No. This is not a post about going to the theater. Or the symphony. Or a museum.

According to http://www.justculture.healthcare it is the balancing of accountability and safety.

Not only the safety of the patients but the accountability and safety for the nurse.

It is learning from mistakes. Not stifling the reporting of said mistakes.

It is doing a deep dive into why the mistake happened, not blaming the nurse who caused the mistake.

RaDonda Vaught realized and reported her mistake immediately. As she should have. It was a lethal mistake with so many things wrong with it. A perfect example of swiss cheese model of errors that can harm a patient. What happened after that is on the hospital. But we are not hearing anything from the hospital.

Instead, they did not report it as they are mandated to. This was a sentinel event. A sentinel event is an event in which the patient died or was seriously injured. This poor patient and the events leading to her death was not reported in any stretch of a reasonable amount of time.

Was this a tragedy? Yes.

Am I sure that RaDonda Vaught is remorseful? Yes.

Every healthcare system and hospital that I have worked for stresses that there will be no blame. A mistake should be reported immediately so that what happened can be examined.

But I fear that the self-reporting will go WAY down after this. Should a prudent nurse report problems like what occurred? Yes. But no one wants to harm a patient. No one wants to go to jail.

However, convicting the nurse of negligent homicide makes all of patients, mine, yours, the hospitals, a little less safe.

Just for a wee bit of irony, RaDonda Vaught’s sentencing date is May 13, 2022.

The day after the end of Nurse’s Week.

The day after Florence Nightingale’s birthday.

Makes you hum in introspection. Makes you think.

It makes me think.

Edit 4/6/2022 0903 EST: Today news of a nurse being indicted in NC to an inmate death after officers dogpiled on him, held him down with his hands behind his back, ignored him while he cried out for his mother and said that he couldn’t breathe. She tried to help him, no charges for the officers.

Every nurse should be scared.

The scapegoating of nursing has begun.

When I took this call job it was the understanding that I would go back to school in the fall. Now that this is happening, I am also thinking of what I can do with my time outside of school and my new call shift. Apparently I have 40 hours a week, plus commute time, that I can play with.

There is only so many hours that you can read. Even if there is still a pandemic raging, with a new variant causing havoc. And doing housework is apparently a non starter and a mind block that I have.

I like to write. Freelancing may be good for me. But I have an interest with a limited audience group. But never said I couldn’t try.

I love the OR. All aspects. And I think that the hospital system is on the forefront of the new wave of call jobs. While I was at AORN this past month I spoke to every publication that I could: AORN, OR Manager, Outpatient Surgery. And I gathered business cards from everywhere.

I am going to propose an article, perhaps a column that encompasses why someone might want a call job, all the ins and outs of the call job. How it is a freedom of sorts, but not without drawbacks.

I also made contacts regarding writing for textbooks. This is my overall goal for my PhD and my after career when I can’t do active OR nursing anymore.

The goal for April is to reach out to all the publications, looking for interest in a writer. It remains to be seen if there is a market for such a thing.

All I can do is try.

The post-it reads ‘GuideStar shows salaries of non-profits’.

Of all the things I learned at AORN, GuideStar may be one of the most interesting.

It does many things. It is a blog. It is an accounting for all non-profits in the US. It breaks down how much money it has, how much money it has taken in through receipts.

Including its assets.

Fascinating.

I had no idea that such a thing existed.

Of course, to get more in depth information you need an account. I did a cursory look at the CEO of the company I work for. It would not divulge how much the CEO made, without an account.

But any non profit is searchable.

Including the university I will be going to in the fall.

A company that you want to do business, and is a non-profit is searchable. It is a rabbit hole that you can use to direct your giving.

Money does many things. It eases the world.

I will say that looking up non-profits is a little bit addictive.

I would like more information of what are assets and what are receipts.

To be clear, this is merely a snapshot of the non-profit.

It does not tell the entire story.

But it does tell a story.

It gives you information and data to make your own decision.

Okay.

Deep breath.

I chose a PhD program.

I had FINALLY gotten all the various PhD nurses’ letters of recommendations submitted to South Carolina.

And then nothing.

So I chose the UNC-G program.

Both schools are equidistant from my house.

The kicker was that the program in South Carolina’s grant was in beta.

This means that it could go away at any time.

Although a decision won’t come down for North Carolina grant program until May, at the earliest, I decided to go with North Carolina.

Because state pride, right? At the very least, state residency.

And my husband was hesitant of me driving to South Carolina. Why 70 miles South is problematic and 70 miles North is okay, I don’t know. Something about the highway construction.

I submitted to the program yesterday that I intend to enroll. And immediately after I submitted to be a research assistant, which has a stipend that will mostly pay for school. And, as my husband pointed out, looks good on a resume.

Since some scholarship programs need an enrollment to qualify/apply, I panic applied to a bunch more. After the decision had been made.

Because you never know.

That means I have 4 months to whip my house into shape.

Based on past performance I need someone to kick my ass into gear.

A friend came over yesterday and we weeded and container planted a quarter of the front.

