I had another one of those phone calls.

Ring, ring.

Me- This is Kate. How can I help you?

MD- This is Dr. Z. I have a patient who needs urgent surgery. There is a lot of blood and they are still bleeding. How fast can we start?

Me, after getting details-It is 2310. I am heading in now and the scrub tech is my next call. I will shoot for patient on the table at midnight.

MD- Well, I hope they still stay stable. Do what you can. **click**

Come to find out the surgeon knew about the case a good thirty-sixty minutes before they called me. They were watching to make sure the patient remained stable.

They were doing this by not ordering the type and cross. This is where the patient’s blood type is tested for type and crossmatched to ascertain the most compatible blood to give them in case of a transfusion need.

These tests take 30 minutes at a minimum.

And the order should not be buried in the pre-op orders. The ER can absolutely and would absolutely start the clock on this. This is essential for making sure the patient has blood available if necessary. Especially if they are bleeding.

They were doing this by not ordering the oral medication that they decided the patient MUST have prior to surgery. Again, something the ER can absolutely do. Anesthesia does not like giving anything orally due to the pesky NPO, especially minutes before induction.

By responding, when this oversight on the type and crossmatch was noted just prior to surgery, and the lack of oral medication was also noted just prior to surgery and the surgeon was questioned about the need for these both to be done before the patient heads back to surgery, oh, just the oral medication then.

On a patient we know is bleeding?

This is what you want to do?

Okay.

Handing the patient 2 oral tablets and a scant amount of water (seriously, like 1/8 of a cup) to wash them down with.

That took a minute to have the orders, that were just released, acknowledged, and released by pharmacy. Added 5 minutes to our pre-op time.

By continuing to pace around and say that they were WAITING and what was taking SO LONG?

Deep breath.

Count to TEN.

At no point did I snap back that these could have, should have been ordered just a mite earlier so that the meds would be given, and the type and cross that you no longer want could be initiated.

But it was close.

Managing surgeon expectations is a big part of the call process. But they can help themselves out by not acting like an impatient fool and, you know, ordering things in a timely manner.

Patient is fine and did not require blood.

On to the next case.

As a woman, I know what weaponized misogyny means.

It means every time there is a shred of happiness for someone of the female persuasion, such as a movie, or a kitten (although kittens spread joy regardless), some asshole who thinks they are macho and butch and here to show the little lady who’s boss pops up in the comments

Oh, I know what misogyny is. 

It is fear. 

Fear that a woman might outgrow you. Fear that a woman might be better than you.

Fear that a woman might realize she doesn’t need you. 

For example, the TARDIS (Doctor Who’s time travel box) is traditionally blue. Panetone 2955C, to be precise. Someone made it pink in a field somewhere in Scotland.

For one day.

The comments on the picture ran the gamut of disgusting, from looks like Pepto Bismol (I know this is an American), to ugh, to NOO!!!

From the men. 

Some of them hide behind fake accounts. Probably so the women in their lives don’t find out. Or they are just three kids dressed up as an adult to get into an R-rated movie. (Yes, this is a Loony Toon’s reference)

The Secret London post “Walking through central London with a bunch of gals (and one Ken) all dressed head to toe in pink, with women constantly yelling “Hi, Barbie!” at us was a joyful experience.” First comment? 

Surprised no one called the cops.

Yup, a man. 

Women who like things outside of our “traditional” roles of maiden, mother, crone are shat upon verbally every time we open our mouths. Or by words by typing on the keyboard. Or dare to like something they don’t

The well-actuallys.

The man-splaining The a woman can’t understand this (whatever this is that the man is gatekeeping). 

If we take offense at something a man said, they were just joking!

It’s not funny.

It is not funny to laugh at what we find enjoyable good. Sorry that you don’t, but that is what makes everyone different. The ability to like or not like based on personal preference.

America Ferrara said it best in character as Gloria, the woman whose Barbie it was. It is exhausting being a woman

Find the speech, read the speech, find a video of the speech.

I know there are some out there.

This is why.

It is okay that I like different things.

It is also okay that I like the same things.

