I add the qualifier in Dallas because you never know these days.

Actual assaults on healthcare workers continue.

Remember, there was a spate of them earlier this year. June specifically. At the time there were 6 healthcare workers wounded or killed, and two patients wounded or killed, in less than a week. Remember?

Remember how the hospital tightened its policies around badge usage, and being appropriate with the swipe part of the badge? Remember how some people didn’t even know this had happened? And people were dead.

Remember how hospitals tightened their security? Well, the last one didn’t last too long, but it’s the thought that counts, right?

These killings were on a labor ward. No moms or babies killed. Just the woman recently delivered being assaulted by the purported baby daddy and the nurse jumping in to stop him. With a bullet for her trouble, and the other nurse who tried to intervene also killed.

It was over in an instant.

But the reverberations echo, or should echo, through hospitals.

Hospitals are full of people who are stressed, and sometimes the stressed people have a gun.

I’ve always maintained that nursing is on the front line. Hell, I’ve created and written an entire blog about it.

Do you think we will get anything besides the boilerplate “Employee are our family” rhetoric?

A short-lived furor until it dies down. Pun definitely intended.

How many healthcare workers have to die on the front line?

Are some of the solutions to the tragedy costly? Metal detectors, security wanding of everyone, increased security. Absolutely it is going to cost money. But how do the hospitals stress their purportedly stretched thin budgets?

Or is this going to be just something that happens sometimes?

So sorry the nurse who was part of your actual family died protecting their patient. There was nothing that could have been done about it, it was a fluke. A chance roll of the dice.

Was it, though?

The post-it reads ‘Don’t know and don’t care to know’.

This was brought up by a former coworker of mine. They have years of experience in other hospitals/operating rooms. And I’ve worked with them in other operating rooms and their years in the hospital outnumber my own.

Their bonafides are not in question.

And they are shocked by the lack of curiosity of today’s new nurses and techs. That the newer nurses and techs resemble automatons. Or, to put it more plainly, robots. The case comes to their room, they do the case, end of case they go and sit in the lounge. They are there for the case, and maybe their favorite doctor.

End of list.

Not for the patients who are not their own. Not for the department. Not for the hospital.

There is a lack of intellectual curiosity in hospitals now. It’s been happening for awhile now.

I’ve heard stories about the nurses and techs who are only there for the paycheck, for punching their time clock. And their knowledge and caring for the patients are only while they are on the clock. This is something that is not only happening in the surgical services. I’ve heard about it from other specialties, from the emergency room to Med-Surg to respiratory to the labor ward.

To say that this is not good is to understate the case.

Healthcare workers no longer want to do anything outside of their job duties. Committees? Who wants to do that? But they will be the first to complain when something changes without input by the corporation that they work for.

But we didn’t know, they cry. And they had been asked to be on committees, or taskforces and the like.

This is the dumbing down of nursing.

And it must be stopped.

Do you want the nurse who mentally clocks out when it is time to go to break? Or home?

Or do you want the engaged person who wants to help, even if it is outside their comfort zone and comfort doctors? Who gives ideas, no matter how many times they have been turned down.

The pandemic and the overwhelming patient volume that it has prompted accelerated this problem. But the roots have been there for years.

I can’t make people care about the department, and the hospital.

I wish I could.

I’ve been banging my head against that stone for a long time. The others who and I do not want change without input. That leaders on the C-level (executive suite) don’t know the entire picture, especially what the nurse at the bedside is facing. Input about a change made to keep patients safe is actually doing the opposite.

How do you give input? Join a committee and see.

I’m going to tell you a secret about being an adult learner, back in school long after graduating from high school or college. Are you ready?

Really ready?

Really, really ready?

It is okay to cut yourself some slack.

No, seriously.

Give yourself a break already!

The paper from this class is due in three days!
The midterm from that class is due at the end of the week!
The paper from this other class is due tomorrow!
The homework assignment from class 2 is due in a week!

Deep breath.

In.

Out.

And pause.

It is easy to get caught up in the assignments, and the reading, and the pressure to do it faster.

