That is the only thing on the post-it. “Zoom gremlins”.

This past week, I queued up all the pages I was going to share at a meeting I was leading. All the pages: the agenda, the minutes, the emails that I had received that were bullets on the agenda. ALL of it.

Only to have Zoom fail when I tried to start the meeting. I had to move to a different platform without all the pages I had prepared. There may be something to the gremlins in the machine.

As the world has been shifting more and more to online platforms, I think it is an excellent time to call out the pitfalls of the entire process.

There is the digital divide. Those who have access and those who don’t.

This is a huge hurdle. And one the government is trying to bridge with the new laws from last year. But it is a deep divide.

There is also a generational divide. Both my parents are active and engaged users of technology. But many older adults are unable to be active and present online.

There is the income disparity between those who can access technology and those who can’t because they are just trying to keep their heads above water. And make sure that they and their families are clothed and fed and have a roof over their head.

The earthquakes that shook Turkey and Syria this past week strengthen the argument. Lives, homes, and stuff were wiped out when the earth trembled. And now millions of people may be on the other side of the digital divide than they were 8 days ago.

All of it can be taken away in a breathless moment between then and now.

And those of us on the have it side of the divide must help those who do not have the technology, the Wi-fi, the electronics that make this new world that has been created through the use of the stuff that we have to engage with it.

After all, how would we cope if it all went away? In an instant.

Also why I don’t care any longer for superhero movies where the end battle destroys an entire city.

The professors give you their email addresses for a purpose.

And that is to reach out to them if you have any questions. Or to tell them that you are not going to be in class.

This is a hard one for me.

Our theory professor and our philosophy professor last semester talked about speaking to my classmates, either via email or in person, frequently.

This may be a generational thing. Probably not, as I think we are all Gen X or Millenial in the cohort. This may be a function of how we were raised, or what other schools have instilled in us. The only time I went to an instructor in my ADN program was when I was called to the office to explain my stellar score in the computer test that was supposed to tell us our likely NCLEX results. Not the NCLEX, a preparatory pre-test. And the teacher wanted to know why I scored the highest in the class. Had I cheated?

Well.

Of course not. But this conversation left me convinced that I was being watched, and judged at all times.

Probably explains a lot about my BSN program and how when I was struggling with Econ and Statistics in the same quarter I didn’t reach out. I didn’t because I didn’t want to be judged for taking two very hard classes in the same quarter. Wrecked my 4.0, that’s for sure.

And Generation X, who was largely left to our own devices, does not like judgment. Or being watched. Even if it will ultimately help us.

And actively asking for help?

No, thank you.

But I am learning the higher I go in school, that it is important, and expected for us to reach out if we are having issues. On anything.

This is completely out of my experience.

There is nothing wrong with asking for help.

There is a lot wrong when recognizing that you need help from the professor and struggling in silence.

I hope when it is my turn to be the professor that I remember these growing pains and can recognize and help struggling students.

After all, my job will be to guide them on the path of graduation, of helping them be the best nurse they can be.

Maybe another mantra (you know how I love those).

Teachers are there to help us succeed. Nothing is gained by letting us fail.

Okay, I changed my mind. This is definitely generational. Those of us who grew up and went to school in the 1980s need help with this.

It can start with an email. And the willingness to ask for help.

Eggceptional cookie month continues. This week I made eggless oatmeal raisin cookies. The recipe replaced the egg with 1/3 cup of milk.

But, of course, that isn’t the whole story.

For this recipe, I used my hand mixer. And it is a good thing too. Because this dough is THICK. It’s bad when you can smell the motor in the mixer, and hear it struggling.

There are 2 c flour, 2 c sugar, 3 c of oatmeal to 3/4 c butter and a 1/3 cup of milk. That is a 7 cup to just over 1 c of liquids.

Yeah.

Not enough liquids to solids ratio.

I doubled the milk and it went much smoother.

Yes, that is a pun.

My mixer still struggled, though. After all, it is as old as my marriage. Got the job done.

And today is the in-person portion of the hospital’s annual mandatory education.

There are about 3 hours of preliminary computer-based learning before that.

And when I went to sign up, there were ZERO spots left for today.

The thing is, today is the only day I can attend. The other day is tomorrow and I have classes in another town all day. Can’t miss class.

And Monday is a possibility, but I have research assisting all day.

I have to crash to in-person education.

It is the only thing to do.

Besides go to a different hospital for the same content.

I don’t have time for that. I have real-life education to do. And I’ve worked for the corporation for 17 years, not much has changed.

Continuing on to the next item in a “soft” goods count, needles.

Needles come in many different iterations.

There are sharp needles.

There are even dull needles that we use to access and filter the fluid in a vial that you break open. Yes, those exist, always take precautions. The glass shards can end up in the medication and then injected.

There are curved needles.

There are straight needles.

There are hollow needles; those are called hypodermics and a way to inject medications into the human body.

There are port access needles that are used to access surgical ports. There are different reasons that patients have these; sometimes chemo related, sometimes accessed for surgery because there are no usable veins. If they are on the back table because the port is put in during surgery, it is countable.

