After two years on-line AORN Expo starts next week in New Orleans.

The conference runs from Saturday 3-19 through Wednesday 3-23.

As ever, when a group of nurses get together we are going to make some noise.

Is it okay to be suddenly nervous?

I know these people.

Many of them anyway.

But in-person after two years on screen can be daunting.

We will be driving down on Saturday.

It is a 10 hour drive.

Even with gas prices that is cheaper than flying for the two of us.

I anticipate 2 tanks down and 2 tanks back.

A lot like driving to Nashville, TN, for the last in-person Expo.

Only this time, I am taking my driver.

He’s gonna drive.

I’m going to sleep.

And jamming in a lot of things for the Expo.

In addition to the in-person sessions, I am going as a funded delegate.

This means I have responsibilities.

Voting type responsibilities.

And there will be a party.

I already bought us tickets.

And, today, I get an email that matched me up with 2 Expo newbies.

Oh, boy.

How caffeinated was I when I made this plan?

I get to be the mentor to show them the ropes.

Oh, boy.

Every so often something happens to remind you that you are an elder nurse.

With 21 years of experience.

Like this.

That’s okay.

My introvert heart can take it.

I think.

I’m off to email my mentees about myself and my arrival details.

My plan is to make enough CEUs to complete my 135 needed to renew my CNOR.

Which is due December 31, 2023.

Right now, I have 175.

Oops.

I have lots of time for CEUs.

Okay?

After I prepare the house for my mom to move in an take care of the spoiled cats.

I have a list of things I do for the department.

Outside of my new shift of Sunday-Thursday 2100-0700.

Because someone has to get this stuff done.

First on the list is checking the instrument tracking numbers.

To ensure that people are still doing what is set forth in policy.

And tracking the instruments.

Not so funny story about that.

Something about an infectious disease and the immense need to be able to quarantine instruments.

In order for them to be destroyed and limit other patient’s exposure to the horrible disease.

Because we are in the business of helping, not harming people.

I check each day for complete documentation of instruments.

I make a report for people who are not quite doing what we know is right.

I am the OR representative on the Joint Commission team for total joint replacements.

I continue to be the laser safety officer for the hospital.

At least, until I’m not.

I represent surgical services at the hospital wide shared governance.

Because if we don’t speak to power, who will?

I continue to listen to complaints.

I may have less responsibility than I did, but I will still listen.

I track the IUSS.

Again, someone has to.

This department needs a mom, I swear.

For everything I still do for the department, I have dropped one or two things.

Balance, you know.

And I have to keep my Clinical Ladder Five somehow.

The post-it reads ‘upright and above ground.’

Being a woman of a certain age (above 16), everyone was interested in me procreating.

Well, sometimes it doesn’t happen.

And that is okay.

It sucks a bit.

But is okay.

I used to say when asked how I was, as they LOVE to do in the South, “Present or accounted for.”

This was a call back to parade practice while in ROTC.

It meant that all soldiers were present.

Or otherwise accounted for do to vacation or illness.

Many, many, many people think it means present AND accounted for.

Meaning you are double counting soldiers.

Don’t do that.

And as I matured people would mishear present for pregnant.

Also, don’t do that.

A woman’s reproductive life is not up for discussion.

When I hit my 40s, after 10 years of trying for a child with bupkis, I changed my answer.

My answer to how are you?

Upright and above ground.

It either startles people into a laugh or a commiseratory yeah, me too.

And the further we go along this pandemic path the more I mean it.

How am I?

I’m a working nurse in a hospital who has worked too many hours in the past, and taken ALL the call.

I’m a working nurse in pandemic times who has, so far, remained healthy.

So yeah, upright and above ground.

All present or accounted for means I am ready for service.

So does upright and above ground.

Ready to be deployed in healthcare.

The three PhD nurse hill is the one I will scale.

I promise.

I get that these people are busy.

Although Omicron is waning, the floors are still hopping.

And the credentialing business is no joke.

I heard back from the CCI dude.

And sent him the required information that I had.

Although the school has ALL the information required.

I also circled back and spoke to the PhD program handler that this recommendation letter would be coming the grad school email address, as requested.

I also heard from the intended 3rd PhD nurse.

She and I had a lovely conversation about my ideas and the end goal of having a PhD.