Today after the sun goes to the back, I will do another quarter, including the front two flower beds. I am allergic to something in the front. Not poison ivy, but something. Long sleeves it is.

It’s a start.

Comfort month concludes. And we still need a lot of comfort. What is more comforting than frosting? Were you the kind of kid who ate the frosting first? Because frosting. Or were you the kind of kid who denied yourself, just a bit, knowing that the end would be sweeter? Because frosting. Or were you the kind of kid who ate it all together, because frosting can enhance cake and you knew it?

Because however you ate it, frosting was comforting. The inspiration for this week was a honey cake, a babka, that is of Ukranian origin. They are still going through the last time of their lives and they deserve a little comfort. Top off the honey cake with a bit of frosting.

And think good thoughts for those going through hard times.

Because frosting makes the world better.

Unless you’ve been under a rock in the last week, or have your head down in your pandemic hole because you’re still working all the hours that are, a jury found a nurse guilty of criminally negligent homicide last week for a medication error. The medication error that sadly ended in a fatality.

Most nurses that I know, and I know a lot, are in shock.

At any time that could be us on that stand, in that courtroom. Receiving a guilty verdict for something that should never gone to trial.

I can guarantee that RaDonda Vaught did not become a nurse to kill a patient. All of us live with the fear that this could happen at any time. We work with powerful, dangerous medications every day.

We, as nurses, did not become a nurse to be the scapegoat for the hospital’s system bad policies. Or to be convicted for the swiss cheese effect. This is where the system of errors

This will have a chilling effect on healthcare.

On nurses.

Errors will still continue. That’s what makes them errors. They are unintended. Hospitals will still have bad policies that do not protect the nurse.

Nurses will take extra care around medication errors

Let us pretend that there is a patient S. S for seizure. He feels terrible and goes to the ER. Patient S is not a patient not in the system because he was new to the hospital he presented at and normally went to the other hospital system in town. Patient S promptly had a seizure. Because he was not in the system, he was not in the Pyxis (which is the medication dispensing unit). And they were unable to get medication to help him. Because that was an override medication. No nurse is going to override for that medication after this. Because RaDonda Vaught’s story teaches us that we can go to jail for that. Could he die from a seizure? Absolutely. Could he die from not receiving the Valium that would stop the seizure? Yes. No nurse I’ve talked to will override the medication now.

No one.

Will Patient S receive substandard care for not being in the system? Probably. Until all the systems kick into place to release the medication under his name.

You can’t have it both ways. Horrible that Patient S is suffering. Horrible that the nurse is powerless to stop it.

Here’s what I know.

Nurse RaDonda Vaught was stripped of her nursing license in July 2021. After the board of nursing declined to rescind it before.

She was convicted of criminally negligent homicide in the death of Charlene Murphey March 25, 2022. Something the family didn’t even want.

She has yet to be sentenced to jail.

She lives knowing everyday that she caused the death of a patient.

Was she stupid for overriding the medication?

Yes.

Was she stupid for not looking at the medication vial? At the paralytic warning sticker on the vial? For not realizing that the vecuronium was in powder form and needed to be reconciled? Unlike versed which is a liquid.

Yes.

Was a criminal conviction warranted?

No.

Should it even have been sought?

Hell, no.

A root cause analysis should have been done at the hospital level. Changes could have been made. Improvements could have been made. And the patients kept safer.

The system in that hospital allowed this to happen. She reported it right away. The hospital did not. The hospital has not said much about the entire thing.

And the ADA said that “RaDonda Vaught PROBABLY didn’t intend to kill (the patient) but she made a knowing choice.” The word choice of ‘probably’ makes me mad.

So very mad.

None of us became nurses to PROBABLY take care of patients. No. Full stop. We became nurses to take care of patients to the best of our ability.

Like a human. Taking care of a human patient.

Nurses are people too.

District Attorney for Nashville, TN is Glenn Funk. He is up for what purports to be a tough re-election.

He needed a win.

That’s how I see it.

Me, I wonder why the medication was in the radiology department AT ALL.

This could be happening to any of us.

No sooner than we got home at the wee hours of Thursday morning then I got an email from AORN. I am talking 0330 here; after driving 10 hours through the night. Best way to travel.

Well it felt like immediately upon returning home, but in actuality was 1600. What? I had to sleep. And do house fairy stuff including a trip to the library and to get the oil changed in the car. Duly masked of course. I had just been somewhere the positivity rate was classified as moderate.

However, the email I received from AORN was that there had been positive cases among the attendees. Oh, you mean those attendees that ignored the please mask sign? That had no respect for social distancing? Those attendees.

Of course I wore a mask and followed social distancing guidelines. If I felt a place was too crowded, we left. Walking the streets we wore masks.

With a quick glance around the conference floor there were maybe 30 of us who were masked. Including some intrepid soul who was wearing 2 masks, one of them an N-95. There was ample room to spread out in the seats during all the ceremonies: opening, house of delegates x 2, closing. All of them.

Even during our breakfast because we had a bunch of no shows.

But immediately upon closing of the conference, and maybe before, people were testing and being tested.

