When I get a green light, especially if I’ve been sitting at the red light and I am the first to go, I pause, very briefly, and look both ways.

You know, the way we were taught to cross a street as a pedestrian.

As children!

I do this because I have noticed a distinct increase in red light runners.

Those who cannot be bothered to be stopped by a bit of red plastic.

I mean, who does the light think it is?

Doesn’t the light know that you in the little sportscar, or the big truck, or the minivan, or the sedan are important and have places to go!

Time is a-wasting, after all.

This habit of pausing has saved my life many times.

I mean it, MANY times.

Because someone is too impatient to follow the rules of the road or the laws in their state.

Because, they have places to go, man!

I am important.

Yeah, so is the stroller that you hit, or the pedestrian that you creamed with the several thousand-pound machine.

Why is your life and desires and needs more important than theirs?

On my way to the hospital last night, I saw three red-light runners. During a three-mile trip, that is impressive. And dangerous.

Not only to you who is piloting the car but to the others that you might impact by pursuing this dangerous habit.

Is there a scare-them video for this like the ones we had to watch to get our driver’s license in the 1990s? A Blood on the Highway type video?

Maybe it can be called Red is the Blood. Or something to that effect.

Maybe Red Death, Green Insurance Money to the Victims.

I’ll keep thinking about it.

Until the dangerous drivers get their collective heads out of their collective orifices, take a second to pause at each red light.

You might save yourself and anyone else in the car.

Apparently, last month I started doing the monthly personal reports on the first day of school. Which led to September’s report being today.

I’m okay with that.

We just finished the 5th week of school. The professor in my policy and ethics class pointed that out.

And I’ve already done so much.

In my first class, which is a quantitative research class, I gave a presentation yesterday on Quasi-Experimental Non-Equivalent Control Group. Every time I said the entirety of what I was discussing I cringed a bit. That is a lot of words. Of course, I broke down the discussion by defining all the words and then bringing the definition of each word into the presentation before I explained the entire thing.

I am not a good presenter. But I keep plugging at it in hopes of improvement.

In this class, there have been 5 weeks of reading the textbook, 11 articles to critically read, one presentation given, and a discussion post where we dissected an article. Next in this class is a literature synthesis exercise due at the end of the month.

Behind door number 2, there is a health disparities class. This class is completely asynchronous, which means there isn’t a face-to-face online class every week. It is read and learn on your own. This class is the only one of the three like this.

So far in this class, there have been 5 weeks of reading parts of the 2 textbooks, watching of many videos and a few Ted Talks, the reading of 22 articles, and more taped lectures. So much reading! My presentation in this class isn’t until the end of the month, with a discussion question due at the end of next week.

Last, but not least, is the advanced health policies and ethics. The students in this class, myself included, are not shy when it comes to discussing the importance of the 6-9 articles we’ve read. There are also weekly textbook readings and videos to watch. The next assignment I have in this class is a policy presentation around a policy of our choosing, but hopefully around our area of interest. This is due at the end of the month, and I already have an idea, and I’ve started researching it.

There are less assignments in grad school which ratchets up the pressure to perform well on them.

The research assisting that I am doing is going well. I met with the PhD nurse and she has been giving me assignments. I am learning a lot, which is what I wanted.

Of interest to my cohort is the qualitative class we have to take during spring semester, and also the comprehensive exam. This is the multi-paper written exam that shows what we have learned in our time in the PhD program. It is also the mark that separates us as PhD students and, with the addition of an approved dissertation project, after which we can call ourselves PhD candidates.

I’ll just keep plugging away at my reading.

I dislike peanut butter cookies. I don’t seek them out as a matter of fact. The last time I baked a peanut butter cookie there was frosting involved because I made a Nutter Butter knockoff. You know, the peanut butter sandwich cookies with frosting in the middle.

Frosting makes everything better.

But as the theme of the September is Sourdough Wastes I was looking at recipes for using the sourdough waste that I generate every time I feed the sourdough. Most of the recipes are bread-based. But bread can’t be scaled up to feed upwards of 60 people.

Then I saw the sourdough peanut butter cookies recipe. I thought I could do that.

And I did.

Is the resultant cookie a bit sourdough-tasting? Yes, and I think it complements the peanut butter well.

Is the resulting cookie not very sweet? Yes, which I would see as a detractor for this cookie although I often bake not very sweet cookies.

Instead of white sugar, brown sugar was an ingredient. Otherwise, the recipe was very familiar. With the additions of peanut butter and sourdough waste.

I found them a little bland with not as much peanut butter flavor, more fragile than I expected, and not as sweet as I expected. But I am biased against PB cookies. To me, peanut butter cookies would be best augmented with chocolate.

When I experiment with this cookie, and you know I will, I think I will add more peanut butter and change the sugar to half white sugar and half powdered sugar.

