Care before Computers in my new mantra.

They updated the electronic health record for the system this week.

Sunday went fine.

Monday and today, not so much.

They are still finding things that are broken.

Today endo was in a tizzy because they couldn’t pull the patient in to their prep room and they wasted ninety minutes trying to figure it out.

I told them to just do the case on downtime.

Because what was important was the patient getting the care they needed.

The charting could be done at a later date.

The case needed to be done now.

And then I spent ninety more minutes on the phone with support trying to get them back to being able to chart in real time.

I did this so they could do the case and make the patient feel better.

Would do it again.

As I alluded to yesterday I have two rules.

These are rules that I abide by.

These are rules that I would like my coworkers to abide by.

These are rules that I would like my bosses to abide by.

The first is be fair.

This was a rule that was given to me by the leader who gave me the job of the staff schedule.

I was to be fair.

I added that rule to my internal rule book.

And I adapted it as a leader myself.

Be fair.

You’d think the second rule would be a no brainer, I certainly did.

I was wrong.

Don’t lie.

Always tell the truth.

Sometimes the truth hurts.

If  you get found out in a lie it will rebound on you so fast.

And, also, lying makes you untrustworthy.

There is a meme I have on my Pinterest account. On my this is me board.

The meme says “Expect blunt, honest answers. If you don’t want the truth, don’t ask”.

This is so, so, so very true.

If you ask I will tell the truth.

And I expect you to as well.

Now I will e-mail my boss about what transpired yesterday, now that I’ve blogged about it and calmed down some.

 

Now that I am no longer in a towering rage I can calmly discuss what happened today.

The number one thing is to be fair.

Number two is don’t lie.

Today, I had to call my tech with 15 minutes left until go time with our case.

This happens frequently.

Yes, it is the same tech.

He lied to me.

He told me he was on his way.

He had had a flat tire.

On the exit that is 5 miles from the hospital.

FIVE.

He did not call when he got the “flat tire”.

It hadn’t occurred to him.

When I say right the sarcasm is evident, correct?

The highway was clear of accidents.

He was supposedly five miles away.

I called him at 0942.

He was allegedly five miles away.

He didn’t show up to the hospital for our case until 1015.

Uh, huh.

Right.

“Flat tire” five miles away.

In that time I had interviewed the patient and set up his table.

Which, in retrospect, was a mistake.

As it gave him time to interfere with my job.

I am so close to refusing to take weekend call just for this reason.

Two things will be my saving grace.

1. The weekend tech, who he’s been trying to warn off, starts her weekends in six weeks.
2. The rest of the weekends’ call shifts have been scooped up by another tech.

But don’t lie to me.

Okay. Time for a haunting story.

No, it isn’t scary.

It’s just something I think about.

A lot.

Be careful when discussing care in front of an awake patient.

The surgery was going to be a big one for our little hospital that could.

We were doing a lung lobectomy for cancer.

In the five years I worked there this was the first one I was going to participate in.

This is a BIG set-up.

The anesthesiologist was preparing to put the patient to sleep and I walked in to relieve the nurse for lunch and also to count as it was expected to go past 1500.

I picked up the chart and looked at the consent. There was no mention of laterality on the consent. It just said on the top line of the consent lung lobectomy.

I asked the nurse I was relieving about the laterality.

The room fell quiet.

The anesthesiologist hissed at me, It’s the left lower lobe.

The word stupid was implied.

I remembered the patient was still awake.

This was no time to inspire fear in him that we didn’t even know what we were doing.

And I spied it.

An itty-bitty notation two lines away from the bulk of the consent writing: left lower lobe.

This was duly initialed by the surgeon and the patient and the nurse who was correcting the consent.

But the patient still heard us discuss in the room the laterality.

He must’ve been so scared.

Now I am careful about the level of consciousness when I ask clarifying questions.

Tonight as my tech and I were setting up for yet another ectopic my favoritest OR song in the world came on the radio.

Play that Funky Music, White Boy by Wild Cherry.

It brought me back to my first days in the OR.

We would play that song, LOUD, at 0630 to get us hyped up for the day.

It always worked too.

I was telling my tech about it as we were grooving around the room opening the supplies and preparing the bed.

She said that no place had ever played music to get ready for the day.

I think it was because it was such a small place.

And to slow it down in the afternoon, as we wrapped up the day.

We played Over the Rainbow by Iz.

It was the perfect song to play for closing.

It makes me want to start doing that here.

I say this in my non-nurse life. If you don’t vote, you can’t complain.

This means for president or senate or anything else.

This also includes for state boards of nursing.

I always vote for the nursing officers for the state.

These are the people who will be representing us to the rest of the nation and they are important.

And my pager just went off.

I have to go reduce a hip.

I will finish this thought later.

I know I’ve been in healthcare for 20+ years but loss is inevitable.

I have lost patients.

I have lost coworkers.

I have lost favorite doctors.

And I don’t mean to retirement, although that happens.

Or to going to another job because the OR is full of job hoppers.

I’ve taken care of a lot of people I work with.

Anesthesiologists, nurses, techs, friends and family of all of the above.

And I’ve experienced a lot of loss.

But this last six months we’ve lost a wonderful anesthesiologist.

He was amazing with patients.

He would always joke about the breast enlargement for male patients.

He was gentle with children.

And with parents.

And with patients.

And with nurses and techs and other doctors.

He knew when to say no to a surgeon before they wanted to do a dangerous case.

And he died after a very brief illness.

That is the best ending I could hope for him.

I just wish he’d been in the world a little longer.

Last week was rough.

My boss added it up for me:

One nurse left.

One of the travelers left.

The other traveler was not suited to our fast-paced OR and left.

One nurse was out on FMLA.

Two nurses were on vacation.

SIX nurses down, out of 16 is a lot of man hours that need to be covered.

And last week was uncommonly busy.

I added 4 cases a night.

Plus the three or so that came in during the day.

All the hours were worked.

Oof, no wonder I napped all the naps today.

I heard from another tech that my weekend tech claimed to work 18 hours call back this weekend.

Um, no.

We worked an hour and a half on Saturday.

Well, I worked two but I was there 40 minutes before he waltzed in.

He was there at 1100 on Sunday and he should have left after it was determined there would be a 3 hour lag before the first case while the instruments were sterilized.

Don’t ask me what they were doing.

We finished at 1830.

I went in at 1430 and got the case started and finished.

There was an appy (there very nearly always is) and that took 2 hours.

Okay. I went and looked at my hours for this weekend. Saturday I was there 2.5 hours but I was there way before him.

Sunday, I worked from 1430-1900, which is 4.5 hours.

And 2146-2349. This is two hours.

This marks me 9 hours at call back.

He was there during the day shift before me.

But still, the numbers don’t add up.

And no matter what I am doing after the case, department related, scheduling cases, etc., he’s always “leaving” when I have changed and I am about to leave, even if I saw him “leaving” a good thirty minutes ahead.

My only conclusion is that he is milking the time clock.

Which is fraud.

And one of the rule violations that will get you fired immediately.

This is a very serious accusation.

I need more data.

I do not find it easy to make friends.

My sister says I look severe, although I am not when you get to know me.

RNF I call it.

Resting Nurse Face.

However, I find it easy to be friendly with my coworkers.

I find it easy to make conversation, to ask about their children and their spouses.

And sometimes I make enemy is the wrong word.

Let’s just say people who don’t care for me.

I tell the truth, even if they don’t want to hear it.

I expect them to work, even if they don’t want to.

I no longer expect them to do the same caliber of job that I do.

Because their top caliber may be different than mine.

I can be brief when I’m tired.

I can be cranky too.

But that’s okay.