24- Time outs are not a bad thing

The gown card reads “One act of charity by a despicable person is always held up to the light as an example of why they aren’t as bad as everyone says they are… Sure, Jan.”

You know what I am talking about in the political world.

And in the real world.

But it happens in the OR world as well.

Some doctors are just not nice people. They are demanding, and exacting, and not willing to look at issues from anyone’s perspective but their own. They are belittling and always see delays as a personal attack on them, on their time, on their golf schedule.

We have all had this surgeon, this person in our lives, this politician in our political life.

But to their chosen few, sometimes very few, they can do no wrong.

Oh, they threw suture scissors at you? Did the scissors hit you? If they didn’t, it’s okay then. They didn’t mean it.

Can you feel the eye roll from where you are?

The very fact that they thought the suture scissors throwing was an acceptable behavior is a problem. A big, write-them-up kind of problem, refer them to peer review kind of problem. NOT to be swept under the rug by management and their preferred team kind of problem. Not addressing bad behavior in the moment allows them to think they can continue it.

The fact that they are kind to the people in their room is not the flex you think it is. The team that they’ve chosen to be brought into the inner circle is definitely not the flex you think it is. Just because they are not mean to them does not give them the permission to be an ass to everyone else.

Sometimes they just need to pull up their grown-up panties and try to be such a pain in the OR’s behind.

Stop yelling, for Pete’s sake!

Yelling surgeons are kind of like yelling toddlers, it is okay to give them a chance to do better. Sometimes it is a choice- If you, Dr. X, can do this and not do that then I will see what I can do to put your next add-on into the schedule. Sometimes it is as as simple as “Dr. X, I see that you are upset. Can you not upset your patient, and your team and we will talk about the issue later.”

DO NOT give in to them. No matter how unreasonable their request is. This emboldens the bad behavior and sets you and the OR up for confrontations in the future.

Why, yes, dealing with surgeons is akin to dealing with toddlers sometimes.

Sometimes time outs are required.

School Me Saturday-Break’s over!

The Winter break is over. As Theodor Geisel would write “Don’t cry because it is over, smile because it happened.”

You may know him better as Dr. Seuss.

Time to buckle down for the next 4 months. It’ll be over in the blink of an eye.

Check those syllabi, write down the major assignments and due dates, and remember this won’t be forever.

In April, you may wake up and wonder where the time went. But that is okay.

Maybe you vowed to do better this semester. Get the reading done on time, turn your papers in on time, early even.

It is easy to be optimistic at the beginning of the semester. You are back with your classmates, all talking about the 4-6 weeks you’ve just had off. The adventures while on break, the holidays, the presents, the FOOD.

It is time to take that energy and put it to work for your semester.

Find your study tribe.

Find a librarian worker who can help you find all the things.

Make a solid plan for how to tackle this semester.

The most important thing about having a plan is that you have to put it into action.

Don’t stay up too late or sleep too late. Naps are your friend when your brain is whirly gigging around. If you want a rubber ducky to practice your presentations on, buy the rubber ducky.

But also don’t forget to have a little fun too.

I know this time can feel grueling like you’ll never be done. At times like this is it important to spend some time in reflection on what amazing things you’ve done. Of all the things you’ve learned. Yeah, it might’ve been a bit sloppy, but you survived. And you will survive this.

Each semester is closer to the finish line.

You can do this.

Cookie Thursday 1/11/24-cheddar dill cookies

This week continues the “why is there so much cheese!” theme for January 2024.

I love dill. I love how bright and savory it is. It is the perfect complement to so many things. Why not cheddar cheese?

The original recipe called for gouda. I don’t have gouda in my cheese drawer and I was not about to bring more cheese into the house. But I have some Unexpected Cheddar from Trader Joe’s. This cheese is a mix of parmesan and cheddar and is a whitish cheese.

Which makes it perfect for this recipe.

In my head.

As always, Cookie Thursday is a Thing started as experimentation on my coworkers and I’ve never really stopped.

But yes, the dill complements the Unexpected Cheddar perfectly.

The cookie, more like a cracker, is smoky and cheesy in all the best ways.

Apparently, this cookie doesn’t keep well. I wonder what I can add to change that?

To bring it back to the OR, sometimes it is the unexpected element that allows for the most exciting cases. This can be a code, this can be a power outage, or this can be a doctor yelling at you over the phone because the OR is running late. Again.

In these instances, the first thing to do is to keep your cool and reach for your calm. As my first ACLS instructor told me, “In the event of a code, the first thing you do is take your own pulse.”

Which is the unexpected element of this make? The Unexpected Cheddar? Or the dill? Or is it the synergy of both?

Mentor and preceptor, explained

There’s a quiz going around on Facebook about who a new peri-op nurse would want in their life. A person who has clinical competence and experience and mimic them. Kind of a fake it until you make it.

The answers are preceptor, mentor, role model, or educator.

Let’s break those down.

A preceptor is the person who trains you in the policies and procedures of the hospital. They are the one whom the new peri-op nurse follows to gain knowledge about their new role in that particular hospital.