But probably frosting would be great.

Today I presented Cookie Thursday is a Thing in poster form to the North Carolina Nurse Association annual conference. Many people dropped by the poster and expressed interest in doing such a program at their units. Of course, I had business cards to hand out and told everyone to reach out to me with any questions or ideas for recipes. It would have been way cooler if the venue had allowed me to bring in a few dozen cookies.

But it was a Cookie Thursday is a Thing poster presentation on Thursday which was very neat of the universe. At least 10 nurses asked me what about today, where were the cookies for the department on this Thursday? I reassured them all this week’s cookies were brought to the hospital early this morning and put away in an office with instruction to put them out at 1430. At least 50 nurses also expressed dismay that someone had never had a homemade cookie before.

Questions that I will have to address the next time I give this presentation- cost per Cookie Thursday. I was asked this several times. To me, this is a conversation about themes and why this theme and not another. It led to me telling the participants that there were 2 months of inflation bakes last spring and summer when ingredient prices were out of control. This led to a discussion about the most controversial theme of them all: If You Want a Women in the 18th Century So Badly… Reminder this was post Dobbs decision.

I am pleased with the interest and genuinely good questions about Cookie Thursday is a Thing.

For the really fun, today I got an email accepting Cookie Thursday is a Thing at the AORN Expo 2024.

For the really, really fun, I’ve been taking a short 5-week class on Writing for Publication and the subject I am writing about is Cookie Thursday is a Thing.

Maybe this little project of mind has some wings. Morale is important. Small steps to improving morale are also very important. I can’t wait to see how far this goes.

For years when I was the evening shift charge nurse, I kept a curated list in my head of people who would be willing to pinch hit in the event of an emergency. The reinforcements, to call them by another name.

And carry the battle theme of life in the operating room still further.

I knew who to call to ask for help.

More importantly, I knew who would not come in to help under any circumstances.

No shame to them, kids and other life commitments, including having healthy boundaries, can mean that not everyone is available to help at the drop of a hat.

I utilized the list when the scrub tech was in a car accident on the way to the hospital to do a call case.

I utilized the list when it became apparent that the patient needed another set of hands because they were that complex.

A facet of the list is knowing if the PACU nurse on call will be able to help if they were called in prematurely. Frankly, some are not able to help do the nitty gritty gross stuff. Again, that is okay; the OR is not for everyone.

In PACU terms, I have utilized the list several times, most often in hemorrhage cases where blood has to be ordered, and labs sent, and suction cannisters changed, and a higher level of care than med-surg has to be arranged for WHILE taking care of the field and their needs. In a true hemorrhagic emergency, the field needs a lot, such as suction, and lap sponges, and not to mention the needs of the anesthesia team.

Sometimes cases are nerve-wracking.

Sometimes the blood wells up after incision too fast for the suction to clear it.

Being evening charge with limited staff is curating a list of your own of people to call in as reinforcements.

Because, if when you call, they will come.

A story to end the post today, the longest day I’ve ever worked was 1030-2300 for my normal shift, call from 2300-0700 with four add-ons with just enough time between to get home and lie down for 10 minutes before the pager went off again, and the beginning of the Saturday call shift, with another four add-ons ready to go on. At the 27-hour mark, I called in one of the nurses who I knew would come and they allowed me to take a MUCH needed nap for 2 hours. I got up after a desperately needed nap and finished the last case of the marathon. Is such a stretch advisable, no, or against policy, yes but the cases were emergent and had to be done. BTW, this was YEARS ago and several policy changes since.

Know your reinforcements. Recognize that using your reinforcements is good for the patients and good for you.

This is very top of mind because it is a new presentation of a poster at a new conference.

The conference I am referring to is the North Carolina Nursing Association conference. It is on Thursday and Friday.

I will be unable to attend both days. I have two classes on Friday. With a 15-20 minute presentation to give about a research methodology: quasi-experimental nonequivalent control group.

When arranging for the poster presentation, I made sure that my presentation day was going to be on Thursday.

To that end, I have to make the cookies for Cookie Thursday tomorrow.

Not so coincidentally Cookie Thursday is a Thing is what the poster is about. The beginnings of CTIAT, the changes of CTIAT, the LONGEVITY of CTIAT, the favorite cookies of CTIAT, and more.

I had my first cold in years doing the layout of the poster and I wasn’t feeling my best but it will be fine.

To give a poster presentation at this particular conference, you have to have a free-standing tri-fold poster. You are given a segment of the conference to present to anyone who wants to know the idea behind the poster.

This will be the 2 of 3 presentations in a week. And I am ready for all of them. I’ve done the readings, prepared my speaking points, and gotten the poster printed.

I’ve only ever had one other poster that actually made it to printing. I had three but covid happened and the conference was cancelled just as I was preparing to get them printed. I had the poster layout already done and was able to present that.

