The post-it reads “What happens if there is an emergency outside of their experience/script?”

How to be a nurse is taught by examples of the usual. A cause and effect story. If the patient has pain, nurse administers pain medicine and patient’s pain diminishes. If the call bell has gone off, the nurse answers the call bell and helps the patient to the bathroom. If the oxygen saturation upon taking the vital signs, the nurse increases the oxygen and the O2 goes up.

Event, response to the event, event decreases or goes away.

Some nurse go their entire careers this way. And they always have the proper response to the event.

But what if the event is outside of their knowledge? Outside of their script?

How do they cope then? (hint: the answer is not always notify the provider)

Precptors, and mentors, and schools need to teach nurses to expect the unexpected.

AND

How to react appropriately to a situation outside of their knowledge or their script.

Because, after 22 years in this business, I know that normal is not expected. And we best serve the patients by being flexible enough in the mind to react to all events. No matter how out of our knowledge it may be.

To go off script is to be able to improvise solutions on the fly, outside of the expected trajectory of events.

I bet you didn’t know that nurses were so adept at improv.

On no shift is this more evident than the shift where the support staff and management involvement is limited. I’m looking at you, evening and night shifts.

The news dropped on Wednesday that some nursing schools in Florida were selling fake diplomas for upwards of $15,000 apiece. Two nurses I’ve worked with and respect sent me the articles. And I read more on the subject, cross-confirming like you should.

I’ll just let that sit there a moment.

(silence)

I hope that everyone is as outraged as I am.

I hope that all nurses are as outraged as I am.

This is despicable.

And the perpetrators of this scheme should be charged and convicted at the highest level.

The public has tremendous trust in nurses. And now some people out for a quick buck in Florida have decided to shit upon that.

Apparently, the name the investigators gave the investigation was Operation Nightingale.

This goes far beyond the college admissions scandal that caused so many people to be outraged just a few years ago.

The people who bought their nursing school diplomas then sat for the NCLEX. And some even received their RNs.

It is a thing of great fun right now, joking about checking nurses from South Florida. Jokes galore.

But we have to remember that the real victims here are the patients.

Who deserve nurses who have actually been to college to learn to care for them.

I can hear people now if they passed the NCLEX they must know something.

Yes.

They know how to pass a test.

They know how to get around the rules.

Did they pass? Really?

And how do we know?

No Cookie Thursday is a Thing this week.

I worked until 0700 and the White Whiskery Wonder known as Dot woke me up at 1020.

I mean, cool, I made my 1045 meeting.

But I had already informed the OR that there would be no cookies today.

Because in the past couple of weeks, I’ve been writing about kindness in Dispatches from the Evening Shift. The first post was about being kind to the patient who is scared. The second post was about being kind to yourself. Another post was about being kind to the patient who is going to be in the hospital long term (meaning more than a couple of days, this can be because of IV antibiotics, or chemo, or not quite recovered enough to go home) and who just wanted to stretch their legs a bit.

Today’s post will be a further exploration of practicing kindness to yourself by the creation of boundaries. Before, I would absolutely have slept only a few hours, gotten up, made cookies, brought the cookies to the hospital, and returned home to nap. Or slept a few hours and gotten up to buy cookies and bring them in.

No matter how close you live to the hospital this is a bit unhealthy.

Especially for a thing you created and do 99% of the baking.

As I was leaving this morning, I told everyone that Cookie Thursday is a Thing needed to sleep. And there would no cookies.

Could I have made cookies when I got up? And brought them to the hospital? Yes, thanks to Dot.

But that would have been a terrible lesson for me. Instead of setting the boundary I had already created and sticking to it.

No Cookie is a Thing today.

Setting and keeping boundaries can be healthy too.

And a very hard lesson for a nurse to learn. You see, we are used to doing all the tasks, and caring for everyone else.

I will make the Leftovers recipe next week. Because I kind of already spilled the beans on what I was planning.

Anticipation whets the appetite sometimes.

Did I whiff and forget I had a meeting at 1400?/ Thereby missing it? Yep.

Also did I rudely wake up Dot this afternoon during her nap by wedging my freezing feet under her warmth when she was napping on top of the covers when I got under the covers to take a nap?

Absolutely.

This happens.

A patient decides not to go through the entire rigamarole of leaving AMA.

Sometimes it is a confused patient who slips away unnoticed.

Sometimes they are just in another department, getting a test, or an X-Ray, or a treatment. The Epic EHR that the hospital I work for uses has a system in place that shows where the patient is in real-time. But sometimes this is buggy and places can’t show where the patient is. But they try.

And sometimes there is an alert that goes over on the PA, explaining what the patient looks like, and what they were wearing at last sight.

Sometimes it is a room-by-room search. Because you know that the computer system just may not be capturing their location.

Depending on the patient’s needs and condition this can escalate to a full-blown, all-hands-on-deck search. Maybe they are late for a test, or maybe they need their meds.

Sometimes a patient who has been weeks in the hospital and is finally feeling better just wants to stretch their legs. Maybe see the hospital a little. Maybe they want a snack from the cafeteria that is different than that on offer for their lunch. Maybe they have a hankering for Frito chips and they know that the vending machine in the basement has it.