It is easy to get caught up in laundry, and dusting, and general chores that is life.

It is easy to get caught up in emails, and demands from your boss, and watercooler talk.

Put the three together and you have a maelstrom.

This is your friendly advice to schedule breaks into your week.

Breaks from school.

Breaks from housework.

Breaks from work.

The work will still be waiting for you if you take half a day to just breathe.

I tell my coworkers that doing all the things is good. A recipe for burnout, but good.

I know, pot meet kettle.

I just want people to realize that they can take a break.

And it will be okay.

The break can be 5 minutes to sit in silence.

Just turn off the phones, turn off the lights, turn off the television, turn off the music.

And sit in the silence.

Just a little restful pause in your busy, busy school/work/ life combo you’ve got going on.

Just be.

Spooky Cookie month continues on Cookie Thursday is a Thing. Today’s make is bloody bandages.

These are operating room folks, and it is hard to gross them out.

No ick matter here!

Bloody Bandages

Sugar wafer cookies, the ones with the cream filling between thin crispy wafers.

white chocolate Candiquik. This is meltable chocolate that comes in a variety of flavors and colors and here in the United States it goes by that unfortunately spelled name, or some craft stores carry it for candy making. It melts fast in the microwave and smoothly.

toppings- for effect I used a combination of green sprinkles, and freeze-dried raspberries

I had to experiment a bit with technique. The first tray I laid the wafers out, melted the chocolate, tried to make a square of chocolate with a spoon, put the toppings on

This works but it gets messy as the chocolate begins to dry.

The second tray I had the wafer cookies in a stack, picked them up, spread the chocolate using a knife, added toppings. This worked much better and I was able to get a more uniform square of chocolate

What makes these bloody bandages is the rectangular shape of the wafer cookies, and the hopefully white square of chocolate. And the raspberry “blood”.

On some I added green sprinkles to simulate infection.

I think they are adorable, and they were very fast to make. I barely got through NPR morning edition podcast, which is about 15 minutes long. Seriously one of the fastest makes yet.

Silly post incoming.

Dot is our 9 year old cat.

She is a brat.

And deeply bonded to me.

Oh, so deeply.

Her favorite thing to do when she is not sleeping is to sit in touching distance.

And STARE.

I’m not sure what she thinks I am going to do.

When I drive up from a call case, not matter the time, her little head is in the window.

And when I start up the stairs she meows at me. I’m not sure what she’s saying, she’s still inside, and I can’t hear her. And she’s a cat. Probably something along the lines of “where have you been, lady!”

I unlock the door and head inside. And she meows at me, and does that cute little ankle rub that all cats do. She accompanies while I lock down the house for the night and turn off the lights. She heads to the bathroom at the same time when I am brushing my teeth and getting ready for bed. And drinks water out of her cup that lives in the bathtub. The cup used to live on the counter but she kept knocking it over when they drank it down to half full. Because she’s a brat.

Sometimes she sleeps with us, most of the time she sleeps in the office distraction chair.

She does this no matter what time I get home: 2300, 0000, 0200, 0400, 0600, 0800.

But she started doing something obnoxious since I’ve worked the call job. I’m not sure if it is because I am home more, or what.

No matter what time I head to bed, even if it is after morning feeding time, she has to wake me up by 1100. Usually by applying her whiskers to my face in whisker torture.

Every damn morning.

As soon as she sees that I am awake, she curls up in a ball next to me and goes to sleep.

Why 1100?

Don’t know.

And she loves Zoom, especially the camera. I have to warn members of the zoom meeting I am on that they may see a white cat and her name is Dot and she has zero zoom chill.

Right now she is sitting at the top of the stairs, waiting for me to go downstairs.

Again, I have no idea why.

I mention it because she did it again this morning, even after I got to bed at 0500. And now I am tired.

I certainly hope that everyone knows about the neo-natal nurse in the UK who is on trial for killing babies. She has been accused of murder of 7 babies from 2015-2016, and the attempted murder of 10 more. Caught in the act of one of the attempteds she tried to backpedal, to blame the deterioration on being something that was actively happening.

