The Facebook memory from March 19, 2017 reads “Today is Certified Nurses Day.What does that mean? It means that these nurses went on to get specialized certification in the particular realm that they practice in. It also means that to keep the certification hundreds of hours of education has to be done.I have been certified for eight years. To keep my CNOR (certified nurse operating room), I have to complete 135 hours of CEUS every 5 years. My mom (Billie Schaberg) has been certified for years, and is a big part of the reason I am as well.I don’t get any extra per hour for being certified and I am lucky in that the hospital I work for will reimburse me for the hours and the recertification. But even if they didn’t I still would do it. Why become certified? Why not?”

Why not? This is a loaded two words.

Certification is important in the nursing world, just like in the real world.

It indicates commitment.

Not only to the profession, to the patients, but to themselves.

Is it hard to obtain certification?

No. There are some fiddly bits.

Like a test.

And I know how some people fear tests,

And, depending on where you work there may be an hourly bump, or a point on the clinical ladder, such as in my hospital system.

Hospitals are also interested in certified nurses. And some are doing their best to bring in test prep or paying for the test.

I know mine is.

Contact me if you want to learn more about certification, no matter the department that you work in. We can figure it out.

What?

Already?

Are you sure?

Didn’t the semester just start?

Yes, depending on your college or university, class selection starts for the next semester/quarter early.

And when I was at Creighton there was a mad dash to sign up to ensure that there was room for all the people who wanted to take a particular class.

The internet makes it easier and harder at the same time.

You have to remember the password. And read about all the classes you want to take and decide which classes would be best for your major.

And meet with your advisor.

And decide which class to take next.

I’ve been lucky. I’ve only had to choose three times in the last several years.

Otherwise, I have followed a set path in the classes that would get me to my degree fastest.

There may be some wiggle room timing of classes, especially in a larger university. Or you could decide to take a semester off.

But, unless you’re a morning person, do not sign up for 0800 classes. You probably won’t like that. Unless it is the only time the class is offered. If so, make sure you get a good night’s sleep the night before.

And as an adult learner, you may have to pick classes that correspond with your shifts.

Evening classes and even weekend classes are offered.

My advice is to talk to your advisor. They may be able to tell you the best path to take.

I wish I had listened to my advisor when they cautioned against taking statistics AND economics in the same 6-week block. But I was in a hurry to finish and I had four classes left to take for the next 3 quarters.

I counsel people not to do that.

But the good night’s sleep advice?

Definitely do that.

What I was gonna do? This week also has Pi Day in it. You know, 3.1459, etc. I read about a Venn Diagram Pie. For this three pies are needed, and a cut-out for the intersection part. Three flavors are needed, with the intersection pie being a combination of the other 2. As I was working out how to do this, I decided it was too complicated and would be hard to serve. If I have learned anything about serving up cookies weekly for EIGHT years, it is that the simplest cookies are best.

And tomorrow is St. Patrick’s Day, a high holy holiday in my book. And, in keeping with the theme of the month, the recipe had to be something I had not baked in months. Reminder, the theme of the month is Blast from the Past. I made these cookies during one of the two Booze theme months. These were January 2021 and January 2022, where I had recipes for cookies that included alcohol. Why these months? Do you not remember the complete shitshows 2020 and 2021? Especially in healthcare?

I digress. And I’ve already written about covid this week.

The cookie for this week has ingredients that I don’t normally use, Bailey’s Irish Cream and espresso powder. There is a good coffee flavor to it.

I have been baking exclusively for CTIAT in my lower oven. This isn’t ideal because of the time that it takes to pre-heat, or the energy used running it. I am going to give the top oven a good cleaning and see if that improves the evenness of the baking.

Bailey’s Irish Cream Chocolate Chip Cookies

1 c butter, room temperature

1 c brown sugar

1/2 c sugar

3-4 tbsp Bailey’s Irish Cream, more if desired

2 tsp vanilla

2 eggs

2 1/2 c flour

2 tsp baking soda (I’ve been using more these days)

1 tsp salt

1 tbsp cinnamon

1 tbsp espresso powder

2 c chocolate chips

Combine all the ingredients, and bake in a 375 degree oven 10-12 minutes

Oops, I forgot to finish the sharps.

The most important sharp of all.

The entire reason there can be surgery at the basic level.

The blade.

AKA the scalpel. AKA the knife blade. AKA the sharp thingy.

The thing that makes the incision.

There are many types of blades. The most common are the numbered blades. Each number corresponds to the shape of the blade. The most common in the surgeries that I do are the #10 and the #15. The #10 is a fatter blade that is used to make big incisions, such as over a joint, or into the abdomen. The #15 is a skinnier blade that is used to make incisions that don’t need to go as deep, such as for laparoscopic surgeries, or lipoma removal.