It is best for the patient to explain that they are going for a walk. Of course, depending on who they tell, the message is not passed on.

I happened upon such a patient. They had done everything right, informed someone of their destination, not gotten something they shouldn’t have on their diet, stayed plugged into their IV, took the IV pump with them. They did it all.

And were still scolded like a child who was late for dinner.

This was not the best reaction from the nurse. The patient is an adult, and had informed someone where they were going, and was only gone a half an hour.

It turns out they were only looking for a phone charger as the one they had with them broke. And the promised replacement never appeared and the phone was nearly dead.

And the nurse reacted in exasperation.

Stop.

Think about what is going on from the patient’s point of view.

And stop scolding an adult like a child, threatening to withhold a treat after dinner.

And maybe follow up when there is a problem and a promised solution.

The confused patient who slipped away unnoticed? That was more problematic than an adult looking to solve a very real problem.

Thankfully the confused adult happens very rarely.

But don’t get mad at someone who was seeking an answer to their problem. And maybe tell them about the charging stations in every waiting room.

Zoom is a good thing. It allowed us to keep in touch with far-flung family members during the pandemic. It allowed for the rapid emergence of tele health. It allowed for children to keep up in school. It allowed for me to finish my MSN. It even started before that. My hospital system went to it in early 2019, shunning, oh, what was it?

Hold on, it will come to me.

Skype! That was it. A precursor to Zoom still in use.

Zoom, Skype, all of the platforms have this in common.

Crickets.

Dead air.

No one saying ANYTHING. Just a dog barking.

Maybe.

No one wants to say anything. In case they are wrong.

And the silence hangs there.

Any minute now.

I’ve forgotten the question.

Getting uncomfortable now, isnt it?

I’ve told my professors that if they ask a question to a group and there is silence, I will answer it.

I can’t stand the anticipatory silence

I mean, it’s just there waiting.

Four seconds is all it takes for silence to become awkward.

I know. I’ve broken enough silences.

Did you know that?

The post-it reads “Don’t worry, healthcare workers do not judge your body. We judge how difficult your particular body habitual will make our job.”

If I had a nickel for every time someone apologized for not shaving ‘down there’, I would be rich. Not retired, just rich.

If I had a dollar for every time someone asked for us to do liposuction while they are under anesthesia, I’d be rich.

I am not sure what it says about our society that patients who are ill, and coming for emergent surgery are so hung up on their appearances. And what we can do for that, or that we would be judging them for that.

Some patients, especially when sent over from the office to be admitted, go HOME. And shower, and change, and shave. Or let the dog out, or clean the kitchen, bent over in agony, in case their friends and family who are coming to take care of the children, or the dogs, or the cats judge them because a plate is left out or the coffee maker is not set-up for them. This is because they don’t want to be judged. Or they pack a bag, anticipating a hospital stay when most people go home from surgery.

Often this delays their care.

And delays other surgeries.

Not our job to be judges at a beauty contest. Our job is to take care of you.

We see scores of bodies weekly and do not judge any of them.

Please don’t delay your own care to go home and run around making sure that the people who are coming to take care of you are not inconvenienced.

Just come on in!

The rest will take care of itself.

During my very, very, very long first day of in-person classes, the entire class cohort went out to lunch during the break between morning and afternoon classes. It was long because I had worked all night the night before and slept in the car while my husband drove me the 90 minutes to school. Made for a very long day. I should have taken a nap during the lunch break in my car, but I did not.

I felt it was important to go to lunch with the group, to be more open to learning more about these people. We are going to be together for our major classes after all. Even if some of us are on three-year tracks, and others on the 4-year track, our foundation classes will be the same.

During lunch, which was yummy, (the group had chosen a sushi restaurant, and I went along, knowing there would be something for me to eat that was not sushi; there was a tofu bento box), all the phones came out and we exchanged numbers. So we could commiserate and keep each other up to date with tips. and cheerleading as necessary.

Note to self, there is always a group mom. Yeah, we are all in our 30s, 40s, and 50s, but there will always be someone who is watching out for us. Bless her.

The group text has been remarkably useful. It has only been a week and there have been collaboration texts, memes, and confabbing on the sometimes remarkably vague instructions. And a picture of my cat sleeping on the distraction pillow I put on the dining room table.

To my surprise, the text stream has not devolved into more basic elementary or high school taunts and gatekeeping. I guess we all had to grow up sometime. And, really, is a group of nurses really that kind of people?

Strike that. I’ll rephrase, is a group of nurses who are actively educating themselves for the good of all nurses really that kind of people? No, no they are not. I have never felt as embraced by a class, or an institution of higher learning before. It is amazing. A bit bewildering, but amazing.

Today the text stream was about reading for next week’s theory class and how one article ties into the last set of articles in our philosophy class. Well played, curriculum, well played.

I already know my role in the texts. I will send a funny meme, no more than once a week, as a stress reliever. I can have restraint sometimes. And I only mentioned this blog once, to one member in her personal text. Again, restraint.