I went with a new company. I have been treated very well by this company and will definitely use them next time I have to get a poster printed. I understand that the university also does printing but I want to rely on that only for university things.

I’m going to read research papers the rest of the day/week/month/semester, no wonder research is top of mind for me.

The post-it reads “pulling out clots and throwing them on the floor. 1) we have to measure that blood!”

File this under the hell?

I remember this case. There was blood in the abdomen and the assisting surgeon was helping remove the clots by taking them out of the abdomen and then throwing the clots on the FLOOR.

Don’t they know the floor is lava?

Or that the clots represent blood loss and we have to measure that blood?

Not to mention that blood clot is now a slip and fall hazard? In a room full of hazards, you want to add to them?

The scrub tech said something to them and they kept doing it.

Where was I during this?

On the phone to the blood bank/On the phone calling in reinforcements/On the phone with the nursing supervisor arranging for a higher quality of care bed/Fetching and carrying for the field/Fetching and carrying for anesthesia? Who knows.

I’m a fair shake at this guestimating blood loss thing. But I can’t guestimate blood loss from clots that have been ground into the floor and walked across the floor.

Blood clots from a clueless surgeon is the latest example of why the floor is not the trash can.

Hey, I wrote that book!

I wrote a little OR book (these are kid books that aren’t really kid books, more like grown-up parodies).

My book was called ‘The 2,465 Things that I Pick Up Off the Floor: an OR Counting Book.”

At the brass tacks level, things on the floor, cords included, are a slip, trip and fall hazard.

At the next level up, and I’ll say it loud enough that everyone can hear, SOMEONE HAS TO PICK THAT UP!!!

I personally think the practice of throwing things on the floor delays your turn over, doc. In fact, I am thinking of turning my PhD dissertation project into why it takes so long to turn over a room for another patient, and how to decrease that time.

So let’s agree to not throw things on the floor?

Mmmkay?

This past week, a scrub tech I work with approached me to ask me about going back to school. Nursing school.

A scrub tech can be a degree all on its own.

Often a 2-year associate’s degree. With certification exam immediately upon graduation.

There are also reports of hospitals building their own scrubs, with no degree and no certification.

A registered nurse is registered with the state. Most often there is a degree involved. There are still some diploma nurse programs in existence.

A diploma nurse, an associate degree nurse, and a bachelor of science of nursing nurse all take the same national certification test. The National Council Licensure Exam, or NCLEX, is a national test to ascertain the student nurse is ready to be a nurse in a hospital, in a doctor’s office, in a free-standing surgery center to name a few options. There are more, including working for insurance companies, or medical companies, or drug companies. There are probably still more.

While the scrub technologist can be a certified scrub technologist (CST) through the company CST, this is through the National Board of Scrub Technologist and Surgical Assisting (NBSTSA), they don’t have to be to gain employment. An RN must have taken and passed the NCLEX and be registered in the state they practice.

Can a scrub tech return to school to obtain a nursing degree?

Absolutely.

RNs get paid more. With more responsibilities, true. But they get paid more and have more options for life after the operating room.

I am unclear if some of the classes for scrub tech will transfer to a nursing program.

But all the nursing schools I know of in the state of North Carolina, require all nursing students to first obtain their certified nurse assistant, or CNA. I imagine this is so the school doesn’t have to spend the first semester teaching students about the minimum care for a patient. I had my CNA before I went to nursing school, and it gave me a step up above my classmates who did not.

Depending on the program, BSN vs ADN, there are also minimum standards for GPA. Most BSN schools require a minimum of 3.0 GPA, and ADN require a 2.0.

An ADN requires 2 years. A BSN is a 4-year degree. An ADN can absolutely go back to school after graduating and working as an RN to complete their BSN. Or higher (cough, cough, me). In the last few years accelerated BSN programs have started, often for those who have degrees in something else. I think, though I don’t know, the cost is higher to go through an accelerated program.

A BSN will open different doors for an RN.

Will I help this scrub tech who approached me for information about going back to school? Heck, yeah.

And I tutor.

And know a few things about obtaining scholarships.

If you are interested in certain programs, absolutely reach out to them to get more information. My information might be outdated.

But the first thing I am going to tell them is that they need the CNA certification.

New month, new theme!

When we were in Wyoming earlier this summer, my father-in-law gave us some sourdough starter to bring back home. Mindful of security, and the 3 oz fluid volume restriction, I asked him to split the sample into 2. That way both my husband and I could carry one on. It worked, the starter made it home and was put into a glass container with a loose top. I feed it weekly.

If you don’t know about feeding a sourdough (I know not everyone had time during the lockdowns of 2020, if you could even find flour), feeding it consists of taking some out, discarding it, and adding the same volume back in with fresh water and flour. This has always seemed wasteful to me.

