2025- El Presidente shakedown of Universities

In the so-called OBBB, aka the “big beautiful bill”, where the conservative right laid out most of their demands from Project 2025 that hadn’t yet been begun by the draconian Department of Education policies, the student loans were capped. Yup, at the undergraduate AND the graduate level. This means that the Parent PLUS loans are capped at $20,000 per year, with a lifetime cap of $65,000 per student. For the graduate unsubsidized direct loan limits are $50,000 per year, with a lifetime cap of $200,000.

At first glance, like so much of what this administration does, this is positive. This means that student loan amounts will be limited. That student loans can’t hamstrung young adults and their families long after the principal amount has been paid, often many times over.

But, like so much of what this administration does, this is a poison pill.

You either have to be rich to attend undergraduate and graduate schools, or you have to be able to take out subsidized loans, often from predatory lenders, or you have to have a very robust 529 savings.

Yeah, right, you have to be rich. This decreases the student “talent” pool available for universities and colleges. If you have an unlimited checkbook, you’ll be fine. Otherwise you are fucked.

In all transparency, Creighton cost me about $5,000 a semester when I went there for a total of 4 semesters, or $20,000. Reminder, this was 1993. I had a scholarship from the pharmaceutical company that owned Marshalls at the time for $4,000. I also had an Air Force reserve officer training corps (ROTC) scholarship that began in my second year. I live off campus for the first year and in the dorm for the second year. After I hurt my shoulder (on campus, mind you), I had to leave Creighton and I lost my ROTC scholarship. Don’t worry, the Air Force got their money back in painful $200 amounts over the next TEN YEARS. My next nursing school I paid out of pocket for. This was a community college in California and I don’t recall the per hour tuition from 1998. I had three classes that I took before I was accepted into the program, microbiology lab as I was missing a credit hour from Creighton and CA requires 5 credit hours, algebra, and an English class. Let’s call Napa Valley cost was about $3,000 for the program. My BSN was $24,000 in 2015 that I exclusively used student loans for, and my MSN was $12,000 which I used $5,000 in student loans and paid the rest cash. This was because the student loan disbursement did not jibe with the 8 week quarters. 20,000 + 24,000 + 12,000 + whatever the PhD is costing me= way over the $65,000 lifetime max. Okay, fine, under the $65,000 max for undergraduate and under the $200,000 max for graduate.

Trust me, it was painful to type that out. Imagine students and their families now. I always worked full time except for working part time that first year at Creighton.

But the real meat of today’s post is the shakedown request by the administration to 9 universities to sign a pledge that they (the universities) will uphold the administration’s higher education priorities. Of course, this wouldn’t be a shakedown without the poison pill. If the universities don’t sign this bullshit pledge which is, in effect, a blank IOU to the administration to cleave to whatever subsequent bullshit the administration pleases.

You know, a shakedown.

This is a commitment by the universities to not talk smack about the conservative ideas. I’ve been at five different colleges and universities and I have NEVER heard that there was a concerted effort to silence conservatives.

This is a fever dream, dreamt up by an administration that is so thin skinned that any talk that is not boot licking or ass kissing is seen as an assault.

It isn’t always about you, assholes.

The 9 universities who were tasked with signing this “pledge” were University of Arizona, Brown University, Dartmouth University, Massachusetts Institute of Technology, University of Pennsylvania, University of Southern California, University of Texas, University of Virginia, and Vanderbilt University. The universities would also have to cap foreign student enrollment and give American students an edge in applying.

This is American exceptionalism? Putting the thumb on the scale?

Odd spread, don’t you think? A mix of blue and red and purple states and a mix of Ivies and state universities.

MIT told them to pound salt.

The faculty of the University of Virginia voted overwhelmingly (97%) to say no thank you. But the university itself has not rebuffed the idea.

This is a shakedown at some of the best universities that America has. But it begs the question, why these universities? What can be accomplished by squashing original ideas and original thought in these nine? What about the oldest universities in America? What about them?

The universities have to realize that this is a poison pill. I imagine that the administration thinks this is an iron fist in a velvet glove but no. Excuse me, your iron fist is rusting and your emperor has no clothes.

