The post-it reads “Saying a surgeon is “just that way” devalues me as a person and as a nurse. This is not the way.”

We’ve all been there.

A surgeon acts out and shows their ass and the charge nurse just tuts that it is the surgeon’s way, and they don’t mean anything by it.

This can go a few ways. A gold star for every one you tick off. Or has been told to you by another staff member.

Implied in the they don’t mean anything by it is that they care so much for the patient that they get frustrated.

Implied in the they don’t mean anything by it is that they are so much smarter than the room and this can make them frustrated when the staff can’t keep up.

Implied in the they don’t mean anything by it is the duh, they have a plane to catch/office hours/dinner with the family, of course, they get frustrated and act out.

Implied in the they don’t mean anything by it is that they have stress from outside that is making them frustrated and they act out.

Implied in the they don’t mean anything by it, didn’t you hear their child just graduated from high school and is driving them crazy, they get frustrated and act out. This can also apply to new babies, to toddlers, to school-aged children, to college-aged children, to adult children, and to their grandchildren.

Implied in the they don’t mean anything by it is their favorite Starbucks was closed and they had to drive an extra 5 minutes to the next nearest one, this made them late and frustrated and they act out.

Implied in the they don’t mean anything by it is the poor dear, he was up ALL night and had lots of calls from the floors and the emergency rooms and he is tired and frustrated and they act out.

Implied in the they don’t mean anything by it is their favorite scissors are in the autoclave and they have to make do with a substandard pair and they get frustrated and act out.

Implied in the they don’t mean anything by it the sky is blue today and they want to be out golfing/reading/exercising and they get frustrated and act out.

Or it is night, or cloudy, or their favorite mug at HOME was in the dishwasher, or their PA is off for the day, or…

You get the drift.

Frustrations happen. It does not give them an open ticket to act their shoe size. You certainly don’t see staff acting like this with every frustration, in full view of the room.

Jeesh.

And, yeah, a little Mandalorian at the end of the post-it. This is not the way.

People engaging in school are painfully aware of what they don’t know.

Trust me.

But.

There is a section of students who should be more aware of what they don’t know.

Every instructor has had these students. They are argumentative and turn in half filled in assignments. They know best what to do in every situation. And never pause to think about the consequences. What if they don’t know what to do in every situation and they just skate along, without a care in the world, thinking they are hot stuff. And no amount of explanations will stop their behavior.

And then it happens.

It doesn’t matter what IT is.

Could be anything.

A patient fall when the side rail was left down.

A medication error that had disastrous results.

Even something innocuous, kind of like leaving the car windows down when a rain storm is forecast for the afternoon.

The patient fell, a whopping dose of insulin was given to room 232, bed A, when it should have been given to room 232, bed B, the inside of the car gets wet.

Unintended consequences are a real thing.

And the patient who fell has a brain bleed and requires transfer to a higher level of care. And room 232 bed A’s blood sugar dropped to 30 and they seized because of it. And the bag of newly bought textbooks got wet and ruined.

How to deal with this mess?

Does the student understand what and where it went wrong? Or do they play the blame game?

To be a student is to be actively learning.

But the student also has to really understand that they don’t know everything.

They don’t know what they don’t know.

You know?

This is a horrible lesson for them to learn in those kinds of circumstances.

But needed.

Students, be aware that you don’t know everything and listen to your instructor/boss/charge nurse.

No. I mean it.

Really listen

The staff at the OR is doing a snack day this afternoon. This has been in the works for a bit. There are sign-ups and everything.

They don’t NEED my baked goods for the week so I am declaring it a baker’s holiday.

I certainly don’t want to compete with them. Every time there has been a job celebration on Thursdays, oftentimes with potluck, the cookies don’t get eaten.

I can take the day off. There have been only a few Cookie Thursdays where I haven’t baked in eight years and I think the last one was in summer 2022.

And my oven is cold today. And I am doing homework instead.

And that is okay.

Now that I’ve gone through the importance of counting ALL the things, let’s talk about the instruments themselves. You get a casket (yes that is what we call them) aka a small metal box containing your instrument set. On the outside is a sticker with the load information on it, and a sterility indicator that shows you if the tray has been run through the sterilizer or not. It usually is tape with stripes that turn black when exposed to steam.

This is the first indicator.

The tray is locked.

No this isn’t a dungeons and dragons tale. There are plastic locks that keep the tray closed during transport. And a tray is not able to be opened without popping the lock. If the locks are in place and still intact, the tray should be sterile inside.

Right? Right?

Eh, not necessarily.

The outside indicators are only signals that this tray has been through the sterilizer and been exposed to enough steam to change to black. And the locks allow the person opening the tray to be sure that the tray has not been opened or otherwise tampered with.

It is the inside indicator that shows whether the tray has been sterilized or not.

There can be several layers to trays. How else are you going to pack all the instruments into the metal container, and make it light enough to move, but have enough instruments to do the case?

