The turnover refers to the amount of time from taking that patient to PACU, giving report, seeing the next patient, and returning to the room to continue opening. Basically the wheels out to wheels in.

This is for the circulator.

While the circulator is doing that the scrub tech and the orderlies are to take the trash out and clean the room.

It is not time to disappear while the others do the work.

I am thinking this needs to be my dissertation topic.

How to get the most efficient turnover time possible.

On evenings our turnover times were 10 minutes.

And we got asked a lot how that was possible.

1. Don’t disappear. A quick trip to the bathroom is one thing, having a full meal is another
2. Know that there isn’t anyone available to help, it’s all on you, baby. There are no orderlies at evening/night
3. Toward the end of the case, start preparing the room to be turned over. Pull the trash bags, pull and put solidifier in the irrigation fluid and pull the canisters, pull the irrigation bag down when the field is done with it, dispose of it, make sure there is nothing on the floor, push the towers back after unhooking all the equipment
4. end of list

Basically, prepare the room to be cleaned by you.

I’m not sure which is more important.

The knowledge that it is all the circulator/scrub tech combo to clean the room because there is literally no one else.

Or

Preparing the room for turnover.

Definitely preparing the room for turnover.

A little preventative tidying goes a long way.

Yelling at the surgeons who deliberately drop suture ends also is useful.

At night our turnover times are about the same as they were on the evening shift.

Oh, I almost forgot the second most important thing.

Have a discussion with the team in the room: surgeon, scrub tech, yourself, and the CRNA and lay out how this is going.

After all, the team wants to be done with the case as much as you do. If not more.

Preparation is not only half the battle, to borrow and mangle the GI Joe quote, it is the only thing that is going to get the good turnover times.

This is more light-hearted Monday Musing than I’ve written about lately.

Well, I say light-hearted.

I’ve been working as a Teaching Assistant for the last 8 weeks and one thing I ALWAYS tell the students is that it is okay to take a break.

This is something that real-life me needs as well.

You, too, probably.

I would bet money on it.

Yesterday was a gloriously lazy day.

I decided that, since it was my birthday, no chores, or self-inflicted honey-dos would be done.

I did no dishes.

I did no laundry.

I did nothing at all, except read and play my computer game.

And it was great.

But at the end of the day, a little boring.

Now back to regularly scheduled laundry, and dishes, and chores.

You know what?

They didn’t miss me.

Like at all.

They were still there waiting when I got up this morning.

They are very loyal that way.

Life will wait for you to take a break.

Take five, will ya?

Where I live in North Carolina, summer has set in with a vengeance.

The beginning of the fall semester is a bit off, summer classes are winding down.

What is a student to do?

This student is preparing the poster for the North Carolina Nurse Association convention. It is due at the end of July.

Also due at the end of July are the virtual convention hours from AORN.

Other students may have their eyes on vacation on these hot days.

Hours at the beach, if that is your thing.

Hours hiking in the mountains, if that is your thing.

Hours huddled in the air conditioning, if that is your thing.

Hours reading books that you don’t have time for during the school year.

You do you.

The point is that there are very few weeks until the end of summer and the beginning of the fall semester.

You might as well enjoy it.

It will be time soon enough to buckle down for the 16 weeks of the fall semester.

Time to recharge and get the brain cooled off so that you start the fall semester with a cool brain, enough sleep, and ready to tackle the classes.

One of my favorite mantras is useful here “the only way out is through.”

I took a poll, on two different pages about what the theme for July should be.

The options were 1) Christmas in July and 2) Fake-out cookies (these are homemade versions of commercially available cookies).

Of the people who voted, 90% of them voted for Christmas in July. Only three people wanted the fake-outs.

I still want to do fake-outs, that will be at a later month.

What is the hands-down favorite that I make at Christmas?

What was requested in the response to the poll?

Chex mix.

Okay.

Easy enough.

I don’t even need a recipe.

Which is good because I worked all night last night. And the cat kept me up most of the morning with her need for attention.

Not a lot of sleep was had.

It’s a good thing this is a fix it, stir it a few times during baking recipe. Which enabled me to zone on the couch until it was time to stir the chex mix every 20 minutes.

How popular is my recipe?

Several people asked for baggies. You know, in case they missed out.

That is a sign of a good Cookie Thursday is a Thing make.

Chex Mix

1 box each of whatever kind of Chex you want- I use a family-sized box of Corn Chex and a family-sized box of Rice Chex. You can also add a small box of Wheat Chex.

Any add-ins that are desired. Pretzels, mixed nuts, new this time I added Specialty rye crisps. You know the ones.

The sauce (AKA the good stuff)

For this amount of cereal I used 3 sticks butter, melted, 2 tbs seasoning salt, 2 tbs garlic powder, 2 tbs onion powder, and 1/2 c Worcestershire sauce. Melted and mixed together on the stove and pour over cereal and add-ins.

Bake at 250 degree Fahrenheit oven, stirring every 20 minutes, for 1 and half to 2 hours.

Let cool before eating, this will allow the nuts and cereals to firm up and become crisp again.

