No sooner had I clocked in today when I was stopped by a good ACU friend.

She asked, “Have you heard? About the new variant? We’re never getting to go back to normal.”

How do you reassure someone who is working so hard to keep people safe?

One of my favorite surgeons stopped by the desk to thank me for getting his case going so fast.

He also asked me about the new variant.

He said he and his wife had not been out to eat since January.

Of 2019.

They had gone out for an early Valentine’s Day dinner.

He and I spoke about the new variant.

And the New England Medical journal and the 800,000+ person study that had been done and reported on recently.

And we spoke of hope for the vaccine for children 5-12.

His child is more than 5, less than 12.

He and his wife are hopeful the vaccine for children will be released within 8 weeks.

October.

We smiled grimly at each other through our masks, our eyes hiding the same pain.

October.

What the post-it says, ‘day shift says can’t stay late.’

Dude!

I didn’t ask you.

And you have three hours left on your shift.

Do I expect you to work your entire shift?

Yep.

Nothing irritates me more that someone stopping the conversation I wasn’t even having with them.

I don’t want you to stay late.

That means I am not doing my job well.

That means I have not judged the board well enough to allow later cases to start on time, rather than pushing them out so that the OR can be down to the requisite 3 rooms at 1700.

Or 1 room at 1900.

Of course, since I am no longer making those decision until after 1700 due to the asinine new rule that the days shift charge makes ALL the assignments, talk to them.

Yes, I’m still a little salty over the entire situation.

Don’t worry, I will still be blamed for running rooms late.

As I have been looking at different doctoral tracks I have been thinking of how best to use the resulting degree.

A DNP would be useful if I had any desire to be a nurse practitioner.

Which I don’t.

There is a DNP on a leadership track.

Also, no go.

I have turned down opportunities to advance.

I have turned them all down.

A PhD in nursing is about research.

I love research.

I love seeing if the changes made have had any impact and what that impact is.

Call it straight research.

Or quality improvement project.

I love them all.

When the organization started talking about hiring a salaried night time call staff it got me to thinking.

1. can I do that job-there’s an entire decision tree I am working on with that one
2. what kind of impact would that have on the regular staff whose call is now limited (I can’t be the only call dog out there, can I?)
3. what kind of impact would that have on the staff who chose to take that role

I want to find out.

I reached out to our nurse scientist to ascertain if anyone was doing such a study.

She said no.

And gave me the green light.

Tomorrow I will look at all that entails.

I also have to think about making this a mixed method study.

With a qualitative and a quantitative arm.

I’ve never qualitative.

To the library.

Online of course as the biggest organization library is 65+ miles away.

But I have access online.

I have research to do.

Evenings IS magic.

Or, it has the potential to be so.

It all depends on how the stars align.

And which surgeons are on call.

And it takes a lot of mental energy.

Because I firmly believe that the OR can make certain things go well.

If you will it hard enough.

This is a skill that is hard to learn.

The day charge calls it my zen.

Not quite.

It is me exerting my energy and my stamina against the world.

If I believe that two rooms will be done by 1700, I have to believe it hard.

It is a little bit of faith, and a lot of experience.

And the ability to read the board.

And experience to know the most likely outcome of a case.

And how long it will take.

I’ve done this for 7 years as the evening charge nurse.

I’ve been a nurse for 20 years.

It doesn’t always work.

But when it works, it is magical.

Last week of No Heat August and I’ve not turned my oven on once this month.

It is hot here in the South.

And humid.

This cookie is one of the most requested cookie and easily the most nostalgic.

The fudgey cocoa no bake cookie.

Several of my department have declared to be their all time best, after the jalapeno chocolate chip cookie.

For me it invokes Summertime as a child.

It is a cookie that is frequently used or adapted for Cookie Thursday.

The first adaption, not used today, is to replace 1 cup of oatmeal with 1 cup of unsweetened coconut.

And its taste is evocative of an Almond Joy.

For this Thursday I wanted to do a throw-back.

And they also come very quickly together and take less than 15 minutes, excluding drying time.

And I have hit a rough call patch and I wanted to take a nap instead of baking for 3 hours.

630,000 is so close you can feel the singe.

Never mind.

I thought I should check my math again.

Not only is the US past 630,000.

It is nearly 1000 past.

At some point it ceases to be funny.

At some point it ceases to be sad.

We are at the point that it is pathetic.

Early, early on a morning, think 0200, I put in for a transport request for a patient who needed emergent surgery.

A patient who happened to be on the floor.

Next I picked the case, spread the case.

No patient.

Consents and other paperwork were pulled.

No patient.

The scrub tech arrived.

No patient.

I didn’t think there was that much competition for transport at 0200.

I was wrong.

I called the transport center.

The patient was 4th in line.

That’s not what the computer says, but whatever.