There are many other blade #s. A #11 blade is used for arthroscopic surgery. It is sharply pointed. A #22 blade is a bigger blade but shaped like a 10. I’ve seen them used for autopsies, useful because it can cut through thicker tissues I’ve never used a #12 but it has been in every operating room I’ve worked at, it is shaped a bit like a scythe with a curved tip. A quick search reveals that it is used for some nasal surgeries or also to open an artery.

And then there are the specialty blades. Besides the ones that are used to cut bone and there are also lots of those, there are beaver blades. These have rounded tips. These do not fit on the usual knife handles that are used for the numbered blades. These are good for delicate tissue surgery where precision is paramount. I’ve used these most often on hand surgeries, and some foot and ankle surgeries.

Blades come separately from the handle. This is for a variety of reasons but the most important reason is to not harm the sterile processing tech who will be reassembling the tray. And, if you ask surgeons, it is so that they can always have a fresh, sharp blade. Depending on the surgeon and the tissue that they are cutting through and the preciseness of the surgery, the number of blades open on the field can be upwards of 20.

There are disposable blades/handle combos. These are used when the regular blades are on backorder, or are used in the ER, or in the field. In the field is outside of the hospital.

In my experience, there are four kinds of knife handles. These are countable on an open case. And is shaped to accept the blade of surgeon’s choice. Handles can also be different. Some only are used for a certain numbered blade, and some can be used with more than 1 blade number.

This is one of the things that makes the OR so challenging. Not only do you have to know what each instrument is called and what surgeries it is used for, but you also have to know about the blade numbers and the surgical needles. And some surgeons expect you to remember all of their minutiae as well.

Of course they do.

I know, I know. I just posted about covid round-up last Monday.

And I had known this was going to happen I would not have posted last Monday.

What happened?

The Johns Hopkins University covid dashboard stopped collecting and updating. As of March 10, 2023, at 0821.

Moment of silence please.

JHU had announced that they were ceasing updating the covid map several weeks ago.

This is where I have gone to get factual numbers and information about infection rates and death. Both the US and worldwide. And a drill down to North Carolina if I desired.

I guess I have to find a new repository of covid data. The JHU website hyperlinks to the World Health Organization (WHO). But the data isn’t presented visually, and it takes several clicks to get through to a dashboard. Of course, there is a discrepancy between the two dashboards, even allowing for the differences in time and accrual techniques. Same for the CDC.

As of March 10, 2023, at 0821, the US covid death total was 1,123,836. And globally, the death total was 6,881,955.

And more every day. 900-1000 per day. Worldwide. And as previously discussed about 1000 per week here. And the hospital I work still has not dropped to zero.

The shutting down of the JHU dashboard data collection is to be expected from a country who wants to negate the changes and challenges of the last three years. Even if they continue.

As long as it does not impact them.

I find the lack of empathy on the behalf of the US to be alarming.

But not surprising.

There is a scene in Princess Bride where Count Rugen asks Westley a question after he’s used the “Torture Machine” on him for the first time. That is very, very applicable to time change Sunday.

The gown card reads “I’ve just sucked one year of your life away. I might one day go as high as five, but I don’t really know what that would do to you so let’s start with what we have. What did this do to you? Tell me. And remember this is for posterity so be honest.”

There is a lot to unpack here.

We’ve just lived through a once-in-a-lifetime pandemic. There are people, including myself, who exclaim that time has no meaning.

I know I’ve written that babies who were born in the first year of the pandemic are THREE this year, and may have a sibling by now.

As for me, in 2020 I was graduating with my MSN, took a year off of school, changed it to 2 years off of school, and now I am in a PhD program.

All of a sudden, I worked all the hours that were during a pandemic, taking care of patients, and supporting the hospital. Fearing bringing covid home.

All of a sudden, people were on lockdown. And the streets were empty.

All of a sudden, my niece is graduating from high school.

All of a sudden, my nephew is taller than my sister.

The point is that time feels disjointed.

I would like my hour back, please.

Enough of the recent time has already been taken away from us.

Perhaps this is compounded by Spring Break and being off school for a week.

Maybe a nap will help.

Before I dive back into the grind of research assisting work and papers and graded homework assignments and presentations and quizzes.

Oh, my.

Definitely a nap on this rainy, dreary day.

Before my week begins anew.

Midterms were just a week or so ago. And your student got rewarded with Spring Break. Unlike the spring breaks of their childhood, this has nothing to do with Easter.

The run-up to midterm is exhausting. All the papers, all the readings, all the tests.

All the presentations.

Makes me tired to write about it and I just lived it.

And now that we’ve had our fun and a break, back to the grindstone of the semester.

Your student may or may not have been assigned homework on the break.

Your student may or may not have DONE their assigned homework on the break.

Sounds familiar, right? Just like high school.

Now that the excitement and rest of spring break has passed, your student may turn their eyes to their calendar and realize there will be a test almost immediately upon returning.

Now that the panic doing of homework has set in, or maybe passed, the mid-semester doldrums can move in.

Many assignments and tests and presentations before the end of the semester. Oh, boy.

And, for me at least, the ennui of having to face it all.

