the chore list got done except for instruments. Any they complained that they didn’t have everything they needed. When they complained to me when I got in at 1430, I shrugged and said, “Maybe you should’ve done that before you left, instead of pawning it on us.” They weren’t very happy with that response.

I don’t care. My first responsibility is to the patient, not to day shift.

Who’s looking like the chore bitch now?

Every time the hospital rolls out a new endeavor that shoves their nurses into upheaval they don’t share the reason behind the new change. They just shove it down our throats.

I know lots of nurses in three states and let me tell you this is not just a “my” hospital problem.

Their new thingy is a prepping champion. Because all of a sudden there are new prepping guidelines. In all preps, betadine, chlorahexadine, chlorahexedine and alcohol. We’ve been doing it wrong, according to the company.

I’m not sure if this is a thing. Or the company that brings us betadine kits were jealous of the mandatory three minute dry time for the chlorahexadine and alcohol.

This was a 45 minute waste of my time. And the company paid for “experts” to fly in and awkwardly “teach” us how to prep.

It was all that I could do to stop the rolling of my eyes being audible.

If there is new evidence please bring it to us. We’re college educated, we’re smart. Don’t tell me there must be a change. Show me why there needs to be a change.

Or the rolling of my eyes will become audible.

I’ve been the scheduler for the OR for about five years now. And the OR has decided to blow up the fucking call schedule.

Because, as near as I can tell, three people complained they were getting too many calls on certain days or nights. And my night tech went home at 2130 on two of those evenings and sometimes (often) I needed to call in the evening call tech to cover.

Instead of asking me about it, or seeking my opinion, or doing some basic research and data collection, they decided to throw the baby out with the bathwater and chuck the whole thing.

Instead of 2 calls, one evening 1700-2300 and one night 2300-0700, there will only be 1900-0700 and the two pools of call taking people will be combined.

On paper this looks amazing, less call evenings or nights per week for the complainers.

But there are a few holes that no one is interested in hearing about.

1. I use the evening call a fair amount, at least once or twice a week and now I will have no bridge person in case the schedule requires it because some surgeon is running over late.
2. If I or the evening tech becomes ill or injured and can’t work there is no bridge person to cover from 1700-1900.
3. I am taken out of the call rotation because there will be no one to cover from 1900-2300. This directly impacts my bottom line. Their answer is that people will be dying to give me their call. This is not untrue.
4. If the evening tech is on call from 2300-0700, there is no one on back up from 1900-2300, goes back to point 2.
5. No one likes this change, we’ve lost 2 nurses because of it.

But, sure if it stops the complaining that the two bosses have to deal with, no problem. It just is the problem of all the non complainers who will have to take unfamiliar call shifts and sometimes work until dawn.

No problem, as long as there is less complaining.

Sometimes I feel like Cassandra from the Greek myths who was cursed to only tell the truth but no one ever believed her.

For weeks my coworkers and I have been consoling each other with “Maybe it’ll get easier when December is over.”

How quickly we forgot.

Once the glitz/fun/parties whirl of the December is over, the schedule craziness still  hangs over us like miasma after bad seafood.

There will be no lightening of the schedule until the flu season starts to lift.

At least, that is how it has been in the past three years.

And although the year is still very young (nine days old), it looks to repeat the pattern of heavy patients, heavy case loads, heavy call shifts.

But without the fun of the holidays.

Joy to the OR,

I am the scheduler for my OR.

Shocking, I know. Extra work, where do I sign up?

The first two weeks of this current schedule started with the week of Christmas and the second week was that of New Year’s.

The current schedule wasn’t due to be completed/published until December 10th. It was decided to complete the first two weeks early so that staff could plan their holidays. I finished the first two weeks before Thanksgiving and published them.

I then worked like an idiot because Christmas/December in the OR is anything  but merry.

I did complete and publish the rest of the schedule by December 10th. This means the last 4 weeks of the schedule was complete with all calls, weekend and otherwise, and days off by December 10th.

It being December I didn’t look at the schedule again until Thursday, January 3.

Whereupon I discovered that the last four weeks of the nurse weekend call days were missing.

Well, fuck.

The schedule had been published, I can’t go back and re-add the call days in for the RNs.

But I have a worksheet that I make myself with the calls planned out.

Some of the nurses copped to the fact that they were scheduled on certain days and they were rescheduled.

Some of them did not. I refrained from shouting liar, liar pants on fire.

I, of course, will bat clean up and take any calls not spoken for. Maybe 4 out of the 12.

But, when I discovered that the program had eaten all the nurse calls from January 5-February 2, I was mad, sure I would have to cover all 12 of the weekend call days by myself.

And my husband would be mad at me.

And my cats would be mad at me.

4-6 out of 12 isn’t so bad.

And you bet I e-mailed the staffing program’s inbox and told them of the hiccup. My OR may not be the only one affected.

My computer is back and I’ve reloaded all of my internet stuff.