There has been a movement away from having unit educators anymore. I know in the hospital system I work for, the unit educator’s role has been centralized to a central office. This means that less of them can do the work that is necessary for annual education. However, this also means that the unit loses that person who is the dedicated educator for the unit. Our last educator left after having a baby and they centralized the education department. She was never replaced and the education got punted to the assistant nurse manager, and those of us in the unit who stepped up to serve in the educator role. Even if a unit had a dedicated educator they serve the entire unit and personalization of education goes to the wayside.

A role model is someone to look up to in the department. They could be good at their job and admired by staff and surgeons alike. They have clinical competence and experience. But this is a shallow relationship. A role model is sometimes imitated, but sometimes it is for a reason that is not in the patient’s or the department’s best interest. Especially if they are admired by cutting corners. Cutting corners is dangerous.

A mentor relationship is all of the other three and a deeper relationship. They are the one that the peri-op nurse goes to with questions, or reassurance. They are the ones that notice when someone is having a bad day, and invites them for a cup of coffee to talk about it. Mentors are important.

Luckily, I have a built in mentor in my mom, a still working nurse with 50 years of nursing experience who does all the things a good mentor does. She listens when I have concerns, she talks through solutions with me, and she will give me a mild correction when I need it.

This is what I think is the answer to the question. A mentor is all the things in one.

All new nurses need to find themselves a mentor. All nurses need to find themselves a mentor too.

Tuesday Top of Mind 1/9/23-scary times, ranked

It is hard in the now times to decide which issue takes precedence in my mind.

Let’s rank them, shall we?

no abortion for dying patients.

This is what the 5th Circuit Appeals Court shouted at all of us near the end of 2023. In their ruling, Texas doctors are not obliged to perform abortions. At all. Not even if the woman is dying. Not even if the fetus is dying. News flash, if the mother dies while carrying the fetus, they both die. Did someone flunk biology?

This makes me so mad for women in Texas. Also, this is Supreme Court bait that will be appealed to the Supreme Court. This might make it the law in the land, especially in those states that do not have provisions for care of a dying mother because what is killing her IS THE PREGNANCY.

Yeah, there is a story in the New Yorker about a young mother who was excited to be pregnant, and wanted the pregnancy but being pregnant ultimately killed her. And the baby. Because they are linked. Do people not understand that?

2. war is contagious and spreading. More evil has been done in the name of a holy being than ever conceived before. Or, in the case of Ukraine, in the imagined getting the band back together sentiment of the Russian leader. And the band, in this case, is the USSR. I can’t imagine that people don’t understand that Ukraine is only the first step. And the first war.

3. Covid is actively killing people again. Not that it ever stopped. But the newest variant, the JN.1 variant, has gone from 14% of cases to over 60% of cases in less than a month. I have also read reports that it is more contagious even. You know that covid has been bashing at the bars of the vaccine for a while now. Someday it will find the key to ignoring vaccination entirely.

Speaking of covid, some towns are whining that they are running out of supplies. This after most Americans gave a cold should shrug to giving money to efforts to stop and contain covid. We are too interested in going back to how it used to be. Not gonna happen, there is no going back. There is whining, though, because we as a society don’t give enough forethought to things we don’t like.

Lots of things are top of mind today. But those are the main ones.

Not the least of which is the winter storm that is currently battering the Southeast.

School Me Saturday 1/6/23-the semester is coming

Break time is over and the semester is starting soon.

There are two ways of looking at the imminent start of the semester.

On one hand, there is excitement. Yay! The semester is beginning. This is the semester where I turn it around and get all my papers/studying done early so I won’t feel so stressed when the due date looms.

On the other hand, there is dread. Another semester? Didn’t we start break like a minute ago?

Or a combination of the two.

Me, I’m a combination of the two. Each semester is bringing me closer to the end of the PhD program! And each semester is bringing me closer to the dissertation!

Both things can be true at the same time.

Ultimately I think that the beginning of the semester is a chance to wipe away the previous one and begin anew. After all, we are learning how to create and build the project, do the project, and write up the project.

Of course, we won’t do it perfectly the first time.

This is where the mantras come in handy.

Right foot, left foot, the only way out is through.

As long as you do no harm, take no shit in the process.

Cookie Thursday 1/4/24- Happy Birthday, Cookie Thursday is a Thing. It is NINE years old this month!

Happy birthday to Cookie Thursday is a Thing.

Believe me, when I started this, I had no idea I would be able to sustain it for NINE freaking years!

Besides my 25-year marriage, this is the longest I’ve sustained something outside of work.

The theme for the month is Why is There so Much Cheese?

The cheese drawer is packed. And we got cheese from my brother-in-laws.

Every make this month will be cheese-related.

I wrote down 8 of the cheese recipes, including one of the department favorites, on gown cards and I walked around and had my coworkers pick.

A little gamification for the birthday celebration month. I could have made the 4 favorite cookies of the department, but there is SO MUCH CHEESE.

The make for this week is feta and spinach sconelets.

These are just little bite-sized scones.

Coincidentally I’ve not made these in about 6 years but they still made it onto the best list with one vote. Maybe this is a celebration month after all.

