24-Make it bigger!

The gown card reads “Dear Doctors, JUST MAKE THE INCISION BIGGER!!!”

Mic drop.

I don’t know who needs to hear this but, yeah, struggling for 20 minutes because you made the incision a quarter inch smaller than normal.

What do you get out of it? Bragging rights in the doctor’s lounge? A free all-expense paid golf trip at the next conference? The love and devotion of your patients?

The push in the OR is toward smaller and smaller. Smaller incisions, smaller case times, smaller.

Just smaller.

And, yeah, that should be shorter case times but it didn’t fit the theme, you know?

I see you struggling with the smaller incisions that you make.

Yeah, patients may like a smaller incision, but how much smaller can you go? And still have the proper exposure to have to do what you are operating to do? Patients probably will be happier with a regular-sized incision and a smaller hospital bill. Because you ramp up their time under anesthesia and therefore the cost of the procedure while you struggle with exposure

I know that you know the incision is smaller. But the patient is not going to know. The incision can only stretch so much.

We were doing a case in the middle of the night. Of course, it was the middle of the night, you work nights, Kate! But the surgeon was struggling with taking out the specimen from the incision size and I mean, struggling! Thirty minutes they struggled and sweated and fought to get the specimen out, me watching from the sidelines, the sterile scrub tech helping them. Finally, they gave up and started pulling the specimen out in pieces. I asked gently if a slightly bigger incision would’ve been helpful. They sighed and said it would’ve been easier. I asked if the patient was going to notice that their incision was mm longer if they had gone for the bigger incision. They said no.

I said nothing else. I think the point had been made.

Two weeks later we had a nearly identical case, same team, same surgeon. When they had localized the specimen they asked for the knife and said to me “See, I can learn.” They made the incision slightly bigger and were able to only work on getting the specimen out for 6 minutes.

Sometimes you just need to make the incision bigger.

It isn’t a slight on the surgeon; just the facts.

School Me Saturday 1/20/23-Keep your eyes on the prize

Keep your eyes on the prize. The reasons and motivations for going back to school will vary person to person. They can range from just wanting to learn to have to have a degree to get a job to have to get a more advanced degree to keep a job. The same applies to certification.

The idea of the prize is the same for all of these. The attainment of a degree. Or a certification. The degree or the certification IS the prize.

I’ve written about degree creep before. Of always having to have a higher and higher degree. You follow that path and you end up in the terminal degree program. The end degree.

The final countdown, if you were.

Yes, that is a terrible joke.

What makes us want to strive for more, to push ourselves higher, further, faster.

Yes, that is another joke using the Marvels tagline. Which was a good Marvel movie, even if the boys deny it.

What makes us want to do that? To have deadlines, and lectures, and assignments, and the like?

Everyone’s answer to that is different. Some want the promotion, some want to learn, some can’t think of anything better to do. Some, like me, are on the bucking back of the degree as long as they can hold on.

We all have our eyes on the prize.

It is just that the prize has a different outcome for all of us.

I was questioned, quite thoroughly, by my coworkers about what I was going to do after I got the degree. They couldn’t believe that I was going to continue to work as the call nurse. That any work that sprang from my PhD (which I don’t have yet!) will be my side gig.

Operating room for life! Or as long as I can manage it. There is much to research in the OR.

I finally was able to put a meaning to this feeling of education for the sake of education.

I called it an intellectual exploration and an intellectual exercise.

Isn’t that what all education is? An exploration of how high, how far, and how fast we can get there?

Cookie Thursday 1/18/24- Cheddar dill pickle bites

This week continues the Why is There So Much Cheese? January theme. Because there is STILL SO MUCH CHEESE!

This week’s make is one I saw the video on about a year ago. Cheddar cheese dill pickle bites that are baked until they are delicious.

The umami factor on this alone is off the charts. Except that none of the ingredients is actually MSG. But it is salty and bitter and sour and sweet. All the words that describe umami.

The definition of umami is the essence of deliciousness and these deliver.

All that is needed is shredded cheese, either out of a bag, or freshly shredded and pickle chips small enough to fit in the well of a muffin tin. You also need a muffin tin. I used a mini muffin tin.

