ROI. Otherwise known as Return On Investment.

One of the questions that you have to ask yourself is if the outlay for school will be worth what you get out of it.

And that is a very personal question.

It depends.

That is not a cop out.

This university PhD jaunt is my 5th (!) nursing school.

Let’s talk nitty gritty detail and money.

Creighton 1993-1995. This was paid for by student loan, scholarship from Marshalls, and an Air Force Reserve Officer Training Corps (AFROTC) scholarship that covered some of my second year at Creighton.

After I hurt my shoulder and lost my scholarship, I did not return to school after my sophomore year. This was because I had lost my scholarship and I just gave up? I’m not sure. I do know I needed two separate surgeries to repair the labral damage.

The total cost to me for this was $4500 in student loans that I paid back by 1998. And a $10,000 AFROTC bill that I got after I left Creighton. It took me ten years of monthly payments to pay that off. I began paying it back in 1997, and finished in 2007. And I have the letter from the government to prove it.

Considering I didn’t finish, and owed $14,500 was this a good ROI? I would say no. I was not a nurse and had to pay off those student loans. The classes that I did complete did come in handy later and decreased the outlay for Chamberlain. Like many things in life, this was a wash, I guess.

Napa Valley College 1998-2001. My parents bought my books, I paid cash for the classes. At the end of this I was a nurse. An ADN nurse, but a nurse. This was definitely worth the ROI.

However, working as a CNA Thursday-Monday evenings 1500-2300, and class every day of the week but Thursday was a tough road. And probably helped set up my workaholic habits. And I maintained those for YEARS.

Chamberlain College 2015-2016. I had a wild notion to go back to school for my BSN. Things were happening in the hospital system. And I started to think what would I do if I got hurt? The OR is a dangerous place. I needed a fall back position and a BSN would help. I paid for Chamberlain with student loans and $3,000 when the billing cycle and the student loan disbursement did not meet. $19,000 in student loans, which I immediately rolled over into my MSN.

Knowing what I know now, there are cheaper ADN-BSN bridge options out there. I advertise these to my coworkers monthly. And offer tutoring.

Queens University of Charlotte 2017-2020. I went here for the MSN program. It was touted to be affordable and less than $15,000 for everything. I paid with a combination of student loans, and out of pocket expenses. I haven’t used the MSN as of yet, because covid. But I did use it as a steeping stool for my last university. We paid off all $29,000 in student loans from Chamberlain and Queens in September 2021. I was able to accomplish this with clinical ladder money, tuition reimbursement, and picking up extra shifts/extra call. So many extra shifts.

University of North Carolina Greensboro is hopefully my final school. It is $500/credit hour and the PhD program is 57 credit hours to graduate. By my calculation this will be roughly $29,000 for class and another $3,000 for fees. I am paying for this through a loan that will be reimbursed 85% if I teach nursing after I graduate. As this has always been an end game goal of mine, I don’t think I will find that too onerous. If I do the math and I fulfill the faculty part of the loan, I will have to pay about $6,000. That brings the grand total to roughly $55,000 in education over 30+ years.

I am saving all extra money gained from clinical ladder, tuition reimbursement, and hospital bonuses in a separate savings account to pay back the PhD loan if I am unable to fulfill the contract I signed.

My goal in continuing my education is to have a fall back if I get too old or too injured to work as an OR nurse. And to further nursing science in the operating room. The BSN, the MSN would open doors for me to step outside of the OR.

But who wants to do that? Not me. Not yet.

What does this mean for my personal ROI?

If and when I finish my PhD?

Absolutely worth it. Would do again.

Finding if going back to school is an ROI for you is a personal decision. Let’s talk about it. And we’ll see if we can figure out a good program, tuition reimbursement, and scholarship opportunities. Because every nurse can be who they want to be, and have as much education to get there. But if you want to go further, I can help.

Spooky cookie theme continues with the last Thursday of October.

Oh boy! This year, like all years, is going by too fast. Hell, this is the 9th week of the semester for the PhD program. Time flies.

This Cookie Thursday is a Thing is a double biller thriller- the trick and treat cookies.

In years past when I had more time I would make handmade candies for the closest Thursday before Halloween.

I made some doozies in the day-redhots, gummie bears, honeycomb candies, Halloween colored butter mints, Halloween crack candy (crackers, toffee, and chocolate), bacon crack, home made sour patch kids, candied orange and lemon peel, black licorice. The list goes on.

Invariably it rains the day I want to make candy. Which ruins the candy because it is too humid.

This year, to keep it simple, and weather minded and time constraint minded, I decided on a trick and treat theme.

S’mores cookies made with dark chocolate chips and mini marshmallows. In a basic Toll House Cookie Recipe. Did you know that marshmallows essentially melt during baking creating pockets where there should be something. I have seen these called Hocus Pocus cookies recently. Because poof! The marshmallow is gone.

