Just got my approved clinical sites for my MSN last semester

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…

What is informed consent, really?

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.

Reps, what are they good for? Absolutely Nothing. (sing it again, y’all)

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.

 

 

 

 

Worst week ever

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.