Citation.

The word to strike fear into the heart of any student.

Not the ticket you get from law enforcement.

A citation is properly acknowledging where the information that is in the paper/dissertation/article is from.

I do think the world could use a little more proper citation.

But the act of creating a citation is confusing.

The first thing you need to know is which one.

Will it be MLA? Which is from the Modern Language Association.

Will it be APA? Which is from the American Psychological Association.

Will it be CT? Which is the Chicago/Turabian style.

These are the three most common. And they all serve a different need.

The APA is used for Education. This is at the university level. Unless your particular university/college uses something else.

The MLA is used for the humanities.

The CR is used for business. history and the fine arts.

Confused yet?

Which one to use is determined by the program you are in.

And the styles are vastly different.

So it is important to know why one to use.

Not only is the citation style different, each one dictates how the paper etc is to look.

And they change and update!

When I was doing my BSN and my MSN, it was the APA 6th edition. For my PhD, only 2 years later, it is APA 7th edition.

There are books.

There are YouTube videos.

There are websites dedicated to helping you make the citation from an article or scientific paper.

But be careful.

A basic grounding of the rules is important.

This means you can catch the errors that the citation machine makes.

The proper citation of material can be as much as 10-25% of a grade on a paper. That can mean the difference between passing or not.

It is important to learn the basics or to know who to ask if you run into trouble.

Is it obnoxious? Sure.

But at the heart, it is standardization of language. And as an OR nurse whose surgeons sometimes call for the stabby thing or the hooky thing, I know this is important.

Painful.

But important.

No, that is not a typo.

I made chocolate chocolate chip cookies.

I hate making chocolate cookies.

It is too hard to gauge when they are baked.

They are too easy to burn.

I rely on the color of a cookie to gauge when they are done. When the batch first goes in, the dough is a pale cream color. And when they are done they are almost a light nut brown.

If you know, you know.

But in my experiment for this month of changing an ingredient in the standard Toll House recipe, I knew it would be the most impactful change.

Even if I dislike it.

You just can’t add cocoa powder to a chocolate chip cookie and call it good.

There are factors to keep in mind; the balancing of the butterfat and the chocolate.

Look. I don’t make the rules. I just know that it should not be done that way.

If you added solids to a cookie dough, you run the risk of drying it out the cookie.

And no one wants to eat dust.

As I am unused to making chocolate cookies, a new recipe had to be located.

This recipe was a bit different. A bit stiff. And required a minimum 3-hour rest in the refrigerator. This meant I made the dough up last night. And let it rest in the fridge. And after my 0700 hip and knee meeting, I pulled out the dough and let it rest at room temperature for nearly 30 minutes.

The dough was still a bit stiff, even after it warmed up. But I was able to use my cookie scoop to get cookies. The recipe calls for cookie scoop and hands to shape the cookies.

Ew.

I don’t like things on my hands. Cookie scoop it was to be.

The batches baked up relatively good, with me keeping a close watch on the timer.

This is unlike anything I’ve ever made before. A worthy addition to the CTIAT recipes to use.

And not a cookie was burned!

This is a win.

Time.

There is a lot of talk about time in the OR.

How long until my break?

How long until the room is turned over?

How long to count at the cavity closure?

How long as (the desired) circulator been on break?

How long to get the patient back to the room?

How long to go to sleep/get the spinal?

How long to properly process the instrument I just dropped?

How long if we just flash it?

But the biggest is how much longer after prep before I can drape?

Same as the last four hundred sixty five thousand thirty two times you asked.

Chloraprep takes 3 minutes to dry.

There will be no draping before then.

Yeah, I know it feels like it takes forever.

I could have a rude joke here. But I don’t do that. You’re just going to have to imagine it.

If I, as the circulator, were to allow you to drape prior to the chloraprep being dry, what would be the consequences.

Fire.

Burns.

You see, it all comes down to patient safety.

I prefer to keep the patient safe, no matter what time your flight takes off, no matter your tee time, no matter that your significant other is holding dinner.

