Upon the opening of a new OR

Lesson learned the last eight weeks.

Hard lesson.

Upon the opening of a new OR planned for June, life is a little like “If you give a mouse a cookie.” If you plan to open an OR, you have to make sure you have all the furniture ordered early, and once the furniture is in the small details have to be worked out, glove boxes, desk placement, etc. And once the small details have been worked out the OR is opened for business. But there are still a hundred and one details to work out.

The requirements on my time went through the roof. And I wasn’t super involved in the planning or the buying of things. But the organization of the room and the cabinets? That has me written all over it. And then the reorganization of the equipment pieces in lines that I know aren’t going to last a day. And then the reorganization of the former occupants of the supply room that was currently the new OR.

And the 75 hours of self scheduled clinical to be done over fourteen days. Essentially I worked from 0530-2300 for two weeks straight. Ugh.

But self care is important and I’ve had myself a massage, and a pedicure and dinner out.

But next new OR we have to open. I will be taking the quarter off of school.

Annual Education

How does your hospital deal with annual education that leads to the verification of you skills?

At my hospital, they do a massive education push with touch stone stations on a three day stretch where we practice the skills. Which is useful. Practice makes perfect.

But nursing isn’t perfect.

And neither is healthcare.

Nursing is doing the best care, at the best of your ability, at the top of your license so that the patient gets better, if possible. And if they can’t get better, the patient is kept as comfortable as possible until the end.

Is that too much to ask?

Whilst keeping everything sterile and clean as possible.

Because if you’ve contaminate the field at the outset, anything you then touch is contaminated, the germs don’t go away.

So, yes, it is useful to keep all the skills sharp, including sterile technique.

Which can’t be taught quickly, it’s has to become ingrained.

People

This is when a word can change the vernacular of a place and can be embraced by both shifts. And the second evening shift phrase. If you can call a single word a phrase.

People.

People is perfect.

It is a safe for work swear word.

Like fuck it can be many things. A noun, an expletive, an adverb, and a verb.

It is useful when you want to swear but you can’t.

It can be used to express disdain, anger, disgust. PEOPLE

Don’t like what someone did. PEOPLE

Can’t believe that your boss is asking you to do that again. PEOPLE

Express too many reps/surgeons/tech/that strange hanger one. PEOPLE

“People!”

You have to pop the ‘p’s though.

Evenings is Magic

Okay, enough of the gloom and doom and hatefulness that is my life the last month.

Evening shift sayings of the OR.

Oh, yes, this is a thing.

Did you know it is possible to add words to the common vernacular in an enclosed space?

Oh, yes, this is possible.

The first one I coined was after I noticed a uni knee tray in the basement on a table. I had just come on shift and I was pulling cases for the next day. I finished pulling all fifteen of the cases and went upstairs to find something else to do, because evening work is never done. And the manager, assistant manager, sterile processing manager, and day shift charge nurse were all in a tizzy. Multiple trays were open, the rep was pacing around, the assistant manager was on the phone. I casually asked what was up, as you do, feeling my way gently through the emotional crowd.

Elle, the assistant manager, snapped, “We’ve lost a tray, can’t find it, not in SPD, not on the shelf, it’s nowhere and it was will thousands of dollars to replace it.”

Me, wondering if it was the tray I’d seen plain as day on a table in the basement, “Which tray?”

Elle, “A medium uni tray.” She then went back to her conversation.

Me, nonchalantly taking the elevator downstairs and retrieving the tray from the table they would’ve had to pass umpteen times in the day during their franticness and hysteria. I brought it upstairs, handed it to Elle, and asked, “this one?”

You would’ve thought I had paraded naked in the core.

Elle grabbed it, “Yes!!! Where did you find it?”

Me, “On a table in the case makeup section, near the SPD door.”

Elle, clutching the tray to her bosom like a tragic heroine, “How did you find it?”

Me, shrugging, resisting telling them that they could have found it at any time, “Evenings is Magic.”

And, like that, the phrase was born.

 

 

Is the universe trying to tell me something?

Apparently, the antibiotic Cipro makes me mean.

I have had an absolutely shitty three weeks.

Let’s count down the reasons.

  1. Fall on my own stairs on Saturday fourteen days ago. Tripped avoiding the cat. Bruised the right side of my sacrum, tore/strained the top of my left calf. Still hurts with all the pain.
  2. Asked two different surgeons about my calf. Of course I believed the one who told me to walk, stretch, and it would be 6 weeks. The other one told me I needed to be in a boot and I would need physical therapy when I was done in six months.
  3. Bladder infection, first ever, thirteen days ago. All the symptoms, only resolved slightly on Bactrim. Went back to the doctor, urine culture done. She asked if  I wanted to start antibiotics on Wednesday. I said no, to her surprise, that wasn’t good antibiotics stewardship. Only to have a positive culture that was resistant to Bactrim. Cue the Cipro course begun last Saturday, for seven days.
  4. I’m supposed to be doing clinicals right now for school. Last summer I sent in a paper where I had to sign to attest the school was responsible for finding me a preceptor instructor for the particular class. I reached out in week 2 to find out who my instructor would be. No instructor, I have to find my own and do my 75 hours of clinical instruction in five weeks. My first person turned me down, I will be going down my list looking for a preceptor. All the hours (unpaid) will be worked in the next four weeks.
  5. I got called out by my day shift counterpart for being too mean to our staff. I’m sorry, are you not there to work? Remember, I won’t ask you to do anything I’m unwilling to do myself and the list is short.
  6.  Too many hours again this past pay period. Why do I do this to myself?

Stand off, dick, I’ve got this

Anesthesiologist, looking VERY (why?) concerned-what about these two appys? This one room is dropping and there’s an hour.
Me (evening charge nurse)- um, they go at the end of the line. The evening procession will be knee scope in room 4, Moh’s in room 3, toe amp back in 4, cysto fulguration in room 2. It’s 1800 now and I have to be down to 1 room at 1900, from the 3 we currently have running.
A- But an appy is an emergency.
Me- only if the doctor declares it as such.
A- but an appy is an emergency.
Me- room 3 is dropping and there is an hour. I spoke with the surgeon and offered to let him do one now and one at 2100. He declined.
A- but an appy is an emergency
Me- And so is the gas gangrene on the toe and the cysto fulguration. For BLEEDING.
A- have you spoken to the surgeon, when?
Me- at 1750, I told him his two options and he chose to do them together at 2100.
A- but an appy is an emergency.
Me- they started losing that argument when they started waiting until morning to do them.
A- frowning mightily at me. And goes off to ask the same thing of the day shift charge, who is a MAN, who is working the Moh’s.
Day shift charge- what she said. She is the evening charge nurse.
Me-what I wish I’d said- look, dick, I do this EVERY night, Monday through Friday. I know what I am doing. You’re just the call guy.

I posted this on a Facebook site that I belong to. And there were many people who were aghast that I wasn’t listening to the anesthesiologist. And because appendicitis hurts, yo. And arguing that the other cases weren’t as much of an emergency as the appendixes so should be bumped.

  1. I do not bump.
  2. The surgeon is the one who asks to bump, by that I mean he asks the other surgeon and lays out his rationale for bumping.
  3. I do not bump.
  4. I know how to read a board and make decisions all on my own about the OR’s evening line up.
  5. What an ass.

And the anesthesiologist was shitty to me the rest of the night.