And the first in line, the transporter had been delayed on the floor by 20 minutes for an unknown reason.

I flattened my lips and interrupted the transport center to tell the to cancel the transport.

That I would be going up to get the patient myself.

I waved over the surgeon, who had peeked his head in to see if the patient had arrived.

Using short, pithy phrases I told him that he and I would be going to get the patient.

Because transport takes too long and the patient was 4th in line with an unknown 20 minute delay.

We went up to the floor to get the patient and brought them down to prep them.

So they could have the emergent surgery they needed to save their life.

The guiding principle of the evening shift is needs must.

This means if an action is needed, it will be done, within the boundaries of my license.

Not within the boundaries of my job description.

I had hoped to grab a happier note from the pile but alas, the note on the top of the pile has the words ‘Discontent breeds.’

Truer words were never written.

Discontent in a department can breed; from tech to nurse to doctor.

And soon all that is available is a hulking mass of mad.

How to solve this morass of discontent?

How to solve the ‘evening shift does shit’ complaint?

Should I begin to complain?

Day shift outnumbers evenings 8:1.

That means there are 16 day people to every 1 evening person.

There is some bleed over, with shifts ending at 1900.

Every single evening person is a hard worker.

Some of our work is unknown, until it isn’t done.

They may not understand that each room can take 30 minutes to 1 hour to re-set the room for mornings.

Taking out unneeded instruments and equipment.

Changing the beds out.

Making sure that the suction tree is filled.

Making sure there is an adequate amount of prep tables, and OR tables in the room.

Making sure that the morning equipment needs are filled.

There are a hundred and one different tasks to re-set the rooms.

To ensure adequate supplies are available and sterile for the morning.

Sometimes the evening shift puts trays together to be sterilized.

I bet day shift does not know that.

So, please, do not start up the day shift versus evening shift conversations that go no where.

If you are an evening shift worker, thank you.

If you are a day shift worker, give the evenings a break.

Lots of strum und drang this past week.

I am still very, very angry.

I told the assistant nurse manager to stay off my blog this week as should would not like what she read.

The call shift that I told her I wanted, should I?

There are many question.

What about the committees I’m on? Would that be extra?

What about the conferences I want to go to?

What happens to my PTO?

How do vacations work?

Should I?

Would I be happier?

And school?

Will I still get tuition reimbursement?

Or clinical ladder?

To step away from committees, means stepping away from at least 19 points.

To say I enjoy my job is to downplay how much I love being an OR nurse.

Except for 1430-1700 lately, since they started that asinine new thingy.

And if I took a call shift only job how would that impact our bottom line?

What about my committees?

I have obligations.

To the hospital.

How would that be managed?

Folded into my salary?

One of my favorite nurses, the one who mentored me through this entire shared governance journey, stepped away to a different job a few months ago.

Maybe I should talk to her.

Near the end of my shift, as I was packing up to leave, turning off the phones, the surgeon on call texted me to ask if I was on call.

I told him no, but I was still at the hospital and how could I help him.

I sent him the call nurse’s number and proceeded to take the details of the case.

It is 2236.

I look at the ED census.

There are nearly 60 patients in the ED, 36 with respiratory symptoms.

The house is full and there is a 27 person wait in the ED for a bed on the floor.

I text him that the house is full and the ED is busting and it is in the patient’s best interest to have surgery tonight.

I told him I could get and prep the patient and the room would be ready to go at 2315.

And I didn’t feel comfortable with leaving a youngish, healthyish patient in the ED for 6 hours before the requested time of 0530.

He agreed.

And I sprang into action.

As I was scheduling the case the computer told me the patient had not yet been admitted.

I called the ED, told them I would be over in 6 minutes to get the patient and to please have him admitted so I could schedule the case.

I called the call team in and informed anesthesia.

I went downstairs to get the case picked.

I dropped the case off in the room.

Since the patient was in chairs, meaning the waiting room, I made sure there was a gurney in the recovery room, grabbed the admission pack, and a wheelchair and went to the ED.

The patient was not in chairs. They had been upgraded to hallway where they had been admitted to the ED.

And they were on a gurney.

I parked my wheelchair, introduced myself, and away we went to the recovery room/prep.

I pre-op checklisted, had the patient disrobe, and use the bathroom, got consent with the MD, the anesthesiologist and the patient.

I checked in with the room, where the call nurse and tech had arrived and were counting.

At this time, I called the pacu team in.

I made sure the H&P was in and paused with the CRNA.

And waved off the patient to the room, wishing them a good recovery.

They were in the room at 2319.

Damn that was fun.

But best yet, I saved the patient from hanging out in a very busy ED, in a very busy hospital.

During a covid surge.

In other words, I did my damned job.

Oh, and I went back for the wheelchair and parked it with his things.