Patient safety is my paramount concern.

And it should be yours.

The tech will only give you the drapes/square off towels after the 3 minutes are up. And arguing only kind of makes the time go faster and most likely serves to irritate you and me.

Oh, look.

We’ve used up 90 seconds already.

You seen any good movies lately, doc?

In our very first philosophy class at the PhD program, the professor asked us to define truth.

There were many answers.

I spoke up and said, “Your truths may not be the same as mine.”

The professor stopped the discussion that had been going on and said that that was the heart of the problem around truth.

It is for each of us to decide.

The problem is that so many of us are told what our truth is. This truth, which should be part of our morale compass, is too often poisoned by their views on cultural matters.

No, that is their truth.

It doesn’t have to be same as yours. And I would guess that it is not.

This would be good for the society at large to internalize.

For me, the truth is not harmful to others, who are engaging in their own struggles.

Back to the Wiccan tenet, “And it harm none.”

No matter what you think is being harmed, are they really?

Or have you been told to say that by those who drip poison into your ears?

Think about what is your truth? What is your moral compass?

Or do you mean it when you harass marginalized communities in order to curry favor with those whose truth you are using?

Again, it is not your truth.

That is for you to decide.

And don’t be twee and say that your truth is to be against vaccines.

There is a vast difference between science, which is constantly tested and verified, and your personal truth.

My personal truth envelops science. Does yours?

Gown card reads “There is a patient’s bill of rights. Where is the nursing bill of rights?”

I was at the doctor’s office this past week. And I noticed the patient’s bill of rights posted in a very visual location.

Near the check-in desk.

It talks about the right for treatment, the right to have access to your own records, the right to make your own treatment decision, the right to privacy, the right to make your own decisions, the right to end-of-life care, and the right to make informed consent.

All of these are important rights for patients.

At the hospital we work really hard to make sure none of these rights are violated.

As an OR nurse, all of these are done every day. Including the right to make decisions about your own end-of-life decisions, including the decision not to treat.

Immediately after seeing the patient’s bill of rights, I wondered if there was a nurse’s bill of rights.

And what I would want on there.

There is a nurse’s bill of rights. The America Nurses Association has on their website the nurse’s bill of rights.

As nurses we have the right to practice at the top of our licenses in a way that fulfills our obligation to the patients.

As nurses we are the right to continuous access to training, education, and professional development. This goes hand in hand with the pathways for nurses who want to be leaders. It also allows for nurses to be recognized as leaders and to direct shared decision-making for nursing practice, resources, staffing and safety concerns. Does this sound familiar? It should. This is what shared governance is all about.

As nurses we have the right to practice in places that ensure respect, inclusivity, diversity and equity. We do this with leaders who are committed to undo systemic racism and address racist behaviors.

As nurses we have the right to practice for and in environments that prioritize and protect well being and for a place who provides support, resources and tools to stay psychologically and physically whole.

As nurses we have the right to advocate for our patients and to raise legitimate concerns about safety without fear of retribution, retaliation, intimidation, termination, or ostracization.

As nurses we have the right to competitive compensation that is commensurate with our clinical knowledge, experiences and professional responsibility that recognizes the value of nursing practice. My personal hot take is that there is only so much money and it has to be shared equally, but the optics of a hospital system CEO making millions and millions in compensation are not good when the nurse can’t pay their rent.

As nurses we have the right to negotiate terms, wages, and work conditions. Either singly or as a collective. Hot take #2 we have to be careful about unions.

There you have it.

The nurse’s bill of rights. As found on the American Nurses Association website. https://www.nursingworld.org/practice-policy/work-environment/health-safety/bill-of-rights/

What would be your additions?

Gown card reads “There is a patient’s bill of rights. Where is the nursing bill of rights?”

I was at the doctor’s office this past week. And I noticed the patient’s bill of rights posted in a very visual location.

Near the check-in desk.