This is Christmas in July.

As long as there has been modern nursing there has been charting.

Yes, starting back with Florence Nightingale.

How else would you measure improvement?

And did I tell you that Florence Nightingale was the first nurse statistician?

Yeah. She measured and remeasured the soldiers to ensure that her interventions were making the impact that she wanted. What is that but pure research?

Where there was nursing, there was charting. The noting down of a patient’s symptoms/wound size/progress toward goals kind of charting.

When I was at the California hospital, we had a hybrid system. This was 1999 after all. There was computer writing of nurse notes that would be saved to the mainframe at the hospital and physicians could read them. If the computer charting system was down, the nurse wrote notes on paper. Physical therapy and physicians wrote notes on paper.

Not all of the notes were legible, though. Most of the notes required another nurse who could read the handwriting.

Many medical mistakes were made due to poor handwriting.

Fast forward to the electronic health record.

A mere 10 years in the future.

Now there is the electronic health record that is purportedly easier to chart with.

I’ve never charted in the EHR as a floor nurse and I am not the most up-to-date on the EHR for narrative nurse notes.

Medical mistakes went down when there was a clearer way to convey progress.

EHR has some naysayers.

I quite like it.

After all, I had a hand in creating the hospital system’s EHR. I was a subject matter expert who had input into what must be included or not needed.

It has definitely cut down on complaints over my own handwriting.

I can only think it helps with patient safety.

If only from the doctor’s illegible handwriting.

I have begun and discarded this post so many times. I have many questions and many, many, many concerns after Dobbs was decided just over a year ago.

But what can I say about the hellscape that is maternal medicine in this country?

I have bookmarked 1080 articles from various news outlets about abortion. Who can no longer access it at all, who can access with severe restrictions, who is fleeing to another state for the healthcare that they can no longer get in their own state.

The exceptions to save a woman’s life are not worth the paper they are printed on. People are dying, have died, and will continue to die.

Doctors are afraid of prosecution if they stray from the very, very narrow ledge they are on.

Mothers are afraid of complications with their pregnancy.

Women are mad about losing control over our own bodies with good reason.

Again, I can’t make you understand about what this supreme court has done to us with the flick of a pen and a smug, oh, so smug, decision document that was written by the architect of this madness.

Many states are jumping on the bandwagon. Including North Carolina, where I live. They saw the backlash about the “heartbeat” bills. No, it’s not a heart beat, it is electrical activity in what will become the heart. And they decided in their patriarchal wisdom that if the time is DOUBLED to 12 weeks, what would women object to? After all they added SIX entire weeks to the decision process. Of course, they put up roadblocks such as how many visits a women, who may not be able to afford or take time off from her work, has to have with their doctor. I’ve written about it before. 12 weeks is an arbitrary number they made up in their heads. More important information can be gotten at the anatomy scan after 18 weeks such as fetal abnormalities, but sure, 12 weeks is more than enough time (sarcasm, dripping in condescension).

Slow clap.

You sure have shown women who is boss. Who is control of them. Who taught you to be afraid of the female?

What about the infants, inter-uretero or otherwise, who are doomed to be tortured until they die after birth?

I have not heard one peep from the legislatures who are rushing to judgement about the inhumane torture of these infants. Those who are born to die, horribly, gasping for breath, their heart struggling to keep up with its new demands when the infant was never meant to survive out of the uterus. What about those American citizens? Who speaks for them.

What is it? Are you anti-abortion and pro-torture?

Who takes care of these unwanted babies?

Who pays for their futile medical care?

Who pays for their funerals? Which some states have oh so helpfully put into laws.

The African-American maternal death rate has skyrocketed. Some of these are partner violence, and some are forcing a woman to carry a doomed child who is poisong to their host.

We should be ashamed.

And mad. We should be mad.

Vote like your life depends on it.

Because, if you are a woman, it does.

The phone note reads “hey buddy, I get it. You have big feelings about LGBTQ+. You don’t know why you are big mad, do you?”

I have thoughts about why you may be mad.

Control.

It is always down to control.

People want it over their own lives.

They want to make their own decisions.

They want to love who they love.

They want to be who they want to be.

And you can’t stand it.

Because it isn’t what YOU want for your own life.

That’s okay.

No one wants you to be gay, or want to marry someone who you deem to be socially unacceptable, or anything else really. Or to not wear white after Labor Day. Or to not take in your trash containers after the trash collectors come (except for your HOA).

Hell, wear the white.

Don’t take in your trash containers after trash collectors.

But the issue is still there in your mind. You can’t control them.

Make everyone automatons who think like you do, and act like you do, and work like you do. Have 2.1 children and a house in the suburbs. And retirement at age 60.

Can you?

You can make laws and rules and stack the Supreme Court with activist judges who align with your narrow way of perceiving the world.

The world is changing. There are those among us who do not want to be controlled and turned into a puppet so you’ll be more comfortable.

Don’t want to see gay marriage or trans people or people having bodily autonomy. The answer is very simple: Don’t look.

We will still fight.

We are not done fighting.

Happy Pride Month.