There are angiocaths that are used to start IVs. Sometimes we use the soft IV plastic, and not the sharp needle, especially in irrigating in a delicate area. Yes, they are on the field and are countable. Both parts must be counted, the sharp pointy part and the soft plastic.

In short, if it is on the field, it is counted.

Especially if it is sharp and can hurt patients, or people who get randomly stuck because they are bagging the trash and cleaning the room and someone left a needle on a hypo.

Don’t do that.

In the OR, our driving force is safety.

Safety for the patients.

Safety for the surgeons.

Safety for the OR staff.

Safety for the cleaners.

Police your sharps (that means keep an eye on them and dispose in a puncture-proof container made for them).

And there is the needle book that is used to store the used needles in, on the back table after they are used. So they can be counted. But that is another lesson. Stay with the class now.

When I am calling for a patient, the first thing I ask is if they have a family member at bedside. There are a variety of reasons for this: comfort for the patient, the person that the surgeon needs to speak to immediately after surgery is present, if the patient is confused, or has had medication that means they can’t sign their own consent, well the person at bedside most likely can.

Of all the reasons, the last is the most important.

And also, if the surgery is a dire one, they won’t be separated from their loved one until we are ready to head back. And if the surgery is dire, they probably can’t sign their own consent.

Have I called for a pause when the loved one arrives late to the hospital and fetched them so they could say goodbye to the patient.

You bet I have.

And I’d do it again.

Hell, I have done it again.

Does this delay the inevitable in the case?

No.

Does this delay the case?

No.

Does it give the patient who is about to undergo emergent surgery a measure of comfort? Absolutely.

And I will continue to call for a very slight delay so that the loved ones can see their patient before they head back for emergent surgery. Or I will hold the phone up to their ear so the patient can hear their loved one.

I do not regret it. One bit.

The gown card reads “holding up a mirror to the actions of nursing will allow open transparency in healthcare. We have to do it ourselves, no one else is doing it for us.”

No idea what prompted that gown card.

But it holds true every day.

The nursing profession must continuously put a mirror on the actions of the profession. This will lead to openness and honesty in healthcare. And this can only be a good thing and lead to safer patient care.

Do we all want the same things? Safe patients, safe employees?

Yes. Well, most of us.

But it is not ingrained in some of the healthcare workers that this is a job, yes. But their actions lead to more than a paycheck. For too many healthcare workers, their job is only to get paid. No more, no less.

It begs the question, has something been lost in healthcare today?

If we don’t ask the hard questions now and show these paycheck-only healthcare workers that nursing is so much more than the paycheck, what does nursing become in the future?

Everyone who has ever been in the healthcare system, as a nurse, as a worker, as a patient, should be concerned about this slide.

I know, I know it is February and I had this planned for LAST Saturday and then the pay for diplomas news came out and Operating Nightingale. Obviously, I had to talk about that.

Anyway, it makes more sense to do the monthly report of my personal school journey after the month has ended. Sue me.

The Spring semester has started! In fact, this is the fourth week, well, we are one day into the fourth week. And statistics is still continuing. Think happy thoughts for me.

The new PhD class I have this month is Theory Analysis in Nursing. I had to do a theory class for my MSN but this one is completely different. Then I had to choose a theorist to write be part of the scaffold of my final project. Now, we are taken all way back to what is theory, the metaparadigm, and how nursing knowledge is constructed. Heavy stuff. My brain feels very full after this class; to say nothing of the deep reading for this class. As expected this is a very paper-heavy class. That’s okay. I like writing papers.

And I know I have been calling it a cohort class. That is incorrect. The proper term is cognate. These are graduate level classes, meant to be taken in a field that I find interesting and that I might be able to use in my dissertation. I took a financing longevity class last semester. Not sure how I am going to be using that in my dissertation but I learned a lot.

The cognate class for this semester that I choose is Informatics in Healthcare. The OR is so very technical and information-driven. I hope that the work I do with Epic and continue to do on the advisory committee will help with this class. And this is a full semester course. We’ve already had a quiz and a discussion post. And a group project to go. Again, think happy thoughts for me.

And then panic-inducing class- Statistical Applications for Nursing Research II. Math just does my head in, you know. Project in this class as well. And the first homework assignment is in. You’d think I would have good recall since the last class was only 8 weeks finished. You’d be wrong! If you don’t mind me, I am going to be reviewing ALL of the first class lectures and my notes for the rest of the week. And working on my project. And doing statistics crunching using SPSS. AND preparing for the presentation of my project. And doing more homework.

Oh, boy! It’ll be okay.

On the scholarship front, I submitted my grades from last semester and a copy of the tuition statement to the hospital for my tuition reimbursement. Hopefully, I’ll get that next paycheck. I also submitted the same grades and tuition statement to AORN for the scholarship I had from them. I got an email that I should expect a check in two weeks. All of that money will go into a savings account in case I cannot teach after graduation and I have to pay back the grant money. Fun fact, I thought I had a 3.0 GPA, but apparently, I had a 3.4 GPA. I’m not complaining.