I feel fine. But I know there is a subset of people who have no symptoms at all.

More importantly, my canary in a coal mine husband who usually gets things first and who I was in very close contact with all week, has no symptoms.

I did my due diligence. And quarantined in the house, or wore a KN-95 mask out. And tested at 5 days post exposure, as the CDC instructed. That put my last exposure at Wednesday afternoon at 1600. Therefore I tested on Sunday at 1600.

Negative.

But some people who were at the convention were definitely ill. Several members of my chapter tested positive. Every one of them alerted the rest of us who had been in close-ish contact with them.

A few of us remain negative.

However, this serves to illustrate my point that I have been making all along. This was a group of vaccinated and boostered individuals. Who are nurses and should know better. Perhaps they should have kept a mask on a wee bit longer.

I believe this is our next normal.

Sporadic infection clusters.

If you need me, I’ll be chilling at the house, between shifts. And going early to the store when I need groceries. Or late. Whatever gets me face to face with less people.

The note reads ‘poly letters after your name, is it worth it?’.

I know what this is referring to. Especially after going to an international conference and meeting people with what seems like an alphabet after their names. Letters of all kinds-CNS, CNOR, DNP, and CNE. And the letters are followed by more letters.

And going to a conference and paying attention to all of the letters is surreal. Before they were just part of the landscape. Oh, you have letters, me too.

But I know what those letters mean. The most memorable is the education letters.

There are the PhD nurses. This one is self explanatory. I will be going back to school again to earn these letters so I can write textbooks. Teaching has not been ruled out as well. Maybe online.

DNP is a doctorate of nursing practice. This is a degree that can be obtained in a variety of specialties, including leadership. This can be used to teach or to lead.

The MSN which means there is a masters in the mix. This can be any one of three tracks: education, leadership, informatics. There are probably more.

The MBA which means there is a business administration masters. Some leaders get these to establish their bona fides as leaders. And also to be able to steer the ship that is a hospital system.

There are the CNE. This means you are a certified nurse educator. I have to look at getting one of these. Especially if I want to teach at a collegiate level.

CNS means clinical nurse specialist. That you know everything there is to know about the specialty. I admit I did explore this one. But my system already has several. I did not want to crowd the market. And this would not lead to my ultimate retirement goal which is to write textbooks.

Certification is important. It means that you took the time to learn more about the topic you are certified in. I will tout this importance until I can’t any more.

I know, I know. I have a bit of an alphabet after my own name. MSN, RN, CNOR. The most important one is RN.

Because all the letters mean nothing if you do not keep up your RN. This means that we are able and licensed to take care of patients. And they are at the heart of it all.

About a year ago I stumbled across a free CEU place that was sterile processing focused. I thought to myself that sterile processing does not get the focus it deserves. And I clicked on my first Beyond Clean seminar. And I learned so much. Water purity, and piping, and timing. Sterile processing is more than making the instruments sterile.

And that was only the beginning.

I soon learned that the seminars draw an international audience. And I have begun including it on my yearly free CEUs list I make for my hospital system every year.

CCI, which is the credentialing company for the CNOR or certified nurse operating room, allows the CEUs earned to count for the CNOR recertification. And I am due to renew in 2024. When I say that it means that I have to have all 135 CEUs completed and turned in by December 31, 2023.

Why? I don’t know.

But I earned 75 CEUs last year just from the two nursing conferences I went to. And I anticipate earning at least 50 for the AORN conference I just completed.

I am unsure if these CEUs are allowed in the AST recertification for scrub techs. This is still valuable information.

When asked about what I do in my new free time. I do CEUs and I learn things.

It never hurts to be too prepared. Or too educated. The technology and education is changing very quickly in the OR. It always been this way.

SPD is the gears that allow surgery to continue. They wash the instruments, inspect the instruments, sterilize the instruments, and put away the instruments.

Be nice to your SPD technician.

Goodness knows they get enough crap from the OR nurses and techs themselves.

And learn a bit about how they work. Not just the instruments, but the cleaning and sterilization that allows the OR to work.

Comfort month continues.

But I am not in North Carolina to bake. I have been at AORN in New Orleans since last Friday. And then we drove home through the night to not spend another night in the hotel bed. No offense to the hotel bed but it is not our bed. It’s at times too hard and too soft. Weird, right?

We arrived home and I finally got to sleep at 0500. No cookie baking to be done by me today.

Luckily, knowing I was not going to be able to make the cookies today I called in a pinch hitter.

My mom. She is working as a travel nurse in my hospital and agreed to make cookies. Allowing me to relax and SLEEP before I go in tonight.

She and I spoke about the theme for the month being oatmeal cookies. I spoke about the probably inability to bake on the road, as we were originally prepared to return today. And also the planned cookie. I had planned to make oatmeal raisin, one of most requested cookies.

She offered to make the cookies. And, instead of raisins, she was going to add dried cranberries. This is a call back to my childhood. Well, young adult hood. Mom always puts craisins in the oatmeal cookies.

I hope there is some when I get in tonight.

Sometimes you need an assist.