The post-it note reads ‘Gah! Why can’t they give all paperwork to me for editing?’

This puts me in mind of the sign they had posted at the orthopedic hospital.

It read “Authorized personal only”.

It struck me differently every day.

Some days, it amused.

Some days, it made me incandescent with rage.

I know the word they were striving for was personnel.

I’m not sure who put this up, but they should’ve consulted me.

If not me then someone with a proofreading brain.

Because this still, over ten years later, makes me mad when I think of it.

Signage should be in the realm of professional writing.

All signs that patients are in the position to read must be proofread.

I bet that someone who is not dressed out tried to gain access to the OR from these doors.

But, come on!

You couldn’t show the sign around before you, you know, mounted it?

By then, it was too late.

A bit of the Emperor has no clothes.

Either no one noticed.

Or no one wanted to say anything.

Either can be true.

I cannot be alone in noticing this.

I wonder if they finally changed it when they renovated the space.

I must inquire.

That is not what the note was referring to.

This has come up multiple times.

My boss just hands me stuff to proofread now.

Got to put my copy editing, and tutoring to good use.

The news is falling all over itself that covid cases are on a steep decline.

And deaths are on a less steep decline.

Now what?

How do we un-mobilize people who we mobilized when we needed them?

And who is to say that Covid is vanquished?

As a society, we thought the same in late Spring 2021.

With the advent of widely available vaccines.

Who would have thought that there’d be people who would cut off their nose to spite their face?

Who would not have a life saving vaccine in the midst of a global health pandemic?

Um, everyone.

People who say that it’s like a bad cold.

As they are gasping for breath.

And relying on shoddy sham products like Ivermectin.

And, let us not forget, dying.

It’s just a bad cold.

Keep telling yourself that.

I still hear that sentiment from people who should know better.

Before Delta.

I personally thought the covid emergency was waning in summer of 2021.

And then Delta roared in.

Then the shared governance council had an entirely planned symposium.

That we had to cancel.

Because the people who needed the message the most, were working at bedside, or ED.

And would be unable to attend.

And as Delta was waning, and nothing was on the horizon, the symposium was planned again.

And Omicron raised its thorny head.

And we’ve been living in an Omicron nightmare for 2 months.

Now that the case volumes are going down.

And death are going down, kind of.

I am supposed to drop my mask and live life to the fullest?

It’s going to take more than a drop in case numbers and the subsequent forgetting of the last two years because it is easier for some people.

I’ll keep my mask, thank you.

Because now there is subvariant ba.2.

I am watching this one closely.

Fool me once, shame on you.

Fool me thrice, shame on me.

Am I hopeful?

Yes.

But hopeful with a grain of salt.

And not the kind in margaritas.

And cheese month continues.

Cream cheese is a type of cheese in my head.

I wanted to continue the savory cookies.

But I could not find a savory cream cheese cookie.

Instead I adapted another recipe and baked the dough.

These are not very exciting.

I did not add anything different.

I could have used a different flavoring.

And made these cookies into something they are not.

I think a more robust flavoring like lemon or peppermint would have made an edible cookie.

Instead I added vanilla.

Because sometimes middle of the road lets the cookie shine.

These are tender cookies.

Almost melt in your mouth.

Two PhD applications are submitted.

Waiting for letters of recommendation is like watching paint dry.

And don’t get me started on colleges who DO NOT join the transcript clearing house.

Because some don’t.

You have to go to their website.

Somehow remember your account number and password.

Log in.

And chose to have transcripts sent places.

Two universities, two sets of authorized transcripts.

Thank goodness the prices have come down.

I had three separate sent.

2 to universities.

1 to me.

In case they asked for unofficial transcripts.

Which 1 did.

And now I wait.

For people to recommend me for enrollment.

That’s not an easy ask for a shy person.

Um, hi, you don’t know me but I see you have a PhD.

And are a nurse.

Recommend me maybe.

Omicron is way down

Beds taken up by covid patients in my hospital are way down.

They were at 42 at the peak.

With 7 intubated.

What makes this different from Delta is the amount of vaccinated people who were infected.

The hospital did have vaccinated people on vents.

A couple.

But they had co-morbidities that pre-disposed them to being ventilated.

Respiratory issues.

Cancer.

Triple P.

I know I have mentioned this before.

But Triple P stands for piss poor protoplasm.

It is a not very nice short hand to say that the patient is sick.

Has been sick.

Will continue to be sick.

Will never not be sick.

And they did not need another insult to their bodies.

Deaths continue to be high.

As expected the death rate is not falling yet.