Citation

Cunningham, M. (2025, October 2). White House asks 9 universities to sign agreement to ensure access to grants and other federal benefits. Cbsnews.com. https://www.cbsnews.com/news/white-house-nine-universities-compact-federal-funds/

Moody, J. (2025, October 10). MIT rejects Proposed Federal Compact. Inside Higher Ed. https://www.highereddive.com/news/trumps-higher-ed-compact-draws-condemnation-from-faculty-and-college-union/802425

Spitalniak, L. (2025, October 8). Trump’s higher ed compact draws condemnation from faculty and college unions. Higher Ed Dive. ttps://www.highereddive.com/news/trumps-higher-ed-compact-draws-condemnation-from-faculty-and-college-union/802425

No FFS Friday 10/10/25- It’s World Mental Health Day

Boy, do we need a day to stop.

Stop doom scrolling on your phone.

Stop yelling at the kids on your lawn.

Just stop.

For a moment just be.

Go for a walk.

Touch some grass.

Pet a puppy.

Hug your kids.

Remember what Annie taught us “Just thinking about tomorrow, blows away the cobwebs and the sorrow. Tomorrow there’ll be sun.”

We have to hold on to that knowledge, but also acknowledge that it is going to take a LOT of work to get to the tomorrow (Star Trek) that we want instead of the current (Star Wars) that we are in.

But today realize that this shit is hard and we are doing the best we can with the protesting and the speaking up and the witnessing their acts of cruelty.

Have a cookie.

Today of days I embrace the notion and the knowledge that these dark days cannot last forever.

Every time I open an app, I see thousands of people exercising their first amendment rights to peacefully protest.

And I see the Portland Frog Troup and I smile.

And open 5 calls and write my next letter and make my next call.

Call Secrets of the OR 10/8/25- Call bootcamp

There’s this thing I do with new to the OR nurses or new to our OR nurses. It is called Call Bootcamp and I am the guru.

I’ve been taking all the call for so many years it has become my favorite.

And so I teach the new ones about how not to fear the call.

I call it Call Bootcamp. This is where the new nurse and I meet for about 60-90 minutes and talk about call. I also optimize their Epic situation to make it work better for them everyday. Not just on call.

I’ve done this well before the call shift. I used to buddy call with the new nurses and get them comfortable with call. I’ve done this for at least 10 years.

But I have never been able to justify the little call bootcamp on my clinical ladder. There isn’t a space for education items that are not posters or ANCC credited in person experience. That is my next step but it is a helluva lot of work and I have never dedicated weeks of my life to getting ANCC credits for the work.

The following is an attempt to get credit for the call bootcamps that I run. These are not part of my job description but rather are born from wanting to get a new nurse the best shot at a successful call shift.

1) How did you determine the date, location, and time frames for in-service? How did you communicate information to promote attendance?
This is a rolling in-service for new hires to the OR. These are one on one sessions that are not part of my role. When a nurse is deemed ready to take call for the department, the session is set though the assistant nurse manager. This is not expected in my role.

2) How was the need identified for this educational offering?
Surgery call is specific to the types of cases that you might encounter on call. Each time you are called in follows a pattern. This need was identified in new employees, many who had not taken call before. I was the natural answer to this need as the week call nurse.

3) Resources utilized?
None as I was available because of the call hours. The new nurses are paid for their time. Each call bootcamp takes 60-90 minutes, depending on their experience with call.

4) What is the objective of educating the team member?
The program objective is to familiarize new nurses to the call process at this particular hospital. This is done by a mock run through of a call case. From initial contact with the nursing supervisor, scheduling the case, picking up the patient/arranging for transport, picking the case supplies, doing the pre-op checklist through the Quick Prep tab of the operating room navigator, signing consents, doing the actual call case, when and how to call the recovery room team.

The new nurse and I walk through surgical services and talk specific to the OR things and specific to call things. Highlighted is the overhead call system, and the code button location in the OR. Specifics of code situations in the OR are discussed as well as where to find the department code carts. The silver anesthesia emergency binder is located and gone through with the nurse. In the PACU, the highlights include the Broselow cart, the Malignant Hyperthermia cart, the supply room and what might be needed from there. In the ACU, explanation of the pregnancy testing on all patients per policy and where the kits are, the supply room in the ACU is explained. The availability of the test tubes is discussed and demonstrated. The location of general ACU supplies are demonstrated. Matching Broselow band location is demonstrated, specific to pediatric patients, along with a discussion of how important it is for the responsible parent to have a band on as well. Tips and tricks specific to the call routine are discussed. I want them to be at least familiar with emergency procedures in the OR that can happen on call when there is a skeleton crew.