Oven to 375 degrees Fahrenheit.

Place some shredded cheese in the bottom of the well. Top with a pickle slice and more cheese.

Bake until slightly browned. About 12-15 minutes.

The original video called for blotting the pickles kind of dry with a paper towel.

I am anti-paper towel in this house. I skipped that step although I could’ve used a recycled lap sponge or blue towel.

It will surprise no one that I wanted to see what would happen.

This is definitely a trust the process Cookie Thursday is a Thing make.

And definitely one of the most surprising makes.

Convention planning season, anyone?

If there is something a nursing organization loves it do, it is to plan a convention. I’m a member of the Association of periOperative Nurses (AORN), the North Carolina Nursing Association (NCNA), the Sigma Theta Tau (nursing honor society), a reciprocal member of the American Nurses Association (ANA) through AORN, and the association for nursing professional development (ANPD).

Every single one of these organizations, that I pay and get educational benefits from, has its own national or international convention.

There is only so much money to go to the conventions.

I am a lifetime member of AORN (can’t recommend this enough) this means I paid $950 one time about 10 years ago instead of $150-$200 per year with reimbursement from the hospital. That means I get the benefits of the ANA and AORN for free because I am a lifetime member of AORN. The dues for NCNA usually cost me about $150 because I have a student membership. The dues for Sigma Theta Tau are about $125. I won’t be re-upping ANPD because I don’t have enough time in my life.

I am presenting a poster at AORN and will be traveling to, staying at a hotel for several nights, and attending the conference. We are driving because it is close-ish, just the next state over. I already arranged for our hotel room. The travel and the accommodations will cost money but the conference itself will be $580 with early bird pricing, and $680 after February 1st. I am registered.

Through work, I can get reimbursement of $1,500 on educational opportunities. It isn’t gonna cut it. The $580 I spent on registration will be reimbursed. Leaving $920 to spend on the other organizations and the renewal of my CNOR, which is $380. And the NCNA dues will drop that down to less than $400. I am grateful that there is even that amount for reimbursement.

All the other conferences, I will not be in attendance.

Because I cannot afford to travel to all of the places the conferences are. For example, Sigma Theta Tau’s international conference will be in Singapore. The ANPD conference will be in Chicago. The Magnet conference with ANA will be in New Orleans. The NCNA conference I will consider because it is less than 20 miles away.

Going to conferences is expensive. But the education that you can garner from the conferences is very useful to the bedside nurse.

But the only conference I am planning on this year is the AORN.

Tuesday Top of Mind 1/16/23-energy

Some people think that you get what you put out into the world.

I find that too easy. It puts the onus on us as people to put out the energy we want to get back. As a working nurse, I find this exhausting. I question that the universe wants MORE of me.

Ew.

I’ve said many times and have definitely written about energy on Dispatches from the Evening Shift that it is my personal belief that you have a finite amount of energy a day. Let’s call it Z.

You can add to the energy by being positive and kind.

But you can also subtract from your energy by being negative and mean.

Once the energy that you started out the day with is gone, that is it until the next day. When the hourglass starts over again.

I try to keep my own energy up in the hourglass by being positive and kind. When I feel mean, or even yell, I find the energy slipping away faster.

Yes, this is a very California way to view the world. That’s probably where I picked it up.

The thing to ponder if you believe in the energy balance like me is how much is it worth to you to have energy at the end of the day.

You can spend whatever energy you have left on your family or yourself or the house.

But if you don’t use it, it just dissipates until the morning when your hourglass is full again.

This is sometimes a delicate balancing act. There are a LOT of things that can sap this energy.

But where do you want to be at the end of the day? How much energy do you have to spend at the end of the day?

I have no training in this, just what I’ve been exposed to growing up in California.

I’m going to keep my energy up by being nice and kind and not setting myself up for an energy drain.

Some days are hard; you just have to keep practicing.

Post-it Sunday 1/14/24- Time outs are not a bad thing

The gown card reads “One act of charity by a despicable person is always held up to the light as an example of why they aren’t as bad as everyone says they are… Sure, Jan.”

