I had questions after I received my list.

I wanted to know who I had to call to find a preceptor.

The answer: the education department and beg.

I added the beg.

But it seemed appropriate.

I am considering it part of my journey. An extra step I have to take before I graduate next spring.

And then, who knows?

I am definitely taking a little time off.

And reading all the books.

And writing all the books.

This has been a long slog.

Oooh, here we go.

I just got the list of approved sites for our clinical rotation that lasts 4 four months.

My advisor also exhorted us to stretch beyond what we think possible and not go with places we know and understand.

I’ve decided to stretch to other sites, not my hospital or a sister hospital.

Should I choose the community college?

Should I choose the competitor?

Should I go in a completely different direction?

So much to think about.

As I understand we are still responsible for finding our own preceptors.

I will do my best to get this squared away before the beginning of December.

Because I’ve got a LOT to do before Spring Semester starts in January.

If only I knew how…

Informed consent is a very big safety issue.

It came up recently when two doctors, a surgeon and an anesthesiologist consented a family member over the phone for surgery on a patient, who could not consent for himself.

It is a good thing that I was listening in to the call, unbeknownst to the doctors.

Because telephone consent cannot be obtained by the surgeon of record.

BECAUSE of potential bias on the surgeon’s part.

After I reamed them out, the anesthesiologist had more questions.

Can two doctor’s ever sign consent for surgery?

Yes, in a truly dire emergency where if the family was consulted/asked/found it would lead to the patient’s death from waiting. The signer cannot be the surgeon of record.

Why does not have to be a nurse who consents over the phone?

Um, because the bias issue.

What exactly is the nurse co-signing?

The nurse, that would be me, is signing acknowledgement the patient’s signature, of the fact that the surgeon and the patient have discussed the surgical procedure, all risks and benefits and alternatives. There is a lot of other language in a consent, such as who is allowed in the room, whether or not to give blood products, whether there can be photography. Not the actual informing part of the consent, just the acknowledgement of it.

He had further questions. I wonder if he was testing my own knowledge.

I referred him to the state statute that explains the consent laws in our state, such as who can sign consent.

Prat.

Tonight, I had a rep question me about a laser case for Surgeon A.

He was the rep for laser 2.

Laser 2 has specific needs. It can only be used in OR 5. Because of specialized plug that it has.

Surgeon A had a case that he wanted to use laser for.

Small problem.

Room 5 was busy.

I told the rep that we couldn’t use Laser 2 for the case.

I didn’t offer to move the cases.

I didn’t offer to reschedule the case.

I didn’t offer anything.

The rep then said he hadn’t seen Surgeon A in awhile. He asked to see him.

I looked him over my glasses. (I practice this move in the mirror).

I asked, “Why? So you can denigrate Laser 1 to him and point out that Laser 2 is superior?”

My assistant manager was in the room and she snorted, quietly.

The rep became flustered and said, “Gabe said it would be okay.”

Gabe is the biomed person who runs the laser.

Those are fighting words.

Yeah, uh-uh.

Gabe is not the laser safety officer for this hospital.

He’s a guy that never comes in the evenings to run the laser.

I’ve given Gabe a lot of latitude to bring in new goggles, to take our combine goggle cart and separate out the holmium goggles from the carbon dioxide goggles.

But he doesn’t run our laser program.

Just our laser sometimes.

I just looked at him. He scuttled away.

To change so he could come to the room while Surgeon A was using Laser 1.

I was running Laser 1 and I dared him, with a glance, to say anything to Surgeon A while we were using  Laser 1.

We didn’t end up using Laser 1 either.

 

 

 

 

I was calling it the December Doldrums.

The existential dread of the December volume.

But now that it is here in mid-October, I am going to call it something else.

The December Drama?

The December Deluge?

The December Downfall?

The December Dice-Roll?

Hmm, have to think on this more.

Egad!

Everything is coming due at once.

School.

Shared Governance.

Will I survive?

I’ve been a nurse for eighteen years and change. That’s a long time.

And these last seven days?

WORST WEEK EVER!

It started last Saturday with an urgent call from the nurse on call.

She needed help at 1000 and I was at the grocery store.

I paid for my groceries and went in for a couple of hours.

And went back at 1500 for more. I left the hospital after 0300 the next morning.

Sunday, I got called in at 1900 until 2300 for a drawn out ORIF.

Monday, from the time I arrived at 1430 to 1445 there were 5 add-ons. Okay, this is usual. And we worked hard all evening until after 2300.