As long as it is legal, I don’t care what other people like and enjoy.

Why can’t everyone do the same?

Not even a post-it, a subsection of my covid & things that want to kill humans board on my Pinterest “No shit, it’s still trying to kill us”

Just when you thought COVID-19 was gone, had convinced yourself it was gone, had lied to yourself that it was gone, it pops up like an undesired guest at a baptism.

Okay, fine, that was a small Maleficient joke.

But, yeah, covid is still trying to kill us.

It isn’t gone.

The masks are mostly gone, beat down by peer pressure.

I noticed that where there had been zero covid patients in the hospital for a few weeks, all of a sudden there were 3.

And then 6.

And then 9.

A friend of mine asked about the possibility of a covid booster shot, out of concern for their family members who are vulnerable. The fact that the school year is approaching and at the beginning of the last school year, there had been 60% call-outs for students within 2 weeks of the start of school.

In other news, the vaccine companies have nearly completed work on this fall’s vaccine. Apparently, it is to be ready in September. Pending FDA approval.

The news reports began reporting that there was apparently a summer surge of covid, for the fourth year in a row.

The real tell?

The seeming shortage of at-home covid tests. I know I got the last one at the local drugstore, which I bought after noticing that the ones I had expired.

Definitely ‘no shit! it’s still trying to kill us’ indeed.

Good luck convincing others that this is happening.

I’m sure they’d rather keep their heads down, and the masks off.

It is that time of year again.

When the school drives start.

School starts, depending on where you live, in the not-too-distant future.

People are hurting due to inflation. All the strides that have been made in the last forever are being erased, well, eroded by the lapping of inflation. Don’t forget shrinkflation as well. Don’t get me started on that.

It is the time to donate to those who cannot supply the goods necessary for school.

My trunk is full of notebooks, and paper, and pens, and binders, ready to be donated to the hospital’s school drive.

Do I have children?

No, we do not.

That doesn’t mean we can’t help out those who are struggling. It is one of the privileges of those who can donate. Helping out those who are struggling is its own reward.

Donate to the school drive.

Any school drive.

You may be enabling the next scientist on their way to making discoveries that will reshape our world.

Yes, the cookie jar is empty today.

I’m on vacation. Well, stay-cation.

Could I have made cookies?

Yep.

Did I make cookies?

Nope.

I decided to take a week off at the end of July to give my PTO balance a little breathing room.

Wouldn’t do to max out and stop accruing.

The max is coming faster these days since the hospital system started giving us with more than 15 years of longevity in the company a total of 12 hours of PTO a pay period.

I’ll do the math for you.

That is 312 hours per year. (I multiplied 12 hours of PTO earned by 26 pay periods in a year).

As I work 10-hour shifts, that is 31.2 days a year.

Am I grateful that I now earn 12 hours a pay period? Absolutely.

Does this create a bit of a boondoggle for me? It could.

Which is why I took this week off.

The second reason is that school is starting in 3 weeks and I will have my hands full then.

Relaxing week off at home it is.

Have I fielded a phone call from a surgeon who wanted to add on a case for the next day?

Yes, and happy to do it.

It would take more time to explain to them why I couldn’t help them than to call the evening charge nurse and tell them to call the surgeon.

It is a good thing that they reached out to me and not the nursing supervisor.

That is a habit I’ve been trying to break them out of.

I wrote a memo about it and everything.

I don’t think the memo got circulated.

I tried.

No cookies today.

I will pick it up next week when No Heat month commences.

Hi, yes, I work at a Magnet-awarded hospital.

My current hospital has Magnet designation for another 5 days.

Then we lose it.

Because they changed the rules that disallow markets of hospitals to share the load of the sources of evidence. This means that ALL hospitals have to stand alone with all of the needed documentation and sources of evidence.

Can it be done?

Sure.

With the system’s backing. Which, after covid, I am sure we don’t have.

Sure, there are lesser designations.

But I have been hearing rumblings, some from my own coworkers, that Magnet is a money shell game.

Magnet is supposed to stand for nursing excellence.

Do we give excellent care in the hospital where I work?