It makes me feel a bit strange to admit that I want to write textbooks.

Or articles.

Or anything really.

It is why I have this blog, after all.

But I should not limit myself.

The good news is that she says she will have a recommendation letter submitted this weekend.

This is good.

Because this is the painful part of the process.

And I missed the White Rose scholarship deadline.

Like you do when your life is basically unstructured.

I will search for other grants and scholarship opportunities.

Not only for myself, but for a friend who also missed the deadline.

Time is weird.

You know?

I think it is also time for me to stretch my freelance wings and see if I can fly,

Or stumble about.

It’s all a learning curve.

The theme for March is going to be comfort.

The kind of cookies that make you feel safe.

To start off the month, regular Toll House recipe chocolate chip.

Is there anything better than a warm chocolate chip cookie?

With milk?

Nah, I didn’t think so.

With what is going on across the Atlantic, I thought we deserved a little comfort.

Take the cookie.

Put in microwave for 5 seconds.

Enjoy with a glass of milk.

Or a cup of coffee.

You do you.

Today was the Shared Governance Summit that I found and paid for.

Because staff engagement has been… anemic.

Partly due to the staff turnover due to the Great Resignation (if you can call it that).

Partly due to decreased engagement from our hospital leaders.

I get it, they’ve got a lot going on.

All to do with burnout from the pandemic.

I was looking for guidance on creating more buzz around Shared Governance in my own hospital.

Or the hospital system.

The sessions were engaging.

I learned a lot I will be bringing to my hospital council.

But the video clip that one ICU nurse chose to illustrate her session.

Made me incandescent with anger.

I had to take notes.

Well, more notes than I was already taking.

Patients developed a pressure ulcer from the C-Pap mask on the bridge of their nose.

A news person asked this nurse, with a straight face, ‘That’s what a nurse says. What does a doctor say?’

Ugh.

Way to invalidate the entire nursing staff.

Way to go.

This is important.

The news person basically said what the nurse thought was not good enough.

And wanted a man’s take on it.

This is upsetting on many levels.

1. Nurses have been the backbone of the hospital through the pandemic.
2. There are reports of doctors who are pitching in and helping, true, but not every patient, every shift.
3. The nurses were asked to explain their actions that led to patient harm. As though what we just went through as a profession was not heart breaking.
4. It all comes down to blaming the nurse.

And then there apparently was a root cause analysis done as to why the patient developed a pressure ulcer on the bridge of their nose.

Um.

The continuous pressure mask was not designed to be worn 24/7 for weeks on end.

But at least these patients weren’t ventilated.

A handful of people made it out of the ICU alive to go home.

Out of this particular surge.

Of the global pandemic.

Alive because of ventilation.

And proning parties like the ones Florence herself would have had.

Start at one end of the unit.

Keep going until the end of the unit.

Start again.

Nurses have gone through the worst time of our professional lives.

And you want to blame us for it?

Come on, people!

We have to do better than that.

Another month almost gone.

In 6 hours it will be March.

New shift round-up.

Thursday will be 12 weeks since this new shift started.

I can’t say that I am bored.

I will say that I have done so much reading.

Way less organizing than I expected.

But why did I expect anything?

It is not like I’ve been a working nurse during a two year pandemic?

With the exception of staycations (three weeks in total)I have always been at the hospital.

When the elective cases were all cancelled in the beginning, in March and April of 2022, I was at the hospital for my regular shift.

When the cases that came until testing were not tested, I was at the hospital for my regular shift.

When the elective cases resumed with testing, if there was time, I was at the hospital for my regular shift.

When the cases came without time for testing, I was at the hospital for my regular shift and circulating those cases.

When the cases came in the middle of the night without time for testing, I was at the hospital for my call shift and circulated those cases.

When coworkers all were laid ill with Covid in succession, I was at the hospital for my regular shift.

When we coded a patient, twice in thirty minutes, in the middle of the night, I was at the hospital at 1430 for my regular shift.

I went to California on a medical mission of mercy to visit my ailing father in the ICU I went from the hotel to the hospital.

I’ve seen some shit.

All healthcare workers have.

Why, then, do we question when we have a break?

When the call shift opened up I jumped at it.

Not because I did not enjoy my job.

Not because I did not enjoy my coworkers.