Because if Covid has taught us anything, it is that deaths lag behind cases.

That being said the American death toll is nearly 925,000.

Where the death toll hit 900,000 only 11 days ago.

I do not want to celebrate prematurely.

Again.

But someday I hope that covid will behind us.

We just have to be smart as we wait it out.

The AORN conference has not been cancelled.

I don’t think it will be.

That will be fun.

And a chance to get away from home and hospital for awhile.

I have the ticket to the expo.

I have signed up with their preferred Clear app to prove my vaccination/boosted status.

At the behest of AORN.

When I noticed something odd.

After I created an account and uploaded my information about my shots, it told me that the information would expire on 3/16/22.

Two days before the conference.

Sigh.

I have also added my vaccine card to my phone’s wallet.

I figure of the two, one will work.

We have a hotel reservation.

We will be driving down.

The drive has been made before.

Fingers crossed that this conference gets to go forward.

Sunday I was invited to speak to the junior volunteers at the hospital.

These are high school students who volunteer at the hospital doing volunteer type things.

There is a comfort cart that they visit patients who have not had many visitors.

They man the desk at the physicians plaza of offices.

They man the surgical services waiting room desk.

They generally make themselves useful and get exposure to the hospital.

These were 9th grade through to seniors.

And a couple of college students who were to speak after us.

I wish that this had been around when I was in high school.

Of course, I lived kind of far away for this to be feasible.

And I worked evenings at Marshalls starting when I was 16..

Back before Marshalls was owned by TJ Maxx.

That is how long ago it was.

I asked Mom to come with me.

We spent way too long speaking about nursing.

The ins and outs.

The different paths that a nurse can take.

The trials and tribulations of nursing.

The highs of nursing.

And why nursing is valuable.

Why education is important.

Mom spoke about being a new nurse in the mid 1970s.

And how different hospitals are today.

With the technology and the pace.

There were some interesting questions.

What kind of surgeon can be mean?

And how to deal with them.

What about deaths?

How can those be managed.

What has changed the most?

We answered them all.

And took up a lot of time.

But the kids were attentive.

I hope that they would have stopped us if we were taking up too much time.

But mom and I were engaging.

And spoke back and forth.

I spoke about the importance of education.

She echoed how far nursing has come in nearly 50 years.

No one asked about the grossest cases.

That was a worry off my brain.

I was sure that it would be a question.

The college students spoke next.

One who was a junior and one who was awaiting admission to medical school.

They did not have the vast amount of experience that we had.

Mom hit it on the head for them.

In front of them was nearly 75 years of nursing knowledge and experience.

My entire take away for the kids was that nursing can be anything they want it to be.

Mom’s take away for the kids was the more technology changed, the focus remained the patients.

I wonder if we should take this show on the road?

The post-it reads ‘At the same point yesterday, surgeon needed something, scrub needed something, CNRA needed something, OR phone in pocket is ringing, wall phone is ringing. Who to answer first?’

Prioritization is a poorly conceived and executed skill sometimes in the OR.

Which of the 5 somethings got answered first?

Always the first consideration, when presented with such a puzzle, is which need is a legitimate need that puts the patient first.

The CRNA may have only needed a bag of fluids.

Or for me to call the anesthesiologist.

The surgeon may have only needed a refill on the suture.

Or something to do with their next case.

The scrub tech may have only needed more laps

Or for me to turn the radio on.

The wall phone ringing may have only been the pathologist with a read on the frozen that was sent.

Or another surgeon with another case.

The phone in the pocket may have only been PACU with a need.

Or the supervisor with a schedule request.

All of the five could have been something that needed immediate attention.

The patient tanking requiring the anesthesiologist.

The bleeding requiring a stick stitch to throw a stitch across.

The laps needed to sop up more blood that was suddenly there.

The pathologist to tell the surgeon that the sample that was sent frozen showed XY or Z.

The supervisor to tell me that there is a courier at the desk.

All of these scenarios could have been true and have been true in the past.

The best thing to do is to walk to where the monitor is visible, to see if there is anything alarming.

To ask the surgeon what he needed.

To look at the scrub techs sign language to see if it is more sponges that are needed.

The pocket phone can be glanced at to ascertain who is calling.

All of this can be done in less than 5 seconds.

And the priority can fall into place.

The pathologist can speak to the surgeon while you are calling the anesthesiologist and getting the extra suture and lap sponges.

Things can be done at the same time.

But happily…

The surgeon needs to tell you about his next case.

The CRNA needs a bag of fluids.

The scrub tech would like the radio on.

The wall phone is a wrong number.

The pocket phone is the supervisor looking for their schedules.