New semester, new opportunities for scholarships. I submitted another application for another AORN scholarship. I also submitted another scholarship application for the White Rose scholarship which is for the healthcare market that I work in. If I win the scholarships, that would be lovely. The money would still go into the saving account with the rest.

The first semester of the month is always busy. It doesn’t help that the call job has had some very long nights this last couple of weeks.

That’s the round-up for the first month of the new semester. Busy, busy time. But only one class is planned for summer. And it’s ONLINE. Score.

Mantra time- the only way out is through

This month on Cookie Thursday is a Thing I was going to first do International and then Leftovers take 2. And then I changed my mind, again, and declared this month’s theme to be Eggceptional.

Remember last May and June when the theme was Inflation Baking for two months in a row? Yeah, it is kind of like that.

Mostly as an acknowledgement of the price of eggs has more than doubled here in the US, but partly because of a recipe I found where one of the eggs and half of the butter was replaced in a chocolate chip cookie recipe with yogurt.

Y’all know that I panicked a bit last year when the price of butter doubled. I go through a LOT of butter. And now my fridge and freezer have 16 pounds of butter. Bought on BOGO and on deep discount. I’m not mad at that.

And I usually only use eggs for Cookie Thursday is a Thing.

I will get to the chocolate chip cookies with yogurt. But this week I am going to do a yogurt cake, no butter at all, 3 eggs but that’s okay as I anticipate using fewer eggs than normal for the entire month.

Also, a bit of Leftovers because this is Greek yogurt in my fridge from December.

Lots of more research to do. I wonder if I can use mayonnaise as a butter AND egg substitute. I have seen a chocolate cake recipe with that.

The cake was moist and resisted baking in the center. If I do this again, I would add a citrus note, maybe lemon. And some zest would not steer the cake wrong.

Stay tuned for more eggceptional cookies. Or cakes. Or bakes.

Some of the weeks might not even have eggs in them, focusing more on the Leftovers theme.

Happy Birthday to you! Happy Birthday to you! Happy Birthday, dear covid. Happy Birthday to you!

It’s your third birthday, covid! How do you want to celebrate?

If you could celebrate gathering your things, you know, your variants, and get the hell out of town, that would be great! Thanks!

You have WAY, WAY, WAY, WAY, WAY overstayed your welcome.

There, there. I know some people don’t even think you exist. Who think they know more than scientists who have been studying infectious diseases like you for years. What was that? Oh, they read an article. That their friend who also doesn’t believe in you sent to them. Along with a little computer virus, you scamp.

The CDC believes you exist. In fact, it was 3 years ago tomorrow that they declared you a public health emergency.

Please go away, and take your little dog, M-Pox with you.

Yes, I am well aware that those viruses are completely different and don’t even belong to the same classification. Yes, but have you heard of artistic license?

And the US is going to drop end the covid emergency on May 11.

Only one million, one hundred thousand, eight hundred seventy-two Americans have died. Not that the number we are have been getting for months is complete, since states started changing their report dates.

Even the WHO said today that you remain a threat but that the world is at an inflection point.

What is that?

You know, you can either keep going away. Or get super bad again. I know which one I would choose.

Please leave and don’t let the door hit you in the spike protein on the way out.

New series alert: Counting Basics.

I go on and on and on about counting. I thought I would take this time and this platform to introduce people to what exactly I mean.

No. Not one, two. Buckle my shoe.

That is a nursery rhyme to teach toddlers how to count.

Prior to the start of a surgical case the circulator (that’s me!) and the scrub tech count.

What do we count, you ask?

Well, that depends on the kind of case and how many body cavities will be entered into.

Yes, there are more than one.

Basically, as the odds go up for leaving something behind, the count gets more layers. And by that, I mean more counts.

And the something that could get left behind gets its own category.

At the most very basic, we count sponges and sharps.

This is for every case that has an incision.

Yes. Every case.

No matter what the surgeon or the staff say.

Once upon a time, there was a patient who was coming in to have an incision and irrigation of what was thought to be a localized abscess that had developed after surgery. This was on a forearm, just below the AC, a bit laterally. And the lump that was on the patient’s arm?

A sponge that had been balled up very small, to about the size of a grape, and shoved in for whatever purpose at the time. And then forgotten. And missed on the count. Did the previous surgical team even count? No idea. Oh, they might have documented that they counted.

But did they really?

No way of knowing.

Much of the OR is built around the honor system. If an action is charted, then it had been done. Right?

Right?

There are several types of sponges. These can vary from the very little, the appendix tapes which are skinny enough to go into an appendix incision but long enough to be able to pull them back out again. There are ray-tecs sponges. These are thin sponges that are folded and open up to 4-inch by 18-inch single-ply sponge. They are called ray-tecs because they are x-RAY deTECtable. There is a seam of material that is visible on x-ray. And then there is a large lap sponge at 18 inch x 18 inch. These get their name from the type of surgery they were designed for, the LAParotomy surgery. Or a large incision into an abdomen, the laparotomy incision. They also have an x-ray detectable tail.

This is a run down of the basic sponge that must be counted.