And the struggles with no doctor call continue.

Last night I got a text from the supervisor about a D&C on the floor who was bleeding.

I replied no doctor had called me, texted me, smoke signals.

Nada.

I texted the CRNA and told her there was an imminent urgent case that I knew nothing about.

She texted back that she had called in her OB back-up, as she was stuck in endo.

I texted the surgeon that I heard there was a D&C, care to share?

I got an immediate call back.

She said there was a bleeder on the floor who needed to come down urgently.

She said that she had called the anesthesiologist.

I reminded her, gently, that the first call should be to the OR charge, so that I can get the ball rolling, the patient sent for, and inform the anesthesia team.

She pushed back, telling me she had been in the room with the patient.

Um, yeah, but nothing happens until you call the OR charge.

I don’t care that you told the anesthesiologist, who, it turns out, gave you incorrect information.

I don’t care that you told the floor nurse.

You have to tell the OR charge.

Which is me, hello. (waves)

Already behind the 8-ball, I got the tech to pick the case and set up the room.

I got PACU to call for the patient and put a fire under transport.

I finished setting up the room, offered to help with the quick prep.

Reminded the doc again when she came down of the proper procedure for scheduling an add on, emergency or not.

I was hopping mad.

Because this entire circus?

Cost us about 30 minutes in preparation time when we could be getting the patient down, prepping the patient, making sure that the blood that had been ordered was ready and beginning the blood.

And when you’ve already hemorrhaged for five hours, thirty minutes can mean life or death.

I hate beginning already thirty minutes behind.

To do:

I will finish the welcome letter to MDs about add on process.

I will get it blessed by surgical committee.

I will get it posted in all the units of the hospital.

In the midst of the chaos the general surgeon called with another add on.

A lap appy.

Because of course he did.

I have heard it from many surgeons.

“I want an evening shift turnover.”

For a long time I thought that meant that evenings could skip from room to room.

However, we usually stay in the same room and just turn it over.

Monday, I relieved in a case that was finishing at 1500.

There was a case to follow.

When I relieved the day nurse, I looked around.

There was trash everywhere.

The irrigator had not yet been taken down, although they were past that point.

The bovie was still plugged into the generator, although they were past that point.

A trash can had not been readied to receive the drapes and back table supplies.

I set about picking up the trash, taking down the irrigation, emptying one of the large barrel trash cans, putting a new liner in the same large barrel trash can, unplugging the bovie.

Just, you know, generally tidying up the space to make turnover easier.

And it hit me.

One of the reasons that evenings has such a fast turnover has everything to do with the fact that I begin preparing for the next case while still in the previous case.

Trash is picked up.

Equipment that is no longer in use is pushed aside.

Furniture that is no longer in service, such as prep tables and basin holders are placed to where they will be used for the next case.

There is always a trash can that has enough room for the drapes and back table supplies, even if I have to empty a trash can and put a new liner in.

The suction canisters, if no longer in service, are taken off the suction tree and treated with thickening agent to thicken the suctions.

This is done as the surgeon or PA is finishing closing.

At the same time I am making sure they have their dressings, and that PACU has been called.

All that remains is to wake the patient up.

Finishing getting the trash together and taking it out.

And turning over the room after they have left the room.

As we were wheeling the patient to PACU I looked at the CRNA at 1510 and told them, “The wheels in goal for the next patient is 20 minutes. Which makes it 1530.”

And we were.

Huh.

This is the most dangerous phrase I heard last week.

Really, the most dangerous phrase that I have ever heard.

Just doing what I was told.

Just doing what I was told.

That sentence is very problematic.

This is not why we became health care professionals.

This is not why we take care of patients.

Do not think that just doing what you were told is going to get you out of trouble in a court of law.

Please develop a backbone and stand up for what you know is correct.

Not just what you were told.

I’ll wait.

Well, that anniversary slipped right by me.

June 1, 2001 was graduation day for my first degree, the associate degree in nursing.

Completely slipped by, unheralded by me.

The thing is, I do not feel like I’ve been out of nursing school that long.

Before I know it, the 30th anniversary of my high school graduation will happen.

Who is going to tell my brain that, when I feel at most 30?

Now, the date of my passing the NCLEX is next. Which will be July 14th.

I passed in 75 questions. Which threw me for a loop, I was convinced I had failed.

Happy anniversary to me.

What am I going to do next?

To say that I have a ton of post-it dispatches is to minimize exactly how many I have.

I have been writing these little notes to myself for as long as I’ve been an OR nurse.

I have many, many, many to choose from.

Many.

Today I have a note from three years ago, when the hospital was deep in its Magnet preparation.

In the midst of the Magnet notes for myself about the reviewers is a small hand written “What keeps you up at night?”

What keeps me up at night?

The answer may be different for an OR nurse than a Med-Surg nurse. A Med-Surg nurse may be haunted by a med that was late, or a conversation with the patient.

These are not the things that haunt an OR nurse.

Or, at least, this OR nurse.

When I can’t sleep my brain gives me helpful images of awful cases, of times I let my mouth run before my brain.

Lately, I am reminded of the sharp words I give to coworkers, doctors and staff alike, to move the bed away from the OR table before raising the head of the bed.

Because often, the side rail has been snugged so close to the OR table that it is actually under the OR table.

And if the bed is raised, the OR table is raised off the ground.

One of our surgeons almost had a bed dropped on his foot for that exact reason.