The Epic platform for each new nurse is optimized for the operating room. Specific to the OR flowsheets are added to the flowsheets (perinatal demise, and hysteroscopic use). Location of the code button hyperlink is explained but not demonstrated.

The Call Preserver notebook is highlighted. This is a step-by-step FAQ of specific OR things- including blood administration, how to schedule a case, how to put in a culture, what information is necessary to book a case, what specific orthopedic instrument sets are on site, how to use the iPads to do the surgical and anesthesia consents, how to run a code, and more. With a section of the supervisor has called me and I’m on call, now what?

The tour ends with the location of the call sheets. These are the pages that list who is on call for the day. In this hospital there is a call sheet for OR, PACU and Endoscopy.

5) Describe the benefits of the education to the unit/department?
Being on call is a scary proposition for new nurses. It is basically a mini shift, alone in the department with only the other call people and surgeon to rely on. This Call Bootcamp sets them up for success by answering their questions in a controlled environment when there isn’t a patient on the table, or a surgeon staring at you. I continue to offer support after the bootcamp by encouraging them to call me with any call question when they are in the middle of a call case if necessary. In the last week, I have received phone calls about specific supply locations, scheduling a case, and where the tonsillar bleed bovie was located.

By making myself available I alleviate their fears. Sometimes I do their first call with them. It is one thing if you are lectured about what to expect, it is another thing to actually do the thing. I iterate and re-iterate that I am always available for questions, should the need arise.

All of this stuff and there still isn’t a place to take credit for it. Shame.

Tuesday Top of Mind 10/7/2025- Scammy Scamerton called Trump Rx

Let me get this straight:
The president shakes down the pharmaceutical companies, like a mob boss.
The president simultaneously hikes tariffs on medications brought in to the country to triple digits.
The president then announces Eurka! Drug prices will now be falling, no one has ever seen drug prices fall four digits before!
The president then announces that one of the pharmaceutical companies has bit and will be lowering THEIR drug prices.
The president then delays the triple-digit tariffs to allow for “bargaining” time. This is another name for a shakedown.
The president announces a Trump Rx. This is where you give him all of your very personal information, including diagnoses, and current medications, and upcoming prescriptions. This is so your prescriptions, from this one company, are cheaper.

but think what it will cost you in the future.

You are denied a promotion because you are deemed too fat. At least the president thinks so.

The prescription that you need is only $2 less. But hey, the government can have your privileged information. And it use it to line their own pockets.

The prescription that you need now has you on a governmental list. What is the list for? Shh, spoilers.

The prescription that you need is available at the “most favored nation price”. You see little difference between the the price on Good Rx, and that on Trump Rx.

This is so fucking dangerous. I want to see how the website is built to make sure that any information I give up, willingly remember, is protected. If the information is protected this might be adequate. But that is a very high bar.

I am not sure that I am willing to trust the government, this current iteration of the government, to hold my handbag while I am changing clothes.

Perhaps this announcement was rushed out too soon. Before the website is built as a distraction.

Distraction from what, Kate?

Any number of things. The Republican caused government shut down because they won’t protect American’s medical insurance prices. Perhaps it is the Epstein files that they are death gripping. The rising inflation rate. The rising jobless rate. The lowering opinion of the world about America.

I’m stumped as to the reason.

To be clear, this is SARCASM.

Not the very real fear you should have over handing your personal information to the government to be exploited for cash money. That will go to line billionaires’ pockets. Billionaires like the president who has made over a billion after taking office.

Because you know that there is money to be made somewhere. And not by us, the American public.

School Me Saturday 10/4/25- New mantra has entered the chat

I’ve written before about the importance of a mantra.

According to the Merriam- Webster dictionary, a mantra is a mystical formula or incantation. The word comes from Sanskrit and is a sacred counsel that comes from the phrase meaning “he thinks”. Maybe Rene Descartes knew Sanskrit when he came out with “I think therefore I am”.