Each layer should have a sterility indicator. These are usually strips that change color, again in the evidence of steam. However, these strips also indicate how long the strip was exposed to the steam. There is usually a line that is marked acceptable. The color may not be completely changed the entire way through the line, but if it has reached the acceptable line, sterility can be assumed.

As the tech is setting up their table will examine these strips to ascertain whether or not the tray has been sterilized. There should be two for each level of the tray, in opposite corners. And if there is a paper bag full of delicate instruments, there should be an indicator in there too.

No indicator?

Don’t use the tray. Because you don’t know if the tray contents are sterile or not.

The outside lock is broken, or missing?

Don’t use the tray. Because you don’t know if anyone has opened the tray and absentmindedly put it back on the shelf, instead of taking it to SPD for processing.

The indicator color change looks weird and does not reach the acceptable line?

Don’t use the tray. Because sterility of the instruments has not been met.

There are many, many different sterility indicators for this. It depends on what purchasing has bought, or the sterilizer company itself recommends.

I will try to attach the questionable sterility indicator from this past week. This tray was not used because the acceptable line was not reached, although the tray had been through the autoclave. There are steps to be taken after that: informing the SPD, informing the supervisor. But most importantly, get another tray. Sometimes a little outside of the box thinking is required, especially if it is end of day and the day has been busy. If all of tray A are not sterile or are in cases, and tray B is almost the same. Open tray B, you might have to add a few instruments but the case can go on.

There has been a low-level murmuring and protest going on for as long as the US has been a country.

And it is about so-called “right to life”.

AKA, I know better than you what you need, you harlot that got pregnant. Never mind if you are married. That is a sacred baby and thou shalt not kill.

There are so many things wrong with this way of thinking.

Not every religion thinks the way you do. Or the way that you think your god thinks. Lowercase god, upper case God, there is more than one.

I maintain that this is about control. Control of women, control of the fetus in the womb that will not survive birth.

Instead, there is a push to make the woman carry the what will be dead baby to term, deliver what may not be an alive baby, watch helplessly as they die.

Or, as has happened in several states where this mockery of right to life is paramount, a pregnancy is dead, or dying, or will be dead, or die, and the woman is not SICK enough, or dead enough herself to warrant life-saving treatment.

Not to mention that this is costing the healthcare system more money and more resources to care for the dead and dying.

And for what?

A kudos from your god?

An expressway trip to your heaven?

While women and babies in utero suffer?

Where is the compassion?

Or don’t others get it until YOU or your loved ones are impacted?

And the kicker is that so many of those who oppose abortion are okay with the death penalty.

Make up your mind.

The Facebook memory from March 19, 2017 reads “Today is Certified Nurses Day.What does that mean? It means that these nurses went on to get specialized certification in the particular realm that they practice in. It also means that to keep the certification hundreds of hours of education has to be done.I have been certified for eight years. To keep my CNOR (certified nurse operating room), I have to complete 135 hours of CEUS every 5 years. My mom (Billie Schaberg) has been certified for years, and is a big part of the reason I am as well.I don’t get any extra per hour for being certified and I am lucky in that the hospital I work for will reimburse me for the hours and the recertification. But even if they didn’t I still would do it. Why become certified? Why not?”

Why not? This is a loaded two words.

Certification is important in the nursing world, just like in the real world.

It indicates commitment.

Not only to the profession, to the patients, but to themselves.

Is it hard to obtain certification?

No. There are some fiddly bits.

Like a test.

And I know how some people fear tests,

And, depending on where you work there may be an hourly bump, or a point on the clinical ladder, such as in my hospital system.

Hospitals are also interested in certified nurses. And some are doing their best to bring in test prep or paying for the test.

I know mine is.

Contact me if you want to learn more about certification, no matter the department that you work in. We can figure it out.

What?

Already?

Are you sure?

Didn’t the semester just start?

Yes, depending on your college or university, class selection starts for the next semester/quarter early.

And when I was at Creighton there was a mad dash to sign up to ensure that there was room for all the people who wanted to take a particular class.

The internet makes it easier and harder at the same time.

You have to remember the password. And read about all the classes you want to take and decide which classes would be best for your major.

And meet with your advisor.

And decide which class to take next.

I’ve been lucky. I’ve only had to choose three times in the last several years.

Otherwise, I have followed a set path in the classes that would get me to my degree fastest.

There may be some wiggle room timing of classes, especially in a larger university. Or you could decide to take a semester off.

But, unless you’re a morning person, do not sign up for 0800 classes. You probably won’t like that. Unless it is the only time the class is offered. If so, make sure you get a good night’s sleep the night before.

And as an adult learner, you may have to pick classes that correspond with your shifts.

Evening classes and even weekend classes are offered.

My advice is to talk to your advisor. They may be able to tell you the best path to take.

I wish I had listened to my advisor when they cautioned against taking statistics AND economics in the same 6-week block. But I was in a hurry to finish and I had four classes left to take for the next 3 quarters.

I counsel people not to do that.

But the good night’s sleep advice?

Definitely do that.