Tuesday, from the time I arrived at 1430 to 1445 there were 5 add-ons. This night, there was no way to finish all but one by 1900 so we got a CRNA to stay until 2000 to catch us up a bit. He finished his case at 1727 and did not go to get the next patient, that we had to have finished by 1900 until 1815.  Which meant we couldn’t go back with the late case until after 2000. And the late late case got pushed back to Wednesday evening.

Wednesday, from the time I arrived at 1430 to 1445 there were 5 add-ons.  The board still had 12 cases left to start. This night there was no friendly CRNA to stay late and help. I was so outraged that I was in tears (I do this when I am mad) and I was going to have to tell the surgeon who was doing the case that was delayed from Tuesday that his case would be going at 2300, or later. He was unhappy, I KNEW the patient would be unhappy, but I could not get any CRNA to stay. Finally one ponied up to the bar and agreed to stay for that surgeon. I offered to make him any cookie he wanted. A second surgeon agreed to delay his case until the next day due to time constraints. Finally, we finished at 2300 with all cases.

Thursday, from the time I arrived at 1430 to 1445 there were 5 add-ons (do you see the trend?). All the cases are running over. One of the day shift people told me that they didn’t receive their evening break. I looked her in the eye and told her that I hadn’t had a lunch or a break in at least a week and I would get her a break when I could. People. Finally finished the delayed case from Wednesday and the last case finished at 2200. And then an add-on. (apply head to desk here)

Friday, from the time I arrived at 1430 to 1445 there were 5 add-ons. And one was an emergency that was going to be bumping one of his partner’s cases. Oh, well. She was taken upstairs to the ICU immediately upon end of surgery. I ran from 1430-2200. We finished our last case at 2200 and made the conscious decision to not do anything with the core, that I would go in on Saturday to clean up after our disastrous week.

And so I did.

I did the math today.

There are three more classes for my MSN-E.

One is a curriculum class.

One is the monster 150 hour clinical experience.

One is the writing of my master’s thesis, all 75 pages of it.

Bring it on.

Of course, I have to get through the curriculum class I am in right now.

Still, bring it.

Off to the hospital I go.

But, first, update on the gravity situation.

No more prednisone.

Yay!

It makes my mouth taste funny.

And no advil on prednisone.

Sneezing.

That most innocent of actions.

Makes me want to put a knife in my temporal mandibular joint.

You know, the jaw joint.

I had to describe today exactly what it feels like when I sneeze or make sudden jaw movements.

It feels like a 8/10 to the TMJ. With a tearing sensation and a flash of warmth.

Ouchie.

However, my lovely, lovely bruise is mostly healed. Now just the line that shows on my cheek the impact point with subsequent sliding on the trash can remains.  This is still tender to the touch.  So no touchie.

After I told the PA about the pain he ordered me a panoramic x-ray of my face and jaw, with special consideration shown to the left TMJ.

I had to miss 2 meetings to do this.

Bother.

I am awaiting results.

My hospital system has invested in a system wide phone system that works on cell phones. This is a private, secured system that allows us to call anyone at any of the 15 hospitals and work together to solve a problem.

This last Friday I was at lunch when my phone rang with a non-hospital number. Of course I answered it.

I clearly said, “Surgery, this is Kate, how can I help you?”

A voice launched into “Janet, I was your patient today and I think my take home packet is missing information.”

It was a young woman who had been discharged from a sister hospital that day with a new diagnosis of diabetes.

Now, I know there is a TON of education around a new diagnosis of diabetes. But I was curious as to how she happened upon my dedicated system number.

Her floor nurse had written a number on the white board, probably one number off from mine and she called it after she had a question once she got home.

She had tried to call the pharmacy but they couldn’t tell her anything.

She had tried to call her doctor’s office but all she got was an answering machine.

She had been forwarded to the wrong number three times before she remembered her nurse’s number.

And so she called it.

I reassured her that she was absolutely right to reach out and that I would do everything in my power to help her.

I returned to the front desk.

It was an important question and something that needed to be answered before a weekend could start.

I reached out to our house supervisor to see if he had any ideas. He did not.

Okay.

I took her name and number and birth date.  I assured her that either I or someone from the sister hospital would be calling her back with information but that I would need a few minutes to find out information and I didn’t want her to be on hold for that long. She said she understood and hung up.

I called the house supervisor for the sister hospital.

I quickly explained the situation.

The supervisor said absolutely she would take the girl’s name and number and get in touch with their on-site educator or one of the floor nurses to help the young woman out.

I can’t imagine how scared she was, reaching out into the void, knowing she needed information to keep her healthy and that it could absolutely not wait until Monday.

I was glad that I had the number that she called and that I was able to help.