To me, a mantra is a phrase that you repeat to yourself when times are tough. Say you’re on mile 5 of a planned 8 mile run, you repeat to yourself “The only way out is through.” This is also good for school situations. Take a semester- the only way out is through. Take a degree- the only way out is through. Take a nursing shift- the only way out is through.

Another mantra might be “At least there’s [blank]”. The blank could be anything. A cookie. A kitten. A puppy. Your favorite food. This is good imagery to carry you through the hard time. To get you to the other side.

My personal nursing mantra is “Do no harm, take no shit”. This reminds me that I have a voice that can help the helpless. It also reminds me that I have a voice to help myself. This is useful in the event of a bullying surgeon. Especially if I have more years of experience in the trenches of healthcare.

My new mantra, the one that I decided I will be using to deal with the lawlessness of the administration and the frustration that I feel on the daily.

The new mantra is “Remember who the fuck you are!”

This has applications to so many of the world’s dumpster fires.

I look forward to using it.

FFS Friday 10/3/25- The right is lying to you, to your face. Again, and again and again

Who are you gonna believe? Your republican senator/congressman/”news” outlet who had to come clean that they are an entertainment company and not a news company even if it is in their company name? Those who would lie to you to gain imaginary political favor with their king?

Or your own eyes as you read the 1996 Personal Responsibility and Work Opportunity Act (PQRWORA) that states that undocumented immigrants and those immigrants without permanent status like DACA recipients, temporary protected status (TPS) holders, or nonimmigrant visa holder are BARRED from access to most federal benefits, including health care programs and assistance, including Medicaid and the Children’s Health Insurance Program (CHIP). This is taken verbatim from the Immigrant Migration Forum. And a check of healthcare.gov states that people in the groups that can get coverage are United States Citizens, U.S. nationals, lawfully present immigrant.

Oh, you’re being hung up on the word immigrant and ignoring the lawfully present part. These are the people with green cards. According to HealthCare.gov lawfully present people are people who have qualified non-citizen immigration status, humanitarian status, valid non-immigrant visas, legal status conferred by other laws.

To hear that “news” program call it the current government shutdown is caused by Democrats who want to extend medical care such as Medicaid to all the groups who don’t qualify for government health care assistance.

This is a fucking, disgusting lie.

The Democrats want the ACA tax credits that made healthcare affordable for millions of LEGAL AMERICANS to be extended. Without the tax credits the cost of healthcare will double at a minimum for those who are cannot afford it. This has a trickle down affect on anyone else’s health insurance rates to go up as well.

I am going to hold your hand when I tell you that it is a good thing for people to have health insurance.

People who don’t have health insurance don’t get regular check ups or preventative health care.

People who don’t have health insurance use the emergency room as their primary care doctor.

Without it, ERs will be over-run, more than they already are. People will ignore symptoms until they cannot be ignored anymore, far longer than what would have happened if they had access to healthcare. The patients in the hospital will be sicker. The patients in the operating rooms will be sicker.

This is because of another federal rule known as the Emergency Medical Treatment and Labor Act (EMTALA). This act mandated that anyone who presented to an emergency room be treated. End of story. Because of this act, the ER does not care if you are female, non-binary, male, immigrant, naturalized citizen, citizen, everyone must be treated.

But what do I know?

I’ve just been training in how to research for 10 years (through the BSN, MSN, and now PhD). I’m just a nurse who has over 24 years experience.

I’m just a woman who gives a damn.

Do those who you are listening to you care about you? Or do they care about lying to you? Consider that.

Call secrets of the OR 10/1/25- Participating in PACU games

When I started the call shift, almost 4 years ago now, I was asked if I could be the second nurse in PACU. Because I liked learning and shit. And so they wouldn’t have to call in their second PACU nurse.

I like learning and shit so I agreed. Every opportunity to learn is a good opportunity in my books.

Not every call nurse does this. I know this.

However it is a good avenue to learn about what happens after the drapes go down.

But what if there is another case? And only the call PACU nurse is there?

Well, you get the details of the second case. You give them the standard time. I have gotten some push back here. “Aren’t you already there?”

Yes, but the second PACU nurse isn’t. The first step is to call the second PACU nurse in.

The next thing you do is call the anesthesia team and give them a heads up. And then you coordinate with the scrub tech to pick the case and prepare the room.

And you schedule the case.