Now for the trick. I ran across a pickle cookie recipe not too long ago and I was intrigued. It is sharp cheddar, pickle chips, and seasoning, if desired. I made these in both a mini muffin tin and a regular sized muffin tin, depending on the size of the pickle slices.

I was explaining the cookie types to my friend and she said these are keto cookies that her sister makes all the time (she’s a brittle diabetic and there is no sugar).

I call these the trick cookies because a pickle in cheese baked is a surprise! And I mixed up the two types of pickles and there are both dill and bread and butter pickles. Surprise!

Pickle Cookies

To make pickle chips, put a small amount of cheese in the bottom of the muffin tin that is chosen. Top with the pickle slice, add a little bit more cheese. Bake at 400 degrees for about 10 minutes. Let cool and enjoy.

The recipe calls for spraying the tins with muffin tins. I find this makes them pretty greasy and I will be omitting that step next time I make these.

I used both dill and bread and butter pickle slices. And the cheese was very sharp cheddar.

I wouldn’t kick either of these cookies out of the cookie jar. Both have their charms.

Halloween can be one of the craziest days of the year in the Emergency Room, topped only by the full moon.

What is that you say? Studies have proven that there is no such thing as the full moon affect. Tell that to the ER patient who acted out of character and stuck something where he shouldn’t. Or the one who has alcohol poisoning.

Stay tuned for a new theme coming in November.

It’ll be a howlingly good time!

At the hospital level healthcare workers are very concerned about patient falls.

We dissect each fall as they occur and look to see if the guardrails have been in place around the patient.

Things like bed alarms on to remind the patient not to get out of bed. And to alert the healthcare workers on the unit that there are shenanigans afoot. Some places have the bed alarms wired into the call bell system as an additional alert.

There are chair alarms that function as a reminder to the patient, and an alert to the healthcare team. Much the same as the bed alarm.

There are emergency pulls in the bathrooms that someone can pull to alert others that they overjudged their stamina and endurance and are in trouble while in the bathroom.

There are safety attendants who sit with patients to remind them not to get out of bed. There are cameras that can also serve as watchers when there are not enough safety attendants available.

There is paperwork that is filled out on every fall, documenting the presence of these fail safes or absence. In some places they do a debrief after every fall.

There are special fall bracelets that serve as a visual reminder that the patient is at risk for a fall. In some places this is a conclusion for a patient after the nurse fills out a fall risk assessment.

It is understood that the patient is assessed and given a score about their likelihood of falling in the hospital. Which starts the cascade of fall precautions: the alarms, the bells, the pull station, the armbands.

But sometimes all of that is not necessary. Because sometimes a fall is an accident.

And all of the precautions in the world could have prevented it.

And sometimes it is the verbiage of a fall that starts the cascade.

I had a patient once who had all the fall precautions, even though they were under 20 with no balance issues. I was perplexed and investigated more.

Their “fall” was using a bike that someone had left on the side of the road. Did they know how to ride a bike? No. But it still counted as a fall.

Sometimes a fall is due to the very human condition of foolishness.

And that is hard to guard against.

I add the qualifier in Dallas because you never know these days.

Actual assaults on healthcare workers continue.

Remember, there was a spate of them earlier this year. June specifically. At the time there were 6 healthcare workers wounded or killed, and two patients wounded or killed, in less than a week. Remember?

Remember how the hospital tightened its policies around badge usage, and being appropriate with the swipe part of the badge? Remember how some people didn’t even know this had happened? And people were dead.

Remember how hospitals tightened their security? Well, the last one didn’t last too long, but it’s the thought that counts, right?

These killings were on a labor ward. No moms or babies killed. Just the woman recently delivered being assaulted by the purported baby daddy and the nurse jumping in to stop him. With a bullet for her trouble, and the other nurse who tried to intervene also killed.

It was over in an instant.

But the reverberations echo, or should echo, through hospitals.

Hospitals are full of people who are stressed, and sometimes the stressed people have a gun.

I’ve always maintained that nursing is on the front line. Hell, I’ve created and written an entire blog about it.

Do you think we will get anything besides the boilerplate “Employee are our family” rhetoric?

A short-lived furor until it dies down. Pun definitely intended.

How many healthcare workers have to die on the front line?

Are some of the solutions to the tragedy costly? Metal detectors, security wanding of everyone, increased security. Absolutely it is going to cost money. But how do the hospitals stress their purportedly stretched thin budgets?

Or is this going to be just something that happens sometimes?

So sorry the nurse who was part of your actual family died protecting their patient. There was nothing that could have been done about it, it was a fluke. A chance roll of the dice.

