I am a note taker.

To say I love to take notes is not an exaggeration.

I take notes during meetings, just to remind myself what was said.

I take notes during classes, again to remind myself what was said.

I take notes to remind myself why a situation drove me a little crazy.

I take notes to remind myself to bring up a situation with management.

I take notes to remind myself that most things are funny, you just have to find the angle.

But today’s note reads,

“awkward conversations: meeting with nurses at a sister hospital with them asking about nurses they “lost” to my hospital. But I don’t know them. Bitten off comment OR nurses aren’t real nurses.”

This is a 200 bed hospital over 9 units, of course I don’t know everyone.

However, the latter half of the comment is what led me to pick it to discuss.

OR nurses aren’t real nurses.

We have patients, we give medication, we chart. What’s not real about that?

Oh, I don’t take care of patients through my entire shift.

I do. It’s just that my shift is a bunch of little shifts crammed into one.

I have patients that I have to care for. Yes, they are under anesthesia but not the entire time.

I also have to make sure that they are safe going under and waking from anesthesia.

I have to ensure that the surgeon has everything they need to operate on this particular patient.

I have to coordinate care across multiple disciplines: radiology, pharmacy, sometimes disciplines in my own department.

Every single patient represents an entire shift.

And the quicker surgeries, that just means that all the different aspects the OR shift have to happen, sometimes within 15 minutes.

Again and again and again.

Unfortunately this is a sentiment that is pervasive in hospitals.

OR nursing isn’t real nursing.

Alicia Silverstone said it best in Clueless.

As if.

Yes, I yelled at a doctor today.

No, I do not regret it.

The number one thing I say over, and over, and over, and over.

And over.

Is move the bed away from the table when you are sitting up a patient.

We had moved the patient.

The tech and I were conferring near the end of the bed about troubleshooting the table.

I stepped away, after putting the side rails on one side up.

To turn off the table.

I look back and the anesthesiologist is trying to sit the patient up.

My hands flew out.

I called out loudly, “(Name), stop!”

He did not.

The bed clunked as it strained against the hundreds of pound bed.

I could see the table trying to move.

The bed clunked again as it was straining against the bed.

I repeated my warning.

He looked at me, wide eyed.

Rather an Alfred E. Newman look.

I scolded him.

“The one thing I repeat every FUCKING day is to move the bed away from the table before sitting up.”

He put his hands up and stepped away from the bed.

“You can flip the table and damage the bed.”

He carefully didn’t look at me on the way to PACU.

I mean, what the actual fuck?

And the struggles with no doctor call continue.

Last night I got a text from the supervisor about a D&C on the floor who was bleeding.

I replied no doctor had called me, texted me, smoke signals.

Nada.

I texted the CRNA and told her there was an imminent urgent case that I knew nothing about.

She texted back that she had called in her OB back-up, as she was stuck in endo.

I texted the surgeon that I heard there was a D&C, care to share?

I got an immediate call back.

She said there was a bleeder on the floor who needed to come down urgently.

She said that she had called the anesthesiologist.

I reminded her, gently, that the first call should be to the OR charge, so that I can get the ball rolling, the patient sent for, and inform the anesthesia team.

She pushed back, telling me she had been in the room with the patient.

Um, yeah, but nothing happens until you call the OR charge.

I don’t care that you told the anesthesiologist, who, it turns out, gave you incorrect information.

I don’t care that you told the floor nurse.

You have to tell the OR charge.

Which is me, hello. (waves)

Already behind the 8-ball, I got the tech to pick the case and set up the room.

I got PACU to call for the patient and put a fire under transport.

I finished setting up the room, offered to help with the quick prep.

Reminded the doc again when she came down of the proper procedure for scheduling an add on, emergency or not.

I was hopping mad.

Because this entire circus?

Cost us about 30 minutes in preparation time when we could be getting the patient down, prepping the patient, making sure that the blood that had been ordered was ready and beginning the blood.