It’s hot, damned hot!

They changed the parameters of the ORs at my hospital.

Before, the low end of the temperature was 66 degrees Fahrenheit and the high end was 72 degrees.

But now…

The temperature STARTS at 68 and ends at 75.

For a surgical team huddled close together, wearing non-breathable gowns, sometimes working in high-stakes situations, this is too hot.

I said it.

I don’t get either hot or cold in the OR. Never have. As an aside, there is a reason I don’t take baths. Yes, that is out of left field. But there is an explanation for the curve ball. I don’t take baths because my blood pressure drops, and, as someone whose systolic is usually 100-105, a drop of 10 point systolic can make me lightheaded or faint. It definitely makes me nauseous. Now I am uncomfortably warm in the OR and feel slightly ill.

I’ve had a scrub tech have to leave the field because they got too hot.

They went out of the room, threw up, had something to drink, and came back.

And don’t get me started on tempers. The tempers of the surgeons, or the team.

There is a reason that the word temper is within temperature.

The change has been made because it is safer for the patient is the explanation.

Well, if the blanket and hat technology that we have were used appropriately the patient would be warm at 66-68 and you wouldn’t have tempers flaring as the heat rose.

After 18 months in a nursing research PhD program, I know a little bit about research. There has been no change in the data that is out. So why the sudden change in the low number of the OR temperature? I want to see the data they are basing this change on.

I will be reading the latest guidelines when they are released shortly and also the journals. Trying to find a clue.

We are perspiring to know.

Tuesday Top of Mind 1/2/24-yearly disclaimer, edited for 2024

Happy New Year!

Let’s get down to business.

Every year I write this disclaimer. And add to it. And tweak it.

And if I knew how to pin it to the blog start page, I would.

I began writing the yearly disclaimer to be able to point to my posts and say, see nothing to give away the patient here. You know, HIPAA. In case the corporation, that I work for and discuss my blog openly in meetings etc., tries to tell me I cannot write this. Not that they have, but I can believe they would.

I believe in protecting patients’ and staff’s privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about.

I do not use names.

And if I do, they are changed.

I change ages.

I change gender.

I change details such as which limb is fractured.

I change details such as which surgery is performed.

And the cases that I do talk about obliquely are changed in how time is perceived as well. The cases/people/staff may not be the same at the time of the surgery.

I definitely change aspects of time. By that I mean there is no relationship between the moment I write the post and the actual events that prompted it.

Some of the stories aren’t even mine, but even they are changed so as to be unrecognizable.

I change a lot.

So that, if you knew where I worked, you could not figure out who I was writing about.

I discuss issues that impact healthcare broadly.

And, after the events of the past year, issues that impact women’s health. There has been a LOT to unpack here.

And covid. Can’t get away from covid. JN.1 is the newest variant and it is currently causing 44% of the cases. People continue to die.

I do swear sometimes.

But mainly to make an emphatic point.

School Me Saturday 12/30/23-looking ahead by looking behind

This is the last School Me Saturday post for 2023. And it will be a 2023 personal report post.

There is something about the end of the year that promotes introspection, of looking inside yourself to count your accomplishments. Do not count the failures. These are just learning opportunities.

This past year I survived TWO PhD semesters! In a six-semester program that is 2/3 of the way through. I almost called my chair a liar when she told me that I only had 4 classes to go, the rest of the time will be project and dissertation. Mind-blowing.

I learned about so much as well. Nursing Theory, more statistics, types of research. This past semester had a bit of a different feel with 2 of the three classes being mandatory classes in Policies and Ethics, and Health Disparities. I dare say I learned a lot in the two.

I continued to function as a research assistant and was assigned to a PhD nurse who was just starting a project. I got to design and create the survey that she will be using. I got to learn more programs, including Canva and Qualtrics which is the survey program. I love to learn stuff. This next semester will have more things to learn in data cleaning, and using my nascent skills in statistical modeling. But that is next year me’s problem. This post is about 2023 and all that I have learned.

The Tuesday night Writing Group has kept me in good stead to stay on target. This is a group I joined at the very beginning of this endeavor, and I use the three hours weekly to focus my attention and my thoughts. I know I am the only 2nd year who engages with the writing groups but they are very instrumental to my process.

I worked as a graduate assistant over the summer for a group of RN to BSN nurses who were in their last classes. We explored writing and citation, and I spent a lot of time reassuring them. Anyone who knows me in real life knows I am not that person, but I allowed myself to be that person for them. Well, I say I am not that person, but I am relentlessly cheerful and see the bright side. Not for nothing was my MedSurg nickname of Pollyanna Puke.

I survived the busy season in the operating room. To recap, many people have met their deductible and therefore MUST HAVE SURGERY NOW!!! This makes the end of the year, and the beginning of the year very busy in the OR. I still haven’t learned how to say no, and I’ve been doing a bit of evening shift charge during the week.

2023 was a busy year; I’m still on the bridge toward graduation.

Mantras always help. My favorite is “The only way out is through.”

Next week on School Me Saturday I will explore looking forward for adult learners.