Was it, though?

The post-it reads ‘Don’t know and don’t care to know’.

This was brought up by a former coworker of mine. They have years of experience in other hospitals/operating rooms. And I’ve worked with them in other operating rooms and their years in the hospital outnumber my own.

Their bonafides are not in question.

And they are shocked by the lack of curiosity of today’s new nurses and techs. That the newer nurses and techs resemble automatons. Or, to put it more plainly, robots. The case comes to their room, they do the case, end of case they go and sit in the lounge. They are there for the case, and maybe their favorite doctor.

End of list.

Not for the patients who are not their own. Not for the department. Not for the hospital.

There is a lack of intellectual curiosity in hospitals now. It’s been happening for awhile now.

I’ve heard stories about the nurses and techs who are only there for the paycheck, for punching their time clock. And their knowledge and caring for the patients are only while they are on the clock. This is something that is not only happening in the surgical services. I’ve heard about it from other specialties, from the emergency room to Med-Surg to respiratory to the labor ward.

To say that this is not good is to understate the case.

Healthcare workers no longer want to do anything outside of their job duties. Committees? Who wants to do that? But they will be the first to complain when something changes without input by the corporation that they work for.

But we didn’t know, they cry. And they had been asked to be on committees, or taskforces and the like.

This is the dumbing down of nursing.

And it must be stopped.

Do you want the nurse who mentally clocks out when it is time to go to break? Or home?

Or do you want the engaged person who wants to help, even if it is outside their comfort zone and comfort doctors? Who gives ideas, no matter how many times they have been turned down.

The pandemic and the overwhelming patient volume that it has prompted accelerated this problem. But the roots have been there for years.

I can’t make people care about the department, and the hospital.

I wish I could.

I’ve been banging my head against that stone for a long time. The others who and I do not want change without input. That leaders on the C-level (executive suite) don’t know the entire picture, especially what the nurse at the bedside is facing. Input about a change made to keep patients safe is actually doing the opposite.

How do you give input? Join a committee and see.

I’m going to tell you a secret about being an adult learner, back in school long after graduating from high school or college. Are you ready?

Really ready?

Really, really ready?

It is okay to cut yourself some slack.

No, seriously.

Give yourself a break already!

The paper from this class is due in three days!
The midterm from that class is due at the end of the week!
The paper from this other class is due tomorrow!
The homework assignment from class 2 is due in a week!

Deep breath.

In.

Out.

And pause.

It is easy to get caught up in the assignments, and the reading, and the pressure to do it faster.

It is easy to get caught up in laundry, and dusting, and general chores that is life.

It is easy to get caught up in emails, and demands from your boss, and watercooler talk.

Put the three together and you have a maelstrom.

This is your friendly advice to schedule breaks into your week.

Breaks from school.

Breaks from housework.

Breaks from work.

The work will still be waiting for you if you take half a day to just breathe.

I tell my coworkers that doing all the things is good. A recipe for burnout, but good.

I know, pot meet kettle.

I just want people to realize that they can take a break.

And it will be okay.

The break can be 5 minutes to sit in silence.

Just turn off the phones, turn off the lights, turn off the television, turn off the music.

And sit in the silence.

Just a little restful pause in your busy, busy school/work/ life combo you’ve got going on.

Just be.

Spooky Cookie month continues on Cookie Thursday is a Thing. Today’s make is bloody bandages.

These are operating room folks, and it is hard to gross them out.

No ick matter here!

Bloody Bandages

Sugar wafer cookies, the ones with the cream filling between thin crispy wafers.

white chocolate Candiquik. This is meltable chocolate that comes in a variety of flavors and colors and here in the United States it goes by that unfortunately spelled name, or some craft stores carry it for candy making. It melts fast in the microwave and smoothly.

toppings- for effect I used a combination of green sprinkles, and freeze-dried raspberries

I had to experiment a bit with technique. The first tray I laid the wafers out, melted the chocolate, tried to make a square of chocolate with a spoon, put the toppings on

This works but it gets messy as the chocolate begins to dry.

The second tray I had the wafer cookies in a stack, picked them up, spread the chocolate using a knife, added toppings. This worked much better and I was able to get a more uniform square of chocolate

What makes these bloody bandages is the rectangular shape of the wafer cookies, and the hopefully white square of chocolate. And the raspberry “blood”.

On some I added green sprinkles to simulate infection.

I think they are adorable, and they were very fast to make. I barely got through NPR morning edition podcast, which is about 15 minutes long. Seriously one of the fastest makes yet.

Silly post incoming.

Dot is our 9 year old cat.

She is a brat.

And deeply bonded to me.

Oh, so deeply.

Her favorite thing to do when she is not sleeping is to sit in touching distance.

And STARE.