I am often greeted with blank stares as they continue to raise the head of the bed, and the OR table continues to rise as well.

You bet I speak sharply to them, using simple, declarative sentences like “Stop.” Sentences designed to make them, you know, stop.

I inform them that the bed rail is wedged under the OR table and the OR table is being lifted.

Often the OR table gives way to gravity and drops down with a bang, startling them.

I have this conversation on the daily.

At night my brain imagines what would happen if I didn’t have this conversation all the time.

I imagine that a coworker will need to go to employee health, or the ED for treatment for their broken foot.

And I would feel guilty if I did give a warning.

So I do.

Endlessly.

This was a cookie that one of my best friends had been begging for.

For a while.

She wanted anything blueberry.

I showed her the recipe I was thinking of.

Nope, not the right one.

I pulled out a lemon blueberry white chocolate recipe and made it.

Many people stopped me to say how good it was.

This month’s theme is Baker’s Choice.

And today I chose to make the lemon blueberry white chocolate cookie.

Sometimes it is worth a choice to make a friend smile.

It seems that all I’ve done with week has been talking through my disappointment with the call only tech on Wednesday and Friday.

I mean, a lot.

A lot.

Of course I teared up. I was so intensely frustrated.

It all started when the ANM noticed that we were going to have three rooms running past 1700 and only two techs.

I reminded them, gently, not nearly at the top of my lungs, that this was an unintended consequence of only having the call techs cover the Wednesday and Friday from 1900-2300.

That they were leaving evening understaffed, on purpose, twice a week.

And I also mentioned that I was a wee bit upset at doing all the work myself.

Which is what I was told.

That the techs would only come in if there was a case.

I was told by them this was the case.

I had printed out my blog post from that day, the one I was so incensed about, sat the ANM down and made them read it. Because when I am upset words are sometimes hard.

“Oh, no, no, no”, they backtracked, fast. “If you need them, call them in.”

I reminded them this was not the story I got when they informed me about this weeks ago.

And so I had been doing all the evening work myself.

And seething with resentment.

I also pointed out that this whole construct that they made was helping with productivity.

Because 12 hours a week was not being staffed.

“Oh, no, no, no,” they insisted. “That is not the case.”

Forgive me if I don’t believe you.

This weekend was rough for the general surgeon.

He said that he felt like he had whiplash, starting on Friday.

Starting with the quick prep and case for the ubiquitous appy on Friday.

Through to Saturday, waiting around for his emergent septic case.

Unbeknownst to me he had been waiting to get this case started for awhile.

The Saturday night septic patient case with me as his circulator.

To his Sunday morning case that took forever to get started.

He and I had a conversation that although I can sympathize with his feeling like there are two speeds for the weekend versus evening speed, I have no power to do anything.

For that, he would need to take it up with the manager.

And he did!

He said he didn’t understand why and how there seemed to be two different speeds for add on cases.

And then he said the kiss of death, “Kate can do it, why can’t they?”

Facepalm.

Dude.

I have enough trouble with these people thinking that I expect others to work at my gear, which is high.

How many times have I been told that “Kate, they aren’t like you. You shouldn’t expect them to stretch for that.”

Um, why?

Can’t sleep again.

It hasn’t been this bad since last spring.

Case in point, last night I got to bed around 0113.

I woke up from a very strange dream at 0420.

The dream was so strange I had to get up and note down the details.

Because writer, you know.

I got back in bed at about 0440.

And slept until the pager went off at 0700.

I go off of call at 0700.

I texted the day nurse about the page and went back to sleep until 0715 when she texted me back.

Whelp.

That’s another night’s sleep ruined.

According to my sleep log that I keep, because data is power, I haven’t had any night’s sleep over 5.5-6 hours in about two weeks.

All I want to do is sleep.

Pager, be good.

Please.

Last week I got an email that the poster I had submitted to AORN this year was accepted.

I had two accepted last year.

And then COVID.

This year I knocked together a proposal for the long-term flashing project that I have been running in the OR.

Long-term meaning 6+ years.

Flashing is the immediate use steam sterilization of instruments or implants.

This usually means that something has dropped to the floor, or there is a to follow case, but more than likely it has hit the floor.

Flashing is bad.

It has taken 6-plus years to get a 12 month span with no flashing.

Many things had to happen in order for this to be successful.

In 2014, there were at least 25 flashes in the OR.

in 2020, there was 1.

In January.

Fingers crossed, spit, knock on wood, whatever you have to do.

The poster proposal was titled Flash this! How 1 OR systematically decreased IUSS to near 0.

I am going to keep it at near 0.

For the Murphy.

Because Murphy loves the OR.

Best laid plans and all that.

Whatever can go wrong will.

This poster got accepted.

Yay!

I have to design, get it printed and submitted for judging by July 12th.

And go to Orlando in August to the AORN conference.

I’m gonna melt!

Another thing I was kicking around as a better use of my MSN is establishing a writing career.

As a side gig.

I am reading and writing and learning about this.

I was thinking the AORN conference might be an opportunity to connect with other writers.

And one of the best ways for that used to be the business card.

I designed a card and submitted it for printing.

Double sided:

1. the one side is my real name with credentials and email address against a light OR green background
2. the other side is this blog, with my nom de plum, email address, and blog address, with a blog caption at the bottom. The background is clouds. whatever

Regardless, I ordered them to have with me at the conference.

Will it work?

Who knows.

But I will be ready.