But because I, like all of my healthcare coworkers, am tired.

Yeah, I earn less.

But I have not worked so little in my entire working life.

But I don’t take call like it is going out of style.

And that is enough.

There had to be a change.

I was working as fast as I could.

Not because I needed the money.

But because I enjoy working so much.

It is hard to be a recovering workaholic.

It is also hard to organize when I am still so burnt out from the pandemic.

And now there is war in Ukraine.

Excuse me while I doom scroll that.

Instead of Covid.

And worry that this means I will not get to London in August after all.

I’m trying.

To organize my life which has gone unorganized for years because of being at the hospital for my normal shift.

To relax and re-learn that I don’t have to be a workaholic.

I still like work though.

I’m just switching gears a bit.

Sleeping more.

Because I’ve never had a problem sleeping on call.

Writing more.

Because I honestly love it.

Reading more.

Because I’m a reader, always have been.

The post-it reads ‘Why do people not understand? That we can troubleshoot.’

The operating room is a very technical place.

There are a lot of moving parts to a surgery.

The electrocautery.

The bed.

The robot, if we are using one.

The SCD machine.

The tourniquet.

The spot lights.

They are depend on nurses and techs to know how to use them.

And to figure out why they are not working if they fail.

Sometimes it is as easy as turning off the machine.

Waiting.

And then turning it back on.

And re-setting the settings.

And it works.

This is only sometimes.

Sometimes we have to replace all the links in the chain before we open up another disposable.

For example, the TPS.

Or drill system.

There are 3 moving parts.

A console.

The electrical cord.

The hand piece.

The short may be in any one of these.

Rarely it is in all 3.

You start with the easily replacable.

The console.

No dice.

Still unfunctioning.

Another set it opened.

Still nothing.

But instead of opening a third set, test each of the sterile components.

Ah, it was the cord.

Use the new cord from the second set.

Mark the original cord.

Go on with your case.

You have to be systematic though.

I know it is not easy when a surgeon is screaming.

Or anesthesia is making noises about length of time under anesthesia.

You know what doesn’t help?

Putting us on the defensive, surgeon.

Instead of railing on the SPD department.

And you know who you are.

Instead of railing on the operating room.

Again, you know who you are.

Have a little bit of faith that your circulator can figure it out.

Or, at lease, phone a friend.

Trouble shooting is in the circulator’s blood.

Let them think a minute, as they are replacing things.

The CDC dropped the mask mandate today.

Of course they did.

Because cases are down.

This is the end of the surge.

Not the end of Covid.

Don’t you know?

Of course, political pressure was up.

And pressure from parents.

And pressure from people who don’t UNDERTAND.

Because they are tired of this shit.

No doubt about it.

I’m tired of this crap too.

Omicron remains the highest infector of the country.

But.

But 1 in 5 or 20% of cases are BA.2.

That number is climbing.

Rapidly.

Do I know that son of Omicron, as some are calling it, is more dangerous that Omicron itself.

Science doesn’t know yet.

But don’t worry.

We have not won.

The mask mandates have fallen.

In my state, they will be dropped as of Sunday.

Not that people are wearing masks.

I am.

You’d think more people would be more interested in the greater good.

Instead they whine about going back to normal.

There is no normal.

Two Party Opera, an online comic that I read, said it best, “Is it true that Pandemics never really end, people just stop caring?”

And the next panel the other figure says, “Time makes it easy to ignore why people die.”

Yes.

All of this.

2000+ people a day are still dying.

Be sure to tell them they don’t need to wear a mask in the casket.

Today would have been my grandmother’s birthday.

Both of them.

In remembrance of them, the family does their favorite thing.

Read.

I remembrance of them, the family eats their favorite foods.

Pringles, Coke, and usually pork rinds.

But there are no non spicy pork rinds to be had.

Stupid supply chain.

Stupid renovation at the closest gas station.

Although neither of these women were in the health care field, I find it comforting to remember them.

Because we are reflections of who has come before.

I like to think that although they would be flummoxed by me going to a PhD program, they would be supportive of me.

In their quiet ways.

If you need me, I’ll be reading an actual book.

Eating Pringles and chocolate.

Drinking a coke.

Enjoying my day off .

Because although this is new to me, is fast becoming a day of rest.