I’m not sure what she thinks I am going to do.

When I drive up from a call case, not matter the time, her little head is in the window.

And when I start up the stairs she meows at me. I’m not sure what she’s saying, she’s still inside, and I can’t hear her. And she’s a cat. Probably something along the lines of “where have you been, lady!”

I unlock the door and head inside. And she meows at me, and does that cute little ankle rub that all cats do. She accompanies while I lock down the house for the night and turn off the lights. She heads to the bathroom at the same time when I am brushing my teeth and getting ready for bed. And drinks water out of her cup that lives in the bathtub. The cup used to live on the counter but she kept knocking it over when they drank it down to half full. Because she’s a brat.

Sometimes she sleeps with us, most of the time she sleeps in the office distraction chair.

She does this no matter what time I get home: 2300, 0000, 0200, 0400, 0600, 0800.

But she started doing something obnoxious since I’ve worked the call job. I’m not sure if it is because I am home more, or what.

No matter what time I head to bed, even if it is after morning feeding time, she has to wake me up by 1100. Usually by applying her whiskers to my face in whisker torture.

Every damn morning.

As soon as she sees that I am awake, she curls up in a ball next to me and goes to sleep.

Why 1100?

Don’t know.

And she loves Zoom, especially the camera. I have to warn members of the zoom meeting I am on that they may see a white cat and her name is Dot and she has zero zoom chill.

Right now she is sitting at the top of the stairs, waiting for me to go downstairs.

Again, I have no idea why.

I mention it because she did it again this morning, even after I got to bed at 0500. And now I am tired.

I certainly hope that everyone knows about the neo-natal nurse in the UK who is on trial for killing babies. She has been accused of murder of 7 babies from 2015-2016, and the attempted murder of 10 more. Caught in the act of one of the attempteds she tried to backpedal, to blame the deterioration on being something that was actively happening.

But, Kate, why is this so different than the Radonda Vaught case in Tennessee. Because that death happened as a swiss cheese flaw in the system. The medication that was administered should not have been at that particular pyxis, available to be given in an unmonitored place in the hospital.

But this nurse. She has been accused of willfully causing the death of several babies who should have been safe in her care. She would inject air into IV lines, or poison them with insulin, which is very hard to detect by autopsy. She was the only nurse who had been present on the unit for all the deaths and codes. Yes, it is conceivable that someone could have snuck in, but unlikely. The NICU is an open ward, with little bays for the isolettes, warming beds, and cribs.

Please read up on the case, it is chilling.

But that is not what I wanted to talk about.

I want to talk about the mirror that must be held up to the profession. And why it can be a good thing.

Can it be annoying to be the ant under the spyglass? Yes.

Can it go to far, and lead to accusations that are not true? Yes.

We have to rise above that. These are vulnerable people. They are the ones in hospitals, and they are in the healthcare worker’s care. We are observed, our charting is minutely gone over for errors. All of this is to keep the patients safe.

It can be good when a mirror is held up, because someone should be watching. These are people’s lives that depend on us. We need to remember that.

And to not kill the patients.

No, not even for whatever twisted satisfaction it gives you, just don’t

The post-it reads ‘choose your vaults, AKA choose who you disclose to carefully’.

This is referring to the people in the department that lives to gossip and the one who loves to trot over to management and tattle. These might be the same people, or they may not be.

The importance is to know which is which.

The information disclosed may be as simple as ‘oops, I accidentally wasted a supply’ to ‘did you know teammate X did this or that’. No detail is too salacious for this group. They may even share their experiences with a similar situation.

With one group you might get commiseration/shock at the situation. And the discussion ends there.

With the other group you might get commiseration/shock at the situation, and someone who b-lines to the management to tell.

The operating room is hard; we work fast and are told to work faster, lives are on the line everyday in the rooms. Sometimes, people just want to bitch. They don’t intend to complain to management, or even to the charge nurse, they just want to get their rant off their chest. Often, they feel better after and can go blithely on their way. In this instance the person who got the information is now the keeper of the information. And the receiver can either simply acknowledge that they now have information and keep it to themselves, like a true vault, or share it with others.

It is vitally important to know who is the proper vault in the department. And who will share confidences with EVERYONE because it is just something to talk about. Or they feel it gets them brownie points with management.

I cannot stress this enough, know which is which. Because even if vault b (the one who cannot keep details to themselves) only discusses your information, no matter how small, with other members of the team and not management, they have proven themselves unworthy of more than basic keeping of information.

You want a true vault, the one in the department who keeps confidences and details to themselves. And does not share with anyone without your express permission.

Except when there is danger to the ranter to the patients, or their family, or the department/hospital. Or except when there is danger from the ranter to the patients, or their family or the department/hospital. All bets are off then.

It’s a fine line.