Wasteful, you get it?

Apropos because the theme for the month is Sourdough Wastes.

There are recipes for using the waste material created when feeding the sourdough.

But, knowing the department as I do, I decided on sourdough chocolate chip cookies for the first make of the month.

The flavor is subtle, more of an aftertaste.

I am mildly concerned that not a lot of people will pick up on it.

As I read the recipe, the sourdough waste is added with the liquids; this is the butter, sugar, vanilla, and eggs. Nothing has to be taken away, this is just a flavoring addition.

I was remiss in mentioning the 13th counting basic during the Counting Basics series beginning in February. The 13th Counting Basic is you and all the other surgical teams are human.

Humans make mistakes.

Humans miscount

Humans forget to count.

Or, at least, forget to document the count. And we all know that is the same thing.

There has been a story in the news from New Zealand. A surgical retractor known as an Alexis got left behind after a c-section.

FOR EIGHTEEN MONTHS!

The Alexis is a self-retainer that is hard to describe. There is an inside-the-body retractor ring, an outside-the-body retractor ring and the plastic sheeting that connects the two. This plastic sheeting allows the Alexis to be used on any size person, it just expands along the plastic sheeting depending on the surgical wound depth. There are many sizes of Alexis, XXS-XL. This size range refers to the size of the ring. To pass a baby through requires the large, at least.

There are pictures online.

It is considered not countable.

This means it is considered something that is obvious if left inside.

I know a mum in New Zealand who would disagree. She had many doctor visits where she complained of pain in her abdomen after the c-section and she was always discounted. Because nothing showed on the X-rays.

This brings up the specter of women’s pain being ignored, but that’s another post.

It was discovered after a CT scan in the emergency department. The Alexis is not radio opaque. That means it isn’t seen fully on X-rays.

This is considered a never event.

It should not have happened, but it did. The surgical services lens should be to protect the patient.

According to the National Institutes of Health, of the 28,000,000 surgeries each year in the US, there are roughly 1500 retained surgical items.

I’ll do the math for you.

That is 0.0054% of the surgeries have a retained surgical item. Miniscule to some, but what if you or a loved one are of the 1500?

Even from the never events. Especially from the never events.

Because somehow, they keep on happening.

In the OR I work in, we use the Alexis retractor a fair amount, all sizes. Including during c-sections.

It is not countable.

But should it be countable?

Yes. This is ANOTHER covid post. It’s been months since the last one.

Yes. There is ANOTHER covid wave. It has not been months since covid disappeared.

Because it hasn’t.

It has been months and months since the United States decided en masse that they were done with masks.

And social distancing.

And, for all I know, washing their hands.

It has definitely been months since there has been a consistent centralized source of covid information, including number of deaths, number of hospitalization, and number of vaccinations. Yeah, since Johns Hopkins stopped collecting data for their one-stop coronavirus resource center. They stopped collecting data on March 10, 2023.

Now that there is a covid wave hopefully cresting, the information that is needed to discuss it fully is scattered. And hard to find.

People are thinking that this wave isn’t that bad, what are you talking about, Kate?

Well, we don’t know specifically how bad this wave is. All we have is anecdotal evidence.

There has been a marked increase in media discussing covid cases, alluding to the new wave.

Testing has been struggling to increase. This is a two-part fail. The first is because there is a vanishingly small number of people who report their at-home test results as they’ve been asked by the CDC. That is if the at-home tests that you have squirreled away haven’t expired. If they have there is a part on the CDC website to check to see if the test is one of the few that had their expiration dates extended. The FDA states that expired at-home covid tests might give inaccurate results when tested. Such as showing negative when it should be positive, and vice versa.

If they have expired, good luck finding some.

That is another way to know that covid cases are rising; the sudden decrease in available tests. It took me three drugstores to find a test when I was sick a few weeks ago. Even then I had to ask where they were and I got the last one.

It was negative, I had a summer cold. But my husband has been sicker for longer and has a cough that won’t quit. He won’t test, relying on my negative test. Man flu or covid? Hard to gauge. I’m completely back to 100%, he is coughing and sneezy still. You decide.

But, Kate, why didn’t you make him test?

I am not his mother. As the nurse in the house, all I can do is advise. Just like I advise diet and exercise and a good medication regimen.

The last harbinger of a covid wave is hospitalizations.

The hospitals around me had a few weeks of zero covid hospitalizations.

Now all I do is watch the number spike.

Some places are bringing back mandatory masking. I wear a mask at the university out of courtesy to those who are immunocompromised and STILL in danger. I have begun wearing one to stores, in addition to shopping when they are just open or in the last hour they are open.

Mandatory statewide masking is not going to happen in North Carolina. not with the political mix we have here. Hell, many vocal people in the communities still deny the existence of covid, or the advantage of the vaccines.

How about you?