But, Kate, why is this so different than the Radonda Vaught case in Tennessee. Because that death happened as a swiss cheese flaw in the system. The medication that was administered should not have been at that particular pyxis, available to be given in an unmonitored place in the hospital.

But this nurse. She has been accused of willfully causing the death of several babies who should have been safe in her care. She would inject air into IV lines, or poison them with insulin, which is very hard to detect by autopsy. She was the only nurse who had been present on the unit for all the deaths and codes. Yes, it is conceivable that someone could have snuck in, but unlikely. The NICU is an open ward, with little bays for the isolettes, warming beds, and cribs.

Please read up on the case, it is chilling.

But that is not what I wanted to talk about.

I want to talk about the mirror that must be held up to the profession. And why it can be a good thing.

Can it be annoying to be the ant under the spyglass? Yes.

Can it go to far, and lead to accusations that are not true? Yes.

We have to rise above that. These are vulnerable people. They are the ones in hospitals, and they are in the healthcare worker’s care. We are observed, our charting is minutely gone over for errors. All of this is to keep the patients safe.

It can be good when a mirror is held up, because someone should be watching. These are people’s lives that depend on us. We need to remember that.

And to not kill the patients.

No, not even for whatever twisted satisfaction it gives you, just don’t

The post-it reads ‘choose your vaults, AKA choose who you disclose to carefully’.

This is referring to the people in the department that lives to gossip and the one who loves to trot over to management and tattle. These might be the same people, or they may not be.

The importance is to know which is which.

The information disclosed may be as simple as ‘oops, I accidentally wasted a supply’ to ‘did you know teammate X did this or that’. No detail is too salacious for this group. They may even share their experiences with a similar situation.

With one group you might get commiseration/shock at the situation. And the discussion ends there.

With the other group you might get commiseration/shock at the situation, and someone who b-lines to the management to tell.

The operating room is hard; we work fast and are told to work faster, lives are on the line everyday in the rooms. Sometimes, people just want to bitch. They don’t intend to complain to management, or even to the charge nurse, they just want to get their rant off their chest. Often, they feel better after and can go blithely on their way. In this instance the person who got the information is now the keeper of the information. And the receiver can either simply acknowledge that they now have information and keep it to themselves, like a true vault, or share it with others.

It is vitally important to know who is the proper vault in the department. And who will share confidences with EVERYONE because it is just something to talk about. Or they feel it gets them brownie points with management.

I cannot stress this enough, know which is which. Because even if vault b (the one who cannot keep details to themselves) only discusses your information, no matter how small, with other members of the team and not management, they have proven themselves unworthy of more than basic keeping of information.

You want a true vault, the one in the department who keeps confidences and details to themselves. And does not share with anyone without your express permission.

Except when there is danger to the ranter to the patients, or their family, or the department/hospital. Or except when there is danger from the ranter to the patients, or their family or the department/hospital. All bets are off then.

It’s a fine line.

I feel attacked.

No, not really.

Yesterday at school they had a seminar on preparing for the exam that is to be done prior to starting a dissertation. And how to avoid procrastination.

My nearest and dearest will tell you I am a procrastinator. I’ve been one for a long time. And no matter the strategies I’ve learned about, and programs I’ve tried to self-teach to not be a procrastinator, it has been to no avail.

To do lists.

Masterfully crafted schedules.

Pomodoro timer technique, where every hour is chopped up in to 25-minute segments. And you are supposed to go on to something different after the segment. Until the work is all done. This works okay.

Minutely written howler lists that I write myself. A howler is a yelling device that Harry Potter utilizes to have the parents long distance yell at their kids. I use these as a way to prioritize what needs to be done.

Bupkis.

No idea why.

No idea how to train myself NOT to be a procrastinator.

Not much helps.

For example, this week I had a 1-page paper due in the Financial Longevity class I picked up last week, a 45-minute philosopher presentation that I had to give on Friday that needed a PowerPoint made to help deliver the remarks, and a statistics midterm that is due on Sunday.