It talks about the right for treatment, the right to have access to your own records, the right to make your own treatment decision, the right to privacy, the right to make your own decisions, the right to end-of-life care, and the right to make informed consent.

All of these are important rights for patients.

At the hospital we work really hard to make sure none of these rights are violated.

As an OR nurse, all of these are done every day. Including the right to make decisions about your own end-of-life decisions, including the decision not to treat.

Immediately after seeing the patient’s bill of rights, I wondered if there was a nurse’s bill of rights.

And what I would want on there.

There is a nurse’s bill of rights. The America Nurses Association has on their website the nurse’s bill of rights.

As nurses we have the right to practice at the top of our licenses in a way that fulfills our obligation to the patients.

As nurses we are the right to continuous access to training, education, and professional development. This goes hand in hand with the pathways for nurses who want to be leaders. It also allows for nurses to be recognized as leaders and to direct shared decision-making for nursing practice, resources, staffing and safety concerns. Does this sound familiar? It should. This is what shared governance is all about.

As nurses we have the right to practice in places that ensure respect, inclusivity, diversity and equity. We do this with leaders who are committed to undo systemic racism and address racist behaviors.

As nurses we have the right to practice for and in environments that prioritize and protect well being and for a place who provides support, resources and tools to stay psychologically and physically whole.

As nurses we have the right to advocate for our patients and to raise legitimate concerns about safety without fear of retribution, retaliation, intimidation, termination, or ostracization.

As nurses we have the right to competitive compensation that is commensurate with our clinical knowledge, experiences and professional responsibility that recognizes the value of nursing practice. My personal hot take is that there is only so much money and it has to be shared equally, but the optics of a hospital system CEO making millions and millions in compensation are not good when the nurse can’t pay their rent.

As nurses we have the right to negotiate terms, wages, and work conditions. Either singly or as a collective. Hot take #2 we have to be careful about unions.

There you have it.

The nurse’s bill of rights. As found on the American Nurses Association website. https://www.nursingworld.org/practice-policy/work-environment/health-safety/bill-of-rights/

What would be your additions?

This past week I’ve met with a student nurse a couple of times. They are working on a paper for leadership class and they mentioned something that was an interesting spin.

They love to cook and have come to think about each syllabus and each assignment as a recipe.

Huh.

Never thought if it that way before.

That is a very good point.

You have the building blocks of the syllabus or the ingredients in a recipe.

To carry the idea further the dates of the class assignments can be the time until the food is done.

And the ingredients can be analyzed further by their rubrics. This is where I got really interested.

A rubric is a cookbook of sorts for an assignment.

It clearly lays out the expectations of the assignment. And how much was section of the assignment is worth to the grade.

To reference it to my own school work, the syllabus is the cookbook, and the assignments are the different courses.

I like this. As a baker, I can get behind this.

And I will use this idea for Fall semester.

After all, the outcome of the recipe is only as good as the attention to detail of the preparer.

I have three classes, each will have syllabi and assignments. Each assignment will have a rubric. This means that I will have three cookbooks, with the expectation of X number of courses.

And if an assignment simmers too long, the preparer runs the risk of the souffle falling, to carry the idea to extremes.

This I like.

This I understand.

Now, how to convey this idea to students in my TA course who are struggling?

What a difference an ingredient swap makes!

I could find instructions on using malted milk in a cookie.

All I could find was articles extolling it as an idea.

But no instructions.

Okay.

Malted milk powder is a solid.

I will treat it as such.

I was going to use it as a replacement ingredient for some of the flour. Not much, just a half cup or so.

But when I mixed together the butter and the eggs and the sugars and the vanilla, the batter was much too thin.

Same recipe, you’d expect same results.

That is how science is done.

And baking is a science.

Maybe the day was too warm and the butter got too room temperature.

I don’t know.

It is nearly summer after all.

Especially here in the American South.

To recap, the dough was very runny and I decided not to substitute some of the malted milk powder for some of the flour. Instead, I was using all 2 and a quarter cups of flour AND 1/2 c malted milk.

The dough was still really runny.