Yes, the shared governance group and I monitor that closely.

Monthly.

Does the hospital where I work hit all the benchmarks for keeping patients safe?

Yes, this is another thing the shared governance monitors.

I guess I have to amend my resume and take off Magnet designation for the hospital.

Or, can we be like Prince and say the Hospital Formerly Magnet Designated?

But then that would bring up awkward conversations. Did we fail to renew the Magnet designation?

I don’t think so.

More like the goalposts were moved.

I get to bask in the knowledge that the market was able to climb that hill, and do all the sources of evidence.

For five more days.

Something popped into my head after movie and a dinner last night. And it won’t leave.

I was bullied as a child and a teenager. Always the new kid, always the smart kid, always the kid with glasses. But mostly because I was always the smart kid. The one who took attention away from other students when I was engaging with the teachers, often way above the other students’ heads. My hand was always up first, I always had something to contribute to the discussion.

Did I care? Nope. I was going to show how smart I was and how capable I was, even then, in pigtails.

Others did not take kindly to that. I definitely was a target of the “mean girls”. Those girls who looked down on everyone else because they had something none of the rest had, popularity and relevance. Dating the handsome jock. Having a dedicated escort to homecoming.

You know the type.

Did they ask if I cared? No. They just assumed I was jealous of what they had.

Hardly.

But what popped into my head last night as I was reading, yet again, about the bombastic, unhinged group who call themselves the “moms for liberty”. Who spout awful things, and try to exhort influence over whoever they see as inferior. The fact that they were just labeled an extremist group by a civil right’s group. A female-centered off-shoot of the things that come out of right-wing politicians’ mouths, even against women.

Especially against women.

I see you, Tiffany.

The thought that popped into my head was that the moms for liberty group is just the mean girls grown up.

In high school, there were only a few popular kids who thought that everyone wanted to be like them, but they couldn’t because of some flaw that the mean girls decided they were against.

Sound familiar to the moms for liberty group?

They say to know and name your fear is one of the first steps to conquering it.

Was I concerned about moms for liberty before yesterday? I was concerned with the hate and vitriol coming out of their platform poisoning other moms and vulnerable people.

Am I afraid of them? They don’t have power over me. I’m married, to a man, and we have no children. What they are doing is concerning. Yes.

But I see you, Tiffany.

I see you, Regina.

I see you, Karen.

I think you are going to be found to be a group of ridicule.

After all, you’re just grown-up mean girls who are afraid that their looks are fading and losing their grip on the school.

Well, high school is over, we are grown up, and we don’t have to listen to you.

Today something a bit different. Yes, this is a message to myself that I wrote fourteen years ago, July 23, 2009. I want to react to it.

“Leaving the hospital with my chin down, my bag dragging the floor, my shoulders slumped, my feet heavy as I hike to my car. Again, the security car is not waiting for us 2300 people as we leave the building and walk to our cars in the dark. Maybe it’s me.

Maybe it’s me. Certainly, I’ve got a reputation around the hospital.
“Crap, Kathleen’s on call. Oh, well, I need the extra money.”
“Kathleen, you’ve got to tell me when you’re on call so I can avoid that weekend.”
“Kathleen, tell me you’re not on call tonight.”

Is there a color beyond black cloud? Because certainly I’m under it. Who’s cup of coffee did I befoul to deserve this? I’m sorry, okay? What kind of goat do I have to sacrifice to even it up a little?

Maybe it’s me but the last twelve days I’ve worked, we’ve worked balls to the walls until 2245, just in time to go home and not accrue overtime. Except the night I was on call, then we worked until 0230.

Maybe it’s me but the black cloud is following me even on days I’m not on call, as I’ve stayed late three times for my relief no-shows.

Maybe it’s me but the two nights a week I don’t work the OR is slow. Last week, some people even went home early.

Maybe it’s me but we seem to be working harder this month. It’s been so many days since I set up a room and actually finished my evening work that I’ve forgotten how.

Maybe it’s me but I’ve never had a weekend in which I worked less than fifteen hours.