I spent the week doing the reading for the philosopher presentation and witing the pilosopher script and PowerPoint. And the reading for my new class, including an outline for the paper due yesterday. And the studying for my statistics midterm. And blog writing, and outlining the major papers I have beginning in a month. And the philosophy midterm just dropped, a 20-page paper on four different philosophers and what was learned in class due next Sunday.

I am learning something and working every day.

So why do I feel like I am not doing enough?

And writing it down shows me that I am not behind. It just feels like I am.

As I joked to one of the PhD professors living through a pandemic, well, working through a pandemic on the front lines wrecked my brain. After all, when every day is do or die at the hospital, what is the point of a 20-page paper?

Nevertheless, I soldier on. Even if my brain feels sluggish.

I wonder how much of that is the pandemic fatigue that all nurses I know have, how much is recovering workaholic fatigue, and how much is true procrastination.

Hmm. Must ponder that.

There is a Gaelic saying that I printed up for my desk translated into English it means ‘Don’t Lose Heart’. And I’ve offered a copy to those in my cohort. As I feel we are all in the same boat.

There is a post-it on my laptop in my dining room desk that I wrote the same saying on. Right next to the post-it with my favorite reminder from Elyse Meyers, “I Just Do Things Scared.”

To go along with this month’s theme of Spooky cookies, I chose to make Candy Corn Cookies. I make these every year. And every year, people are surprised by how good they taste.

Because candy corn undergoes an amazing transformation when heat is applied. It turns to caramel.

Transfiguration through application of heat sounds familiar to anyone in healthcare.

We are under a tremendous amount of pressure from all sides- covid, flu barreling down on us, the increase of the RSV or respiratory syncytial virus. This is a virus of the respiratory track and mostly affects children.

All of that is still dangerous though. Wear a mask, wash your hands.

It is the sudden increase in pressure that creates the heat for healthcare workers.

I mean, the hits do keep coming. All of the above respiratory viruses, over full hospitals, chock full and holding emergency rooms, increase in the OR schedule and need for more and more from the OR.

And since we are humans living in this society there are other pressures as well, including inflation.

It is no wonder that there is a nursing shortage, and an overall healthcare shortage, and a teacher shortage, and nursing school instructor shortage.

The list goes on.

Like candy corn, we have no choice but to transform.

There is a flow of admissions to the hospital. In, get better, or not, and leave.

Hospitals in winter are usually full. And less so in the summer.

Same with the operating room schedule. Here in North Carolina, most people have an insurance deductible to meet before insurance really kicks in. Once the deductible and out of pocket max has been reached, in theory the rest of hospitalizations, and surgeries, are not on the insured’s bill, but the insurer’s bill. In theory.

This means that many, many people have reached or will reach their out of pocket max toward the end of the year. And can suddenly afford their surgery. This stresses the surgery schedule.

Happens every year. Like a tide.

Of course, the tide doesn’t drop until March. I have a theory for that too. Getting the out of pocket max over with in the first of the year means that the rest of the year will be paid for. This is what I would do.

Some, but not all, admitted patients are surgery patients.

Even the non-surgical patients typically follow a pattern of admission. Up in winter due to flu season and colds. Down in the last spring and summer due to kids being out of school and away from passing the cold around amongst themselves.

In years past, summer admissions decline.

But not during covid times.

My hospital has not had a lighter census (admitted patients) since 2020.

At all!

Hell, we’ve been full 99 times out of 100 all year long. And when the hospital is full the emergency room has to hold patients who otherwise would have a bed on one of the floors. Recently, the ED in my hospital had a hold number of 17, more than half of their total beds. Even with a new unit on the floor, the number of hospital beds available cannot keep up with the demand of patients.

This means that the staff in the ED and on the floors have had no time to rest, relax, or rejuvenate for nearly 3 years now.

I fear for the state of the hospital during the winter months with the certain increase of bed needs due to flu.

Compounding this is even if there was a place and a bed to place them in, there may not be people available to care for them. This I put the blame squarely on the continued covid pandemic. Because it’s not over, not even close.

No matter what you want to believe.