Weird, right?

I added the chocolate chips and baked it up anyway.

The articles were right, the output was a thin, almost flexible cookie that was very flat.

But the flavor though.

Amazing.

A bit malty, a bit umami.

Wonderful flavor, flat cookie.

Must experiment more.

Will report back.

I am sure there is a technical name for the vectors at play when there is an act of gravity in an operating room.

Oops is a hated word in the OR.

An oops followed by where did the needle go is worse.

An operating room is of necessity a constrained place. The smallest I ever worked in was 12 feet by 13 feet and the largest is usually an oddly shaped soccer pitch sized. No, not really, but when it takes your circulator more than 10 seconds to cross the OR, the room is too big.

The OR table with patient and team standing next to it can be 8 feet by 5 feet.

A dropped needle can end up clear across the room near the door.

Sometimes a dropped needle can end up in the cuff of the mayo stand cover.

Sometimes a dropped needle can end up under the operating table.

Sometimes a dropped needle can end up

Definitely a dropped needle can end up where it does not belong.

And the shenanigans we go through to find a needle are great.

The first thing to do is to do a sharp and needle count on the field, the mayo, and the backtable. Maybe the missing needle was mislaid.

The next thing to do is to get reinforcements; call out to the desk for help.

The next thing to do is to get the flat magnet on a stick. This is used to sweep along the floor, in hopes that the lost needle will be stuck to it because its a magnet, and needles are metal. There are magnetic attractions involved.

And let the search begin.

The surgeon will start by stepping back, and peering at the floor. They might scuff their feet at the floor, seeing if they can get the needle to appear. They will pull at the drapes from the level of the bed and peer there too.

Oh, and all OR floors are mottled or dappled in appearance. The better to hide blood and body fluids.

You know what else like to hide in the shadows?

A dropped needle.

And sometimes a needle is NEVER found.

Kind of like the sock that disappears in the dryer.

Or a door to the dropped needle pocket universe.

There is a vast mountain of dropped needles in this pocket universe.

One place it is not is in the patient.

Or stuck in a team member.

At least not yet.

I certainly don’t want to write a debbie downer post.

Again.

In the last several weeks, I have written about abortion (again), and LGBTQ+ rights, and trans rights.

And today I do not want to gin up the outrage to write about those topics. They will be revisited as long as the attacks on women and our bodily autonomy, and the attacks on LGBTQ+ and trans rights keep happening.

But I am tired of shouting into the void about these topics.

And those who seek the power and control wonder about the state of mental health in the country.

It’s the constant grounding down of our rights, stupid.

And the removal of books.

And the banning of books.

Did you know that this isn’t a real problem?

Nope, it is a holy war by a handful of people. Who spread their hate like poison.

Who want to drag everyone in this society back to when they were comfortable.

The 1950s.

When men were men!

And women were subservient.

News flash!

The desire for body autonomy for everyone regardless of what they perceive to be their truth existed back then. As did the LGBTQ+ community.

The thing is the voices of the few are drowning out the more reasonable voices.

Loud does not make right.

And by right I mean correct.

I understand that you are scared and frightened of changes.

I am speaking to the “I don’t like it therefore you can’t have it crowd.”

What if I do like bodily autonomy, and the rights of people to be who they are and love who they love, and readers who want to read what they want.

So, what?

If you don’t want to change your gender identity, don’t.

If you don’t want to read that book, don’t.

If you don’t want a marriage with another person of the same gender, don’t.

If you don’t want bodily autonomy, find someone who will make all the decisions for you.

If you don’t want other people to read that book/identify as a different gender/have bodily autonomy because you want the control dammit because you don’t agree with it?

Then we have a problem.

The thing is these attacks on these groups is very much top of mind these days. And all days.

I will continue to write about them.

To think I was concerned about a blank blog post.

And thinking I would be able to write about anything other than the attacks on women and LGBTQ+ and books because some old white man/woman wants to erase all the progress that blood and tears and lives have bought over the last eighty years.

Silly me.