You know what I am talking about in the political world.

And in the real world.

But it happens in the OR world as well.

Some doctors are just not nice people. They are demanding, and exacting, and not willing to look at issues from anyone’s perspective but their own. They are belittling and always see delays as a personal attack on them, on their time, on their golf schedule.

We have all had this surgeon, this person in our lives, this politician in our political life.

But to their chosen few, sometimes very few, they can do no wrong.

Oh, they threw suture scissors at you? Did the scissors hit you? If they didn’t, it’s okay then. They didn’t mean it.

Can you feel the eye roll from where you are?

The very fact that they thought the suture scissors throwing was an acceptable behavior is a problem. A big, write-them-up kind of problem, refer them to peer review kind of problem. NOT to be swept under the rug by management and their preferred team kind of problem. Not addressing bad behavior in the moment allows them to think they can continue it.

The fact that they are kind to the people in their room is not the flex you think it is. The team that they’ve chosen to be brought into the inner circle is definitely not the flex you think it is. Just because they are not mean to them does not give them the permission to be an ass to everyone else.

Sometimes they just need to pull up their grown-up panties and try to be such a pain in the OR’s behind.

Stop yelling, for Pete’s sake!

Yelling surgeons are kind of like yelling toddlers, it is okay to give them a chance to do better. Sometimes it is a choice- If you, Dr. X, can do this and not do that then I will see what I can do to put your next add-on into the schedule. Sometimes it is as as simple as “Dr. X, I see that you are upset. Can you not upset your patient, and your team and we will talk about the issue later.”

DO NOT give in to them. No matter how unreasonable their request is. This emboldens the bad behavior and sets you and the OR up for confrontations in the future.

Why, yes, dealing with surgeons is akin to dealing with toddlers sometimes.

Sometimes time outs are required.

School Me Saturday-Break’s over!

The Winter break is over. As Theodor Geisel would write “Don’t cry because it is over, smile because it happened.”

You may know him better as Dr. Seuss.

Time to buckle down for the next 4 months. It’ll be over in the blink of an eye.

Check those syllabi, write down the major assignments and due dates, and remember this won’t be forever.

In April, you may wake up and wonder where the time went. But that is okay.

Maybe you vowed to do better this semester. Get the reading done on time, turn your papers in on time, early even.

It is easy to be optimistic at the beginning of the semester. You are back with your classmates, all talking about the 4-6 weeks you’ve just had off. The adventures while on break, the holidays, the presents, the FOOD.

It is time to take that energy and put it to work for your semester.

Find your study tribe.

Find a librarian worker who can help you find all the things.

Make a solid plan for how to tackle this semester.

The most important thing about having a plan is that you have to put it into action.

Don’t stay up too late or sleep too late. Naps are your friend when your brain is whirly gigging around. If you want a rubber ducky to practice your presentations on, buy the rubber ducky.

But also don’t forget to have a little fun too.

I know this time can feel grueling like you’ll never be done. At times like this is it important to spend some time in reflection on what amazing things you’ve done. Of all the things you’ve learned. Yeah, it might’ve been a bit sloppy, but you survived. And you will survive this.

Each semester is closer to the finish line.

You can do this.

Cookie Thursday 1/11/24-cheddar dill cookies

This week continues the “why is there so much cheese!” theme for January 2024.

I love dill. I love how bright and savory it is. It is the perfect complement to so many things. Why not cheddar cheese?

The original recipe called for gouda. I don’t have gouda in my cheese drawer and I was not about to bring more cheese into the house. But I have some Unexpected Cheddar from Trader Joe’s. This cheese is a mix of parmesan and cheddar and is a whitish cheese.

Which makes it perfect for this recipe.

In my head.

As always, Cookie Thursday is a Thing started as experimentation on my coworkers and I’ve never really stopped.

But yes, the dill complements the Unexpected Cheddar perfectly.

The cookie, more like a cracker, is smoky and cheesy in all the best ways.

Apparently, this cookie doesn’t keep well. I wonder what I can add to change that?