This is when you ask the CRNA to wait in PACU and be the second nurse while you get the patient from the ER. If they cannot (OB), you call the nursing supervisor and ask for them to come down and be the second nurse or send someone from the floor.

I mean you could put in transport but you know that there is limited transport at night. And the OR is never first priority.

It seems like a lot but it really isn’t. It is basically all the steps that you do when a call case is scheduled. Plus a second nurse in the PACU who is caring for their own patient. The second case is just stacked on the first case.

A second nurse has been obtained. You get report from the ER nurse and you go to the ER to pick up the patient. It takes less than 5 minutes usually.

This is where the 2 back to back cases blend into each other. This is normal.

The only thing you have to remember to do is bring the patient and their family member to the other side of the PACU.

Privacy reasons, you know?

The second nurse is dismissed.

You prep patient number 2. This is also familiar to you because you do it every call case. Anesthesia is alerted to the patient in the PACU, the surgeon pops in (if it is the same surgeon, but that doesn’t always happen that way). Consents are signed, pre-op checklist is completed and the Quick Prep that you always use to prep a patient is completed.

And just as you are finishing, the second PACU nurse arrives.

You hand over the patient’s family to the second PACU nurse and they take them to the waiting room. But not before you mention again the instructions to pick up the waiting room phone if it rings.

In truth it takes about 20 minutes to prep on a more standard day. This is just a little wrinkle.

But both PACU nurses are now in PACU, the second patient is in the OR, and the first patient is still waking up.

If the surgeon complains about the thirty to thirty-five minutes it took to get the second patient on the table kindly remind them that back to back call cases at night are not the usual. But next time they could go get the second patient from the ER. Or they could sling a mop and turnover the room.

OR call is all about managing the expectations of the surgeon, the anesthesia team, the scrub tech, and hoping there is a bed. Plus thinking about all the possibilities and ensuring you have what you need to answer them. It is a matter of perspective.

Tuesday Top of Mind 9/30/25- Check on your local planned parenthood, the fight goes on

State by state Planned Parenthood is announcing that they will no longer provide any health services for Medicaid patients.

It wasn’t enough that in NINETEEN SEVENTY SIX the Hyde amendment blocked the use of federal dollars for abortion care.

It wasn’t enough that abortion care only comprised 4% of Planned Parenthood services. That, again, federal money has not been used to provide for 49 years. Are you with me?

In 2024 Planned Parenthood cared for over 2 million patients. This was 9.4 million services that were provided in birth control information and services, sexually transmitted infection testing and treatment services, and cancer screenings and prevention services. Not to mention all the education for women on all of these things.

This included birth control information and services. Another naughty no no word by this federal government. After all, the president made a very clumsy analogy to birth control and IUDs being an abortifacient. This means that they cause abortion. Which anyone with a working MD license or a nursing license will assure you that birth control and IUDs do not.

Planned Parenthood also educated a lot of women. Education of women on their rights and their bodies is also a naughty no no word by this administration.

You know what else Planned Parenthood does? It tests for sexually transmitted diseases and gives treatment when appropriate. You guessed it! Another naughty no no word by this administration. Never mind that pregnancy is sexually transmitted.

Planned Parenthood also did over 400,000 cancer screenings and prevention services. These can be your mammograms and your pap smears. I like my grandma not dying of a preventable/treatable cancer, don’t you?

Different states have attempted to push through defunding Planned Parenthood. Yes, mostly red states. (Insert eye roll here)

The “big beautiful bill” that was signed into law on July 4th, 2025 defunded Planned Parenthood. This also significantly cut federal Medicaid funding of all programs. Reminder, again, that no federal money go to abortions and haven’t for 49 years.

Planned Parenthood used the courts to fight back. and there was a pause was ordered. Guess what? The federal government appealed and got a stay on the pause while the case is working its way through the courts.

Of course.

The Planned Parenthood in North Carolina has an announcement on their website that they can’t accept Medicaid patients. They are quick to reassure patients that there are options for payment outside of Medicaid.

Planned Parenthood, the Weebles of healthcare.

Weebles wobble, but they don’t fall down.

Why?

Because they care about women.

Unlike some people I could name.

They really do hate us, don’t they? They want us in their neat little boxes and heaven forbid if we step out of the path that the men have decided for us.