As my favorite hat that I bought after the Dobbs ruling says “Fuck your laws”.

I think the messaging needs to be stronger and nice.

“Fuck your laws, have a nice day.”

That’s better.

Remember, don’t look and judge people who are just trying to live their lives.

I can scarcely believe it is just over a month before the Fall semester begins. I have done so much and so little all at once.

In the absence of classes, I did continuing education units (CEUs) like I did last year. I attended a 7-hour research symposium. I did a 6-hour CEU conference based specifically on SPD. I attended three day, 7 hour a day writing group. Not once, not twice, but three times.

I did life admin: cleaning, yearly physical with my doctor, the establishment of a high-yield savings account to put scholarship money into. I packed and prepared the house for my mom who would be staying while we were out of town. I did the vacation, including getting very mad at the airline when they added a superfluous second layover that has us going north instead of east. This is NOT what we paid for and I tried to get it changed. A two-hour conversation with a rep trying to get it changed back. Four hours and three representatives later on the second day of getting it rectified only to be told that “Gee, it looks like you changed it yourself.” The fuck I did. They will be hearing from me when I get home; I have the original itinerary, plus screenshots from when I was online/hold/robot.

Oh, and I did teaching assistant for six weeks, twenty hours a week. This was invaluable to me as a continuing grad student. I’ve never had the opportunity to do that before. The report is due to my supervisor on Monday and I will get it off to them. I only wish I could have engaged more with the students, I think that would have been good for them, and for me.

Strangely I got invited to a curriculum-building two-day in-person class. I do not build classes as of yet. Or curriculum but it was interesting and information I will be needing in the future. I hope. Everywhere I read there is a deepening shortage of nursing instructors and to fulfill the grant that is paying the lion’s share of tuition, I have to secure a teaching position within 18 months of graduation and keep it for 4 years.

I have been assigned as a research assistant to a new doctor. They are more in line with what is my interest in improving processes and improving healthcare workers’ lives. I will email her on Monday and introduce myself and ask for guidelines. I hope this is a good fit; there is nothing I hate more than being paid for being useless.

The PhD cohort and I will be getting together in person before the beginning of classes. That will be a lot of fun and also a way to get my head back into the game. Since the university changed the curriculum in January, I ended up having to take one less class. In the original plan, there were three elective *** (word) classes that we got to choose what we wanted to take. The new curriculum drops that down to two, and I’ve already taken them in my first year.

When classes do resume, they will be online. Except for the first class of the semester, which is a meet and greet with the instructors, plus class. This is advantage me because it won’t matter if I’ve worked all night the night before, I can do class from home. This will be a huge help.

I want to write about the massive right swing the Supreme Court is currently doing, but this is not the space. Come back later for that!

No cookies today as I am far, far from the hospital. And enjoying the weather in the middle of the country.

Did I arrange a back up baker, like I’ve done in the past?

Nope.

I had enough to do with getting ready for the trip. And occupation of my house by my mom.

There is clean and tidy.

And then there is Mom clean.

Report from North Carolina is that it is smoky, and the cats are being vocal about food times. They must miss us because they are lurking about.

Apparently we did not bring the rain with us. Instead, we left a few raindrops behind.

Have you ever gone to the hospital and felt like you were just a number?

That the receptionist, doctor, nurse, medical assistant just wanted to get through the day and you were an impediment for them being able to finish their day and go on home?

This is not just a feeling that you get from the doctor’s office, the hospital, the emergency room, or the morgue. This has been brewing for a while now, since way before the pandemic. People feel as if they are infringing on the time of the other people who are supposed to be helping them.

This is not right.

Not in the doctor’s office. Not in the hospital. Not in the emergency room. Not in the morgue. People coming for help is the entire reason for those places and for the workers. No patients, no work. No work, no need for employees to staff those places.

No work.

No paycheck.

To reach out for help in these places, a person who will become a patient has to give out a lot.

They have to give up their control.

They have to acknowledge that they need help. This may be a big step. This is a big step for a lot of people.

They have given up so many things. The least we can do as healthcare workers is to strive to meet their needs.

After all, a nursing diagnosis is about meeting the needs of the patients. The patients coming to the hospital have more needs that can be reached.

One of the bigger needs is to not be seen as a burden, a speed bump on the nurse’s way home.

As the evening charge nurse who also took the majority of all the night call, there was no end to my shift. There was an end to my night, when I could go home, but no distinct someone is going to relieve me end to my night.

As the night call nurse there is no end to my shift. My entire responsibility and reason I am at the hospital is to care for the patient. It is the least I can do to be thorough and pleasant.

And never, ever make them feel like they are a number,

As a healthcare consumer I don’t like when I am made to feel like a number. I do not let my patients feel like they are an impediment to my night. Because I am certain they woke up in the morning and said to themselves “I’ve been a bit bored, I think I will try (insert thing that brought them to the hospital to seek care).”

Patients waiting for surgery are vulnerable and may strike out verbally for delays. We must never let them think they are taking up time they do not deserve.

Patients and families are the reason we have jobs, after all.