The post-it says “the other side of the coin with the need? For an abg right before incision and the crush that follows, including ologist handing off the specimen with NO label to someone in black scrubs.’

The universe saw the post-it from 2/27/22 and decided to up the ante.

The CRNA, the scrub tech, the surgeon, and the anesthesiologist needed something at the exact busiest time of the case.

The incision.

This one pushed my skills to the test.

The ologist and the surgeon agreed they needed a baseline ABG.

And decided that the time to request it was right then.

Immediately before incision.

There is much to do immediately before the incision.

The pre-incision pause has been done.

Lines including suction and bovie are being handed off.

The surgeon’s step is being put in place.

You remind the room at large that you are the only person in the room that is free and they will have to wait their turn.

The bovie and the suction are the immediate concerns.

Once the incision has been made, which is happening right now, the need for electrocautery and for suction is high.

Especially on a big belly case.

Where you don’t know exactly what you are getting into.

Of course there is no one in the department.

It’s a call case.

Why would there be?

The ologist bleats again, while you are tending to the possibility of bleeding, about the ABG.

You tell him to put the order in himself.

And you will print the sticker after the suction and the cautery are connected and starting to suck up blood and control the blood because the incision has been made.

And once the pressure of the skin is released the intestinal contents spill out like a trick can of snakes.

Which leads to more immediate requests from the table.

Once those are taken care of, you sign in, again, to the EHR.

While you are doing that you call the supervisor and ask for the respiratory therapist to come to the PACU to pick up the ABG.

You go in search of the blood tube for the ABG, which is not in the room.

Why?

This is the critical case room.

The ologist is sitting there frustrated.

You have no time to re-sign into the electronic health record and print the labels.

It has been 3 minutes.

Haven’t you finished getting the case started yet?

What are you doing?

The CRNA finds the blood tube and draws the ABG blood from the central line.

The phone alerts that the respiratory therapist is in PACU to get the blood sample.

The EHR has timed out AGAIN.

In a moment of calm, when the field and the CRNA are both content, you sign back into the EHR and try to print the labels.

Which do not populate to your to-do list.

You check the ologist’s work.

The order is not in correctly.

You correct that, and go get the printed label.

It has now been 5 minutes.

When you ask where the blood tube is, the ologist calmly tells you that he gave it to someone who knocked on the sub-sterile door.

Someone he didn’t know.

In black scrubs.

Wall, meet head.

The ologist allowed a specimen to go out of the room.

Hell, out of the department, without a specimen sticker.

There are so many ways that could go wrong.

You don’t have time to yell at the ologist.

Much.

But, wait, the sterile field needs you before you can cause bodily harm to the ologist.

Don’t tell me Murphy doesn’t live in the OR.

I know we are all tired of covid.

And we want our lives back.

“I just want to get back to normal!”

Is the refrain I hear over, and over, and over.

And over.

We should not go back to ‘normal’.

It is a fallacy anyways.

The last two years have changed us as a society.

As nurses.

As patients.

There is no going back.

There is only adjusting to what is now.

Many of the ideas need to come along.

Wash your hands.

Don’t touch your face.

Judge the person next to you for still wearing a mask.

Don’t do the last.

You never know what they are dealing with in their lives.

There is no return to normal.

As a society, America is 35,000 deaths away from 1,000,000.

One MILLION.

Should be shocking.

But is probably is a massive undercount.

Covid case numbers are declining.

For the first time since testing began, there is no patients in my hospital with active infection.

A few persons under investigation whose test results have not come in yet.

But no patient with active covid infection.

Don’t let your guard down too much.

Being from California they warn you about the undertow at the beach.

They warn less about the sneaker waves.

Both need to be on our radar.

This is the next normal.

As a society, we can not go back.

Only forward.

Comfort month continues.

I intended to bake Syrniki, a Ukranian cheese pancake.

And I could not find the farmer’s cheese that is integral to the recipe.

And this week has me on the ropes.

I’ve only slept 2 hours at a time, due to cases.

Two hours before and 2 hours during the day.

I’m tired.

I found a recipe to make farmer’s cheese but even that can’t hold my attention.

Cue double-cream cheese from Petaluma, CA, that my brothers-in-law sent us for Christmas.

I shredded the cheese that was part of their amazing gift.

And used it to make Syrniki inspired baked cheese cookies.

I had a cookie straight from the oven.

It was a little… lacking.

Inspiration struck in my pantry.

I brought toppings for the little cheese cookies.

A sour cherry jam, a triple pepper jam, and raspberry jam.

I had a triple pepper jam topped cookie as I was dropping them off.

Transcendent.

I wanted to do my little part, because my husband won’t let me go volunteer in Ukraine.

Making these gave me comfort during a hideous week.

Comfort cookie #2 of the month.

Ukranian Syniki inspired cheese cookies.

A humble little cookie.

Made of cheese, egg, and a little flour.

With toppings.

Good wishes and best thoughts to those fighting in Ukraine.

There are no words.

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.