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.

The gown card reads “We need to stop telling them what they want to hear.”

Everyone does this.

And I mean everyone.

You get into a difficult conversation with your boss and all of a sudden you are agreeing that why yes, the sky is red with blue polka dots (or whatever the corporate coloration is).

Yes, it is absolutely fine to have a double back position, this nurse can do it.

The nurse doesn’t need sleep.

Yes, it is absolutely okie-dokie to have tech ignore the break in sterile technique.

That’s what antibiotics are fore.

All in the name of getting on with the cases.

Of advancing the schedule.

And then when something that you told them would happen happens, all of a sudden they are clutching their pearls, wailing, “how did this happen?”

Because disagreement and dissent may not be wanted in the department.

I hear stories of other hospitals from my nurse and tech friends where the echo chamber is alive and well, as long as it suits the corporate gain.

The word you are looking for after an unreasonable request is “No.”

Now, I have had difficulties with this word in the past. But I have always said no, and meant it, if I didn’t want to do something.

Shoe horn a 45 minute surgery into a 38 minute hole in the schedule? Excuse me, but when a surgeon tells you it will only take 40 minutes, that is their time, not the time to clean the room, open the case, see the patient, prep the patient, get anesthesia involved, go to sleep, do the case, wake the patient up, and go to PACU time. So, no, the *fill in the blank* case will not be going into the small hole in the schedule. Your choice is after this case, after the end of cases for the day, or tomorrow. Choose wisely.

The point is that we as nurses do not always have to agree with what management wants, or what a surgeon wants.

Not if it is going to endanger the patients or ourselves.

“Are you a last-minute Lucy like me? That means waiting until the day something is due to work on an assignment. Or to ask for help? I have absolutely been in your shoes. And not that long ago. Do you need help with formatting? Or APA 7? Or time management? Or just need someone to vent to? I can do all that and more. 

I have added different dates and times (including weekends) to help you with your needs.”

This was an announcement that I wrote yesterday about expanded hours for my TA side gig that I am working this summer. The idea is that the student would email the person in the sign-up genius about taking one of the slots.  And then me, as the TA, would set up a Zoom meeting and meet with the student virtually and address any items they are struggling with.

I’ve had two good meetings with students about assignments.

TWO!

In the four weeks I’ve been doing this!

I am not sure what more I can do, besides sit by the email, waiting for someone to reach out.

I am not sure what the hesitancy is on the student’s side.

They won’t be tracked. Much.

These are established nurses in an RN to BSN bridge program.

I know, because I do it too, that nurses are hesitant to reach out.

Because we are the ones in the white hats.

It is not a sign of failure to use every avenue to aid in passing.

But I know that people will feel judged. If it is only by themselves.

Trust me.

I know.

We all a little help sometimes.

The Beatles said it best “we all need a little help from our friends.”

Consider me your friend.

That’s why I am here, waiting by the email.

Waiting.

Y’all know I have a hatred of being paid for doing little. It is the nurse in me.

As the June theme is same chocolate chip cookie but different ingredients, I wanted to make this week’s chocolate chip by replacing regu0lar butter with browned butter.

A small substitution that yields a mile difference in taste.

When butter is browned, the milk solids separate and brown. This is what makes the taste different.

It tastes nuttier.

This week’s chocolate chip cookie is the same Tollhouse recipe from last week, with browned butter.

I’ve made it before and then I was stopped by one of the CRNAs who told me that this was the best chocolate chip cookie that they’d ever had.

Mission accomplished.

Of course, when the theme was announced, four different people asked which week was going to be the jalapeno chocolate chip cookie. Sorry, guys, not doing that this month. That would be an addition, not a substitution

Just ask the surgeons how they feel about backorders. It is much better than that.

More like, let me pitch, coach.

There is always going to be a time when a situation hits that is completely out of your knowledge or comfort zone.

Especially when you are the only nurse in the department on the evening or night shift.

As my first and favorite ACLS instructor said, “In the event of a code, first thing to do is to take your own pulse.”

Because you have to center yourself to be able to help someone else.

It does no one any good if you are panicking.

In an emergency:

Step 1-take your own pulse and center yourself. This will put you in the mindset to deal with a crisis.

Step 2- is there mortal danger? This refers to a patient dying. Or an active shooter. I would consider an active shooter mortal danger.

Step 3- is there immediate danger? This refers to immediate devolvement to step 1. This can also be self immediate danger. An example of this is an unexpected even happened during surgery, such as a sudden finding during a surgery. This unexpected thing can be a hazardous to the patient.

Step 4- Is there ongoing danger? This refers to natural disasters, where the immedate danger has ended (the storm) but there are still ongoing dangers such as downed powerlines, or broken windows.

Step 5- do you know who to contact after Steps 1-3? Knowing who to contact and what forms to fill out will be imperative. Most hospitals have a form that must be filled out with patient information, details about the crisis or break from routine, impact on the patient. There are also forms for employee involvement in a crisis. The last one I personally filled out was when I fell in the OR and smashed my cheek against a trash can in September 2019. Blood exposure may be handled differently by your organization as well. As the only nurse on the shift others may come to you seeking information on how to fill out the internal forms. Always suggest the forms are filled out and turned in. Because if it turns into something bigger, you want documentation on your side. And it is also important to know the person who knows all in the department. There is always 1. And reach out to them, if only to make sure that you have the steps right.

Step 6- is there evidence that needs to be collected and saved to a central location? Depending on the emergency, this may be key. Also, if there is a fire in an OR, and the fire department is called, don’t forget that nothing can be removed from the room after the fire is out and the people are safe and the fire department is gone. This is for the fire investigators.

Step 7- relax, you did a good job. There may be lots of follow up questions. But for now the patient is safe, you are safe.

Until the next time.