To bring it back to the OR, sometimes it is the unexpected element that allows for the most exciting cases. This can be a code, this can be a power outage, or this can be a doctor yelling at you over the phone because the OR is running late. Again.

In these instances, the first thing to do is to keep your cool and reach for your calm. As my first ACLS instructor told me, “In the event of a code, the first thing you do is take your own pulse.”

Which is the unexpected element of this make? The Unexpected Cheddar? Or the dill? Or is it the synergy of both?

Mentor and preceptor, explained

There’s a quiz going around on Facebook about who a new peri-op nurse would want in their life. A person who has clinical competence and experience and mimic them. Kind of a fake it until you make it.

The answers are preceptor, mentor, role model, or educator.

Let’s break those down.

A preceptor is the person who trains you in the policies and procedures of the hospital. They are the one whom the new peri-op nurse follows to gain knowledge about their new role in that particular hospital.

There has been a movement away from having unit educators anymore. I know in the hospital system I work for, the unit educator’s role has been centralized to a central office. This means that less of them can do the work that is necessary for annual education. However, this also means that the unit loses that person who is the dedicated educator for the unit. Our last educator left after having a baby and they centralized the education department. She was never replaced and the education got punted to the assistant nurse manager, and those of us in the unit who stepped up to serve in the educator role. Even if a unit had a dedicated educator they serve the entire unit and personalization of education goes to the wayside.

A role model is someone to look up to in the department. They could be good at their job and admired by staff and surgeons alike. They have clinical competence and experience. But this is a shallow relationship. A role model is sometimes imitated, but sometimes it is for a reason that is not in the patient’s or the department’s best interest. Especially if they are admired by cutting corners. Cutting corners is dangerous.

A mentor relationship is all of the other three and a deeper relationship. They are the one that the peri-op nurse goes to with questions, or reassurance. They are the ones that notice when someone is having a bad day, and invites them for a cup of coffee to talk about it. Mentors are important.

Luckily, I have a built in mentor in my mom, a still working nurse with 50 years of nursing experience who does all the things a good mentor does. She listens when I have concerns, she talks through solutions with me, and she will give me a mild correction when I need it.

This is what I think is the answer to the question. A mentor is all the things in one.

All new nurses need to find themselves a mentor. All nurses need to find themselves a mentor too.

Tuesday Top of Mind 1/9/23-scary times, ranked

It is hard in the now times to decide which issue takes precedence in my mind.

Let’s rank them, shall we?

no abortion for dying patients.

This is what the 5th Circuit Appeals Court shouted at all of us near the end of 2023. In their ruling, Texas doctors are not obliged to perform abortions. At all. Not even if the woman is dying. Not even if the fetus is dying. News flash, if the mother dies while carrying the fetus, they both die. Did someone flunk biology?

This makes me so mad for women in Texas. Also, this is Supreme Court bait that will be appealed to the Supreme Court. This might make it the law in the land, especially in those states that do not have provisions for care of a dying mother because what is killing her IS THE PREGNANCY.

Yeah, there is a story in the New Yorker about a young mother who was excited to be pregnant, and wanted the pregnancy but being pregnant ultimately killed her. And the baby. Because they are linked. Do people not understand that?

2. war is contagious and spreading. More evil has been done in the name of a holy being than ever conceived before. Or, in the case of Ukraine, in the imagined getting the band back together sentiment of the Russian leader. And the band, in this case, is the USSR. I can’t imagine that people don’t understand that Ukraine is only the first step. And the first war.

3. Covid is actively killing people again. Not that it ever stopped. But the newest variant, the JN.1 variant, has gone from 14% of cases to over 60% of cases in less than a month. I have also read reports that it is more contagious even. You know that covid has been bashing at the bars of the vaccine for a while now. Someday it will find the key to ignoring vaccination entirely.

Speaking of covid, some towns are whining that they are running out of supplies. This after most Americans gave a cold should shrug to giving money to efforts to stop and contain covid. We are too interested in going back to how it used to be. Not gonna happen, there is no going back. There is whining, though, because we as a society don’t give enough forethought to things we don’t like.

Lots of things are top of mind today. But those are the main ones.

Not the least of which is the winter storm that is currently battering the Southeast.