Leftovers month continues. And this week is utilizing the leftover pie crust in the fridge from the holidays.

Crust cookies are one of those things that are popular and will disappear quickly.

You take extra pie crust, spread on melted butter, and top with cinnamon sugar. Bake at 350 degrees Fahrenheit until golden brown and cool before busting the crust into bite-sized pieces.

I did give in to the incessant holiday ads for a spice company and bought the cinnamon sugar topping, even though it is ridiculously easy to make.

This is one of those cookies that are kind of brainless and look oh so very simple to make. And they are. But there is the time involved in rolling out, topping, and baking.

Although this is one of the easiest makes for CTIAT, it still took me 2 and a half hours to bake all three cookie sheets full, cool, and break up.

I used the time wisely by reading a couple of the articles for tomorrow’s class.

Look at me, multi-tasking even while making the cookies!

That was a joke.

In reality, my mid-morning meeting cancelled.

That’s okay, there will be another meeting tomorrow. Or, rather, class all day tomorrow.

Magnet designation. This means that the hospital nurses are the best. It holds the hospitals that have it to a high bar of excellence. The majority of the nurses must be BSN prepared, if not higher. The majority of the nurses must be certified.

There are several more hoops that nurses and administration must jump through. Patient safety standards and incidence are held to the lens of the national numbers. And the goal is that the hospital’s numbers are lower than the national incidence of things like falls, or baby drops, of catheter-associated urinary tract infection (CAUTI), or central line-associated bloodstream infection (CLABSI) from a special IV.

Nursing research is to be done on behalf of the hospital. Often these are from projects that the nurses who are going for advanced degrees participate in.

It is a mark of honor that the hospital strives for. Shared governance councils encourage their member units to participate in all of it as well.

Magnet wants the hospitals to be the best they can be.

Nothing wrong with that.

However, changing the rules isn’t very sportsmanlike. The recent rule change that affects my hospital is that each hospital in the system has to be able to stand on its own. And tick all the boxes, including research.

Before, the four hospitals in my area were allowed to apply as a group. This lessened the amount of work that all the hospitals would have to do individually, while still participating and being able to call themselves Magnet certified.

As of two years ago, the rule changed to the one that all hospitals have to stand on their own.

This means that the hospital that I work at will be losing its magnet designation in August.

Bummer.

Because the hospital I work for has no hope of completing all of the magnet hoops to be able to stand on its own. And the corporation would not support us to apply for magnet designation if we could.

I get it. It is Magnet’s program and they can change the rules. And it is expensive to apply.

I did enjoy working for a magnet hospital for the 15 years that the system was given the designation. If I wanted to work at a Magnet hospital, I would have to leave the hospital I work for and go work at one of the hospitals that was allowed to apply for magnet status.

There is a lesser program called Pathways to Excellence.

And penciled into my overfull calendar is a notation to look into it. For the smaller hospitals in the system.

Maybe my hospital can be on the pathway instead.

But the word is getting out, and some nurses are crushed. Perhaps that can be our research project. The impact of losing magnet designation on nurses.

hmmm

This was a phrase I had never heard before and then I read about it in two nurse articles.

Blue Monday refers to saddest Monday of them all, the 2nd Monday of the new year.

Or at least, it is what a British advertising agency wanted you to think. If they could convince you that you were sad after the holidays, maybe they could convince you to book a vacation to somewhere warm. Acknowledgment of a down period in someone’s life to sell them something. Seems like capitalism to me.

But.

They are not wholly wrong, are they?

In the Northern Hemisphere, it is cold, the days, although not as short as they have been just three weeks ago, are dark, it is after Christmas and there seems to be nothing to look forward to. Except for vacation at some time in the future. Maybe. If you can get the time off.

There is something to the letdown after Christmas. The pretty things are put away, there is no more anticipation of fun times. Just a dreary slog to more sunshine. I have seen more X days until the time change and the days getting longer posts this past week.

Depending on where you live, the weather is not cooperating either. It can be gray and overcast, and downright cold. Or, in the case of California, more rain than they’ve seen in years.

It is okay to feel blue after the excitement of Christmas.

It is okay to feel blue at the dreary, seemingly endless cold of this time of year.

It is important to remember that these days will end.

Not to be Pollyanna Puke on everyone but find something that makes you happy and embrace it. Get a mug of tea, a warm throw, and a block of time there aren’t any pressing matters, and give yourself the gift of personal time. There’s a reason that the idea of self-care has taken off in the last decade. You have to take care of yourself.

And for nurses it is doubly important. You have to take care of yourself. Because, if you fall, who is going to take care of the patients?

Some chocolate or other dietary treats. Some wine. A massage. The aforementioned gift of time to yourself.

Distraction. It’s not just for toddlers anymore.

Acknowledge that this may be a difficult time for a lot of people; more difficult than the holidays. And, going back to yesterday’s post-it post, be kind.

Be kind to others, because you don’t know what they are going through.

But, above all else, be kind to yourself.

Because we are all our own worst critic.