Your student may be blah.

And that is okay.

Just remind them that 8 weeks separate them from summer break.

And they have a lot of work to do.

Maybe they should start with opening their calendar and making a plan. Or, at least, reviewing for the test that is sure to hit after the break.

The impetus for this entire Blast from the Past theme was a Facebook post of a Twix cookie I made way back in the start of Cookie Thursday is a Thing. In February 2015.

To my recollection, I have not made them again since.

This is a multi-step cookie, which is probably why I’ve not made them since.

Bake the shortbread. Let cool.

Make the topping and top cookies. Let cool.

Melt the chocolate and top the topping. Let cool.

I just finished the chocolate layer and I’ve been baking since 0800. And it is not 1220.

A labor-intensive cookie.

I’m on spring break this week from university,

And minimal meetings.

Perfect day to dust off the recipe.

The original Facebook post says that I need to work on my chocolate game.

Still do.

But I realize that the cookie does not have to be perfect.

A fact that some surgeons I work with need to internalize.

I’ve been on many cases that the surgeon wanted to make “perfect”. Only to have the repair fall apart and need to be done again. At the expense of the patient having to remain under anesthesia for that much longer. At the expense of the OR schedule.

Here’s the thing. We are never going to be able to put the patient back together to factory standard. They will still have been broken, or their abdomen entered into, or their uterus cut to deliver a baby. There is no way to unHumpty Dumpty them.

Repairs don’t have to be perfect. They just have to be good enough to work.

And that is the lesson for today.

Is my chocolate enrobing perfect?

Nope. But the cookie still tastes amazing. Which is my goal.

The sterile processing department is where instruments go to be cleaned, counted, put back in order, and sterilized.

But how do they know what instruments go in each set?

What if I wanted a minor tray?

There is a count sheet for that.

This is a standardized to the hospital form that lists all the instruments, in order, and lists how many there are of each instrument that can be expected.

Ideally, the catalog number of the instrument is listed, along with the manufacturer. This makes it easier to be reordered in case of accidental loss.

Not in a patient.

We covered that in Counting Basics #4.

Why do counts exist? It allows us to be relatively confident that what goes in comes out.

Barring emergency cases (the cut or die type) or patients with a large cavity.

The count sheet is begun in sterile processing during tray makeup.

All instruments in the tray are counted and noted on the sheet.

And the tray is sterilized.

But sometimes the count sheet and the tray do not match. What then?

Yeah, SPD techs are allowed to be human.

Just adjust the count sheet and continue with the count.

To you, the count is right in front of you.

To the SPD tech, the tray may have been one of several of the same kind that was assembled at that time. And it might have been days ago, depending on the frequency of use.

And that is why we count again. Comparing it with the count sheet.

Because all that matters is that somewhere, sometime there is an agreement before the patient is in the room.

And the count sheet is kept and maintained, added to if needed, and counted off again as the surgeon is closing.

Is this elementary? Yes.

Does anything better exist? No.

An option would be to x-ray every single person upon closure, exposing them to x-ray unnecessarily, costing them more.

Some places do this.

Of course, some places think that fewer counts are a good thing.

A retained surgical item can cost the hospital thousands and thousands of dollars for retrieval.

A retained surgical item can cost the patient another surgery and recovery period.

A retained surgical item can cost the hospital system big time due to lawsuits.

Follow the policy of your hospital. No matter what it takes. No matter the pressure from the surgeon to just get it done already.

You are not there to keep the surgeon on time or happy.

You are there to keep the patient safe.

Not much has been happening since the US decided that everything all at once could re-open and masks were optional.

All the time.

I mean ALL the time.

No matter the risk level of the community.

Cool.

You do you.

The covid death toll for the US is one million, one hundred twenty-two thousand, and sixty-four.

Yes.

I am still looking at the data.

No, they haven’t stopped the nonsense yet.

Yes, people are still dying.

On February 12th, the death toll was 1,114,377. The difference is a little under eight thousand, or 7800 for those doing the math. This was about three weeks ago. Divide by 3. The answer is 2629 dead a week.

Which, I’ll give it to you straight, is slightly better than the 2882 dead then.

And is 2629 US dead in a week worth not wearing a mask when going out? Or inconveniencing your life in any way.

Think on that a bit.

On the positive side, the hospitals in California have dropped the in-hospital mask mandate.

Why? Because the percentage of people who are fully vaccinated is 85.44.

By contrast, the percentage of people who are fully vaccinated in North Carolina is 66.8%. And we still have the in-hospital mask mandate.

I mean, the hospital where I work had a week, maybe two where there were no covid patient hospitalized.

It has been 3 years since I started doing this covid round-up. We’ve been through a lot.

The terror, the shutdowns, the masks, the vaccines, the refusal to wear masks, the refusal to get a vaccine.

Three years.

On one hand, this is what flattening the curve means; smaller curve, less deaths, longer time frame.

On the other, people are still dying. A lot.

As long as you are cool with that.

Carry on.