It is knowing how to prioritize sometimes conflicting needs of the room that makes a circulator efficient at their job.

This is something I try to teach people when I am doing education.

Do not let the cacophony ear blind you to the immediate needs of the patient.

Because they are why we are all in the room.

Covid infections are down.

Not to pre-Omicron levels.

But they are down.

Deaths are not.

As has been seen in all the different variants thus far, deaths lag behind infections.

Which is logical.

Because a person has to get sick.

And sicker.

And seek the hospital.

And get vented.

And linger.

Or not.

They could die at home because they didn’t think they were sick enough for the hospital.

And people go to the hospital to die.

Not every patient, but enough.

But for a country who just hit 900,000 dead a week ago on February 4, the US is still averaging nearly 3000 deaths a day.

And the newest death toll number from yesterday is 915,000.

That is 15,000 dead.

In six days.

Yes, covid infections are down.

Although the US fully vaccinated rate is 64%.

And the partially vaccinated rate is 76%.

And there may be an under 5 vaccine announced soon.

States are racing to drop mask restrictions.

Except where there is a high transmission rate.

I know because I follow the news where the high transmission rate areas are.

But I don’t think the average person would.

But they are happy and eager to drop the mask wearing.

We will only have ourselves to blame if cases go back up.

Because we were greedy for this to be at an end.

Let us not celebrate prematurely and it bite us in the ass.

Again.

Dead is dead.

Fayta.

Fehta.

Same cheese.

Same amazing taste.

Salty and creamy.

Surprisingly non melty.

And spinach because feta needs a foil.

Something to play against.

This is the second week of cheese Cookie Thursday is a Thing month.

I’ve baked these before.

And they were well received.

A sconelet is a small scone.

One of my tricks to stretch a batch to feed many.

But today, I made a second, gluten free batch.

Some I will send to my sister, who doesn’t eat gluten.

I will keep a half dozen mixed.

Because I said so.

And I will give the rest to the ED.

They’ve had a rough, rough, rough go of it.

Especially lately with Omicron.

And the usual falls with fracture.

Appedicitises?

Appendicitees?

Appendix patients.

And holding patients waiting for a bed.

I’ve already had 4.

Good thing they are small.

Zoom is amazing.

I get to engage in hospital meetings without leaving my house.

I get to stay in my pajamas.

I don’t have to clear the ice from my windshield.

Zoom is the worst.

There just is not a lot of engagement at the hospital, regional or corporate level.

Take the group meeting I led to today.

Our hospital has Med Surg I, Med Surg II, ICU, IMCU, ED, Women’s (L&D and post partum), OR, Cath Lab, Infusion Services, and Interventional Radiology.

That is 10 departments.

In the past we had a much more robust shared governance council.

There were representatives from 7 of the departments.

Sometimes 8.

There was more multidisciplinary participation as well.

Pharmacy updates and conversation.

Housekeeping updates and conversation.

Engineering updates and conversation.

Public safety updates and conversation.

Electronic health records updates and conversation.

Patient satisfaction updates and conversation.

We helped them, they helped us.

Those are also fading a lot.

Today we only had two.

An EHR representative for a brief 6 minute presentation.

And the patient satisfaction updates.

Shared governance is about leading from the bottom of the hierarchy.

If not leading, then it is about being heard from the bottom of the hierarchy.

What else do we talk about?

Safety of patients and staff and data from those efforts.

And quality of patient care and work life and data from those efforts.

I believe in the value of shared governance.

Very much so.

So much that I am leading these meetings and participating in these conversations inside of my salary.

No longer do I get paid hourly for the hours that I put in.

Today there were 4 people in the meeting.

OR, Women’s, and ED.

Our Magnet coordinator was also in the meeting.

These are the the same 4 people who have been the most consistent for the last six months.

Really great information was shared today in our efforts to elevate staff.

And some things to focus our efforts on.

Both will be discussed at unit meetings.

At least in the ED, OR, and Women’s.

And anyone else I can get to listen to us.

I can’t make nurses care about what the council does.

I can, and do, point out the good that has come out of the councils.

Things like improved lighting in the employee parking lot.

Better signage inside and outside the hospital to indicate to patients where they need to go.

Increased clinical ladder participation.

It is frustrating.

And demoralizing.

But at least the four of us care.

Healthcare is hard right now.

So very, very, very hard.

Nurses are leaving for more money.

Leaving the rest of us to shoulder the load.

And I would rather keep engaging in the conversation.

Than let it die.

And this is the part of zoom that I hate.

The silence.

Are the shared governance faithful screaming into the void?