But I was challenged to do creative things for the next 6 months by some writers that I follow.

The update schedule will now be Sunday, Wednesday, Friday.

Yay!

Well, that sucked.

Not only is it December, which always blows in the OR.

But my brand new computer’s solid state hard drive died three weeks ago.

I’ve been without a personal computer for THREE WEEKS.

Ugh.

It has snowed, it is snowing, it will be snowing.

Past, present, future.

Snow, not such a big deal in some places.

But here it’s a huge deal.

Because Southerners have no idea how to drive in it.

Or walk in it.

Or work in it.

But it happens.

Now we have a winter wonderland of ice, and snow, and freeze. I’m going to call no school tomorrow. That is a given.

But there will always be work.

For patients, if there any shred of hope of them having surgery, will make it to the hospital just fine.

Staff, eh, we’ll see.

Some places got 8 inches of snow, then ice, and some places just got a dusting.

We got two inches, plus ice.

Me, I parked my car at the park and ride at the top of our neighborhood. The hill getting out of the neighborhood is going to be practically impossible to get up for the next couple of days.

Just slow and steady when you drive on snow, on ice, on snow covered ice.

And, be safe.

I just finished my shift, with helping prep a lap appy patient. Everything marched out as it should.

Surgeon calls to book a case.

I text the anesthesiologist and the anesthetist that there is an appy to do.

I call the night call team in.

I call and get report from the ED.

I go and get patient.

The night nurse arrives and I tell her to get the room ready, I’ll prep the patient.

The evening tech is opening the case. We both can’t leave until the night team is here.

I begin prepping patient.

Realize I hadn’t yet had a reply from anesthesia.

I call anesthesia, both of them. And inform them there is a lap appy for Dr. X.

I continue prepping the patient.

Surgeon has not yet arrived.

Anesthesiologist arrives to interview patient. He is perturbed that the surgeon is not yet on site.

I inform him I had spoken to the surgeon thirty five minutes before when he called to book the case.

I finish prepping the patient.

Surgeon has not yet arrived.

I walk over to the OR to inform them that the patient is prepped, consent has not been obtained because he hasn’t talked to her yet, and the surgeon is not yet here.

The night nurse and I walk out of the room and toward the patient.

The anesthesiologist confronts me about being called too soon, as his part only takes a couple of minutes and the patient seems healthy.

I change my posture to that of PARADE rest, hands clasped behind my back, legs slightly apart.

I acknowledge his feelings. And remind him that he has asked me in the past to contact him immediately upon notification of a case, even if it is the middle of the night and the case isn’t until morning.

He informs me that what I am talking about and this patient is apples and oranges. And that sleep is precious and he could’ve had 10-15 more minutes of sleep. Unsaid is the how dare I?

I refrain from reminding him forcefully that the previous case he’d fussed about not being called and woken at 0200 was also a lap appy on a very similar patient. Out loud I say nothing.

He leaves the substerile room the three of us had been in.

I shoot the night nurse a look.

We continue toward the prep area.

We are now in the hall outside of prep.

Anesthesiology reminds me again that sleep is precious and he has 26 more years of this unlike some of the other anesthesiologists who are closer to retirement and he would prefer to sleep as long as he can.

I say nothing.

Anesthesiology informs me that he doesn’t like group texts, because there will be an informative text and six acknowledgements. And he’s afraid an urgent text will be missed among the inconsequential responses.

Anesthesiology informs me that he does 2 call shifts a week and it’s a lot and he needs all the sleep he can get and he has 26 more years of call shifts.

I inform him the only group texting I do is to both members of the anesthesia team, him and the anesthetist, including myself in the number.

He says I don’t know what the answer is and goes to the dictation computer to sit down.

I turn to the poor night nurse who is witnessing this and tell her that I was surprised the surgeon wasn’t at the hospital yet, as I’d spoken to him over 35 minutes before.

She says that when she spoke to him, because she had answered his page, that the surgeon said he would see her in a minute before they hung up.

With my eyes I say sorry.

I bid them both goodnight. Hang up my work phone and go the long way to the locker room so I won’t be a visible target.

I’m alone in the locker room and I take a deep breath.

I am upset.

I change my clothes and get ready to go home.

What I don’t do is go back out to the anesthesiologist and inform him that he may have 2 call shifts a week, but I have to work with a different anesthesiologist every evening and I do this five fucking nights a week. So sorry about his two.

I don’t inform him that I do a group text of myself and the anesthesia team because if I had to text each separately it would double my work. And both the anesthesiologist and the anesthetist would ask if the other had been informed, which I would have to reply to separately again.

I don’t inform him that I didn’t have to call him myself, that I could’ve had the nursing supervisor do it and she would have called him when I called her, after talking to the surgeon, instead of when I had the patient in prep.

I don’t inform him that I also have 26 more years of this bullshit.

As I am in my warming car, I text the night nurse how awkward that was and I tell her to have a good case and I would see her on Monday.

I am still upset.