Maybe it’s me but when I’m on call with certain people, forget it. We are bound to work. and work hard.

Maybe it’s me but I’m so tired of this. I know I should be thankful to even have a job, but, damn, it’s got to stop sometime.”

Me, current day:

Well, that was depressing.

Glad I finally learned when to put an apostrophe in it’s.

Current me always likes to read these snapshots of the past.

Look how far I’ve come.

I embraced the call and now it is all that I do. Well, mostly all.

I stopped caring about what other people think.

I came to learn that most surgeons love it when I am on call, and most of the CRNAs.

I think this was the July we did 5 lap appys a night, over 50 total for the entire month. No wonder I was tired.

Don’t forget to be kind to past you.

Apparently, I have been sleeping on replacing some clinicals with simulations. After all, when I was in nursing school, we practiced with simulation for the first semester before we were allowed to go to the hospital for clinical. The only other simulation experience I had, except for the first semester, was when we were learning how to start an IV in the last semester.

Oh, I know that simulation is a big thing. After all, not every patient has the illness/ailment that is being studied. It is just an expansion of the case study.

There was a study done where 25% of clinical time was replaced by simulation, and 50% of clinical time was replaced by simulation. At the end of the study, it compared a whole host of things, including how the students felt pre and post-licensure, who left their first job, and how their managers perceived them. The article was fascinating and, after the statistical math, it was found that there was no statistical significance in replacing some of the clinical time with simulation time.

AI has entered the chat with virtual reality.

This week I read an article about replacing some simulation with virtual reality.

As always the quote that comes to my mind is “Just because we can, doesn’t mean we should.”

I was unable to attribute this to any one person.

On one hand through simulation and virtual reality students will be exposed to patients that they will never have. Because these fragile patients are not given to students. They might also be exposed to patients whose physical symptoms might make them ill. In this instance, I am thinking of critical burn patients. Because these patients are so prone to infection that their interactions are tightly monitored.

However, the nursing students won’t be exposed to the breadth of human suffering, which is a large part of the job they are going to be undertaking. They will never hold the hand of the dying or bring comfort to them or their family. They will never make the real-time “catch” that is so exciting for nurses and students. This is where the nurse realizes that there is an underlying problem that is not being addressed by the doctors and elevates the problem.

Replace some of the clinical experience with simulation. Yes.

Kind of like the practice “babies” we used to do in high school. At the risk of aging myself, I am talking about the eggs and the bags of flour. Before they were replaced by robot babies.

But be aware of the risk to nursing that entails. A further avenue of study is the students who were not adequately prepared for the “ickiness” of the human conditions and leave the bedside.

The bedside needs all the nurses it can get.

Reference
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The ncsbn national simulation study: a longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), 40. https://doi.org/10.1016/S2155-8256(15)30062-4

Well, that’s a mouthful.

Potayto- potahto.

My sister and I were arguing over the appropriate way to say non pariels.

She pronounces the -els. I do not, pronouncing it as the French would. With an -ay sound at the end after the r.

However you pronounce it, they are smooth, often mint, candies that have small candy balls on the undercarriage.

It means without parallel.

Which I take to mean French.

A coworker of mine thought I was bringing in the actual candies, instead of cookies made with the candy. She asked why they looked like cookies when I was bringing in the container, not the candy. I explained that the mini candies were in the cookie.

Why, oh why do I think that non-pareil fits the theme of Christmas in July?

Well, my great-uncle Joe used to send us a Christmas package from the Swiss Colony. It would have shelf stable cheese and sausage, and strawberry bon-bons, and mini mint non pareil.

And I have always associated the candy with Christmas.

Today I have exciting news about Cookie Thursday is a Thing.

It is going to be on a poster for the North Carolina Nurse Association.

The application is also in to present a poster for AORN next year. This application was due at the end of the month and I wanted to get it completed and submitted early.

There is also going to be a project involving IRB so I can get some hard data about whether or not CTIAT improves morale and if it is significant. Spoiler- I think it does and it is.

This is the proper type project that I didn’t know any better to do when CTIAT started in January 2015.

Keep your fingers crossed.