What I was gonna do? This week also has Pi Day in it. You know, 3.1459, etc. I read about a Venn Diagram Pie. For this three pies are needed, and a cut-out for the intersection part. Three flavors are needed, with the intersection pie being a combination of the other 2. As I was working out how to do this, I decided it was too complicated and would be hard to serve. If I have learned anything about serving up cookies weekly for EIGHT years, it is that the simplest cookies are best.

And tomorrow is St. Patrick’s Day, a high holy holiday in my book. And, in keeping with the theme of the month, the recipe had to be something I had not baked in months. Reminder, the theme of the month is Blast from the Past. I made these cookies during one of the two Booze theme months. These were January 2021 and January 2022, where I had recipes for cookies that included alcohol. Why these months? Do you not remember the complete shitshows 2020 and 2021? Especially in healthcare?

I digress. And I’ve already written about covid this week.

The cookie for this week has ingredients that I don’t normally use, Bailey’s Irish Cream and espresso powder. There is a good coffee flavor to it.

I have been baking exclusively for CTIAT in my lower oven. This isn’t ideal because of the time that it takes to pre-heat, or the energy used running it. I am going to give the top oven a good cleaning and see if that improves the evenness of the baking.

Bailey’s Irish Cream Chocolate Chip Cookies

1 c butter, room temperature

1 c brown sugar

1/2 c sugar

3-4 tbsp Bailey’s Irish Cream, more if desired

2 tsp vanilla

2 eggs

2 1/2 c flour

2 tsp baking soda (I’ve been using more these days)

1 tsp salt

1 tbsp cinnamon

1 tbsp espresso powder

2 c chocolate chips

Combine all the ingredients, and bake in a 375 degree oven 10-12 minutes

Oops, I forgot to finish the sharps.

The most important sharp of all.

The entire reason there can be surgery at the basic level.

The blade.

AKA the scalpel. AKA the knife blade. AKA the sharp thingy.

The thing that makes the incision.

There are many types of blades. The most common are the numbered blades. Each number corresponds to the shape of the blade. The most common in the surgeries that I do are the #10 and the #15. The #10 is a fatter blade that is used to make big incisions, such as over a joint, or into the abdomen. The #15 is a skinnier blade that is used to make incisions that don’t need to go as deep, such as for laparoscopic surgeries, or lipoma removal.

There are many other blade #s. A #11 blade is used for arthroscopic surgery. It is sharply pointed. A #22 blade is a bigger blade but shaped like a 10. I’ve seen them used for autopsies, useful because it can cut through thicker tissues I’ve never used a #12 but it has been in every operating room I’ve worked at, it is shaped a bit like a scythe with a curved tip. A quick search reveals that it is used for some nasal surgeries or also to open an artery.

And then there are the specialty blades. Besides the ones that are used to cut bone and there are also lots of those, there are beaver blades. These have rounded tips. These do not fit on the usual knife handles that are used for the numbered blades. These are good for delicate tissue surgery where precision is paramount. I’ve used these most often on hand surgeries, and some foot and ankle surgeries.

Blades come separately from the handle. This is for a variety of reasons but the most important reason is to not harm the sterile processing tech who will be reassembling the tray. And, if you ask surgeons, it is so that they can always have a fresh, sharp blade. Depending on the surgeon and the tissue that they are cutting through and the preciseness of the surgery, the number of blades open on the field can be upwards of 20.

There are disposable blades/handle combos. These are used when the regular blades are on backorder, or are used in the ER, or in the field. In the field is outside of the hospital.

In my experience, there are four kinds of knife handles. These are countable on an open case. And is shaped to accept the blade of surgeon’s choice. Handles can also be different. Some only are used for a certain numbered blade, and some can be used with more than 1 blade number.

This is one of the things that makes the OR so challenging. Not only do you have to know what each instrument is called and what surgeries it is used for, but you also have to know about the blade numbers and the surgical needles. And some surgeons expect you to remember all of their minutiae as well.

Of course they do.

I know, I know. I just posted about covid round-up last Monday.

And I had known this was going to happen I would not have posted last Monday.

What happened?

The Johns Hopkins University covid dashboard stopped collecting and updating. As of March 10, 2023, at 0821.

Moment of silence please.

JHU had announced that they were ceasing updating the covid map several weeks ago.

This is where I have gone to get factual numbers and information about infection rates and death. Both the US and worldwide. And a drill down to North Carolina if I desired.

I guess I have to find a new repository of covid data. The JHU website hyperlinks to the World Health Organization (WHO). But the data isn’t presented visually, and it takes several clicks to get through to a dashboard. Of course, there is a discrepancy between the two dashboards, even allowing for the differences in time and accrual techniques. Same for the CDC.

As of March 10, 2023, at 0821, the US covid death total was 1,123,836. And globally, the death total was 6,881,955.

And more every day. 900-1000 per day. Worldwide. And as previously discussed about 1000 per week here. And the hospital I work still has not dropped to zero.

The shutting down of the JHU dashboard data collection is to be expected from a country who wants to negate the changes and challenges of the last three years. Even if they continue.

As long as it does not impact them.

I find the lack of empathy on the behalf of the US to be alarming.

But not surprising.