And when you’ve already hemorrhaged for five hours, thirty minutes can mean life or death.

I hate beginning already thirty minutes behind.

To do:

I will finish the welcome letter to MDs about add on process.

I will get it blessed by surgical committee.

I will get it posted in all the units of the hospital.

In the midst of the chaos the general surgeon called with another add on.

A lap appy.

Because of course he did.

I have heard it from many surgeons.

“I want an evening shift turnover.”

For a long time I thought that meant that evenings could skip from room to room.

However, we usually stay in the same room and just turn it over.

Monday, I relieved in a case that was finishing at 1500.

There was a case to follow.

When I relieved the day nurse, I looked around.

There was trash everywhere.

The irrigator had not yet been taken down, although they were past that point.

The bovie was still plugged into the generator, although they were past that point.

A trash can had not been readied to receive the drapes and back table supplies.

I set about picking up the trash, taking down the irrigation, emptying one of the large barrel trash cans, putting a new liner in the same large barrel trash can, unplugging the bovie.

Just, you know, generally tidying up the space to make turnover easier.

And it hit me.

One of the reasons that evenings has such a fast turnover has everything to do with the fact that I begin preparing for the next case while still in the previous case.

Trash is picked up.

Equipment that is no longer in use is pushed aside.

Furniture that is no longer in service, such as prep tables and basin holders are placed to where they will be used for the next case.

There is always a trash can that has enough room for the drapes and back table supplies, even if I have to empty a trash can and put a new liner in.

The suction canisters, if no longer in service, are taken off the suction tree and treated with thickening agent to thicken the suctions.

This is done as the surgeon or PA is finishing closing.

At the same time I am making sure they have their dressings, and that PACU has been called.

All that remains is to wake the patient up.

Finishing getting the trash together and taking it out.

And turning over the room after they have left the room.

As we were wheeling the patient to PACU I looked at the CRNA at 1510 and told them, “The wheels in goal for the next patient is 20 minutes. Which makes it 1530.”

And we were.

Huh.

This is the most dangerous phrase I heard last week.

Really, the most dangerous phrase that I have ever heard.

Just doing what I was told.

Just doing what I was told.

That sentence is very problematic.

This is not why we became health care professionals.

This is not why we take care of patients.

Do not think that just doing what you were told is going to get you out of trouble in a court of law.

Please develop a backbone and stand up for what you know is correct.

Not just what you were told.

I’ll wait.

Well, that anniversary slipped right by me.

June 1, 2001 was graduation day for my first degree, the associate degree in nursing.

Completely slipped by, unheralded by me.

The thing is, I do not feel like I’ve been out of nursing school that long.

Before I know it, the 30th anniversary of my high school graduation will happen.

Who is going to tell my brain that, when I feel at most 30?

Now, the date of my passing the NCLEX is next. Which will be July 14th.

I passed in 75 questions. Which threw me for a loop, I was convinced I had failed.

Happy anniversary to me.

What am I going to do next?

To say that I have a ton of post-it dispatches is to minimize exactly how many I have.

I have been writing these little notes to myself for as long as I’ve been an OR nurse.

I have many, many, many to choose from.

Many.

Today I have a note from three years ago, when the hospital was deep in its Magnet preparation.

In the midst of the Magnet notes for myself about the reviewers is a small hand written “What keeps you up at night?”

What keeps me up at night?

The answer may be different for an OR nurse than a Med-Surg nurse. A Med-Surg nurse may be haunted by a med that was late, or a conversation with the patient.

These are not the things that haunt an OR nurse.

Or, at least, this OR nurse.

When I can’t sleep my brain gives me helpful images of awful cases, of times I let my mouth run before my brain.

Lately, I am reminded of the sharp words I give to coworkers, doctors and staff alike, to move the bed away from the OR table before raising the head of the bed.

Because often, the side rail has been snugged so close to the OR table that it is actually under the OR table.

And if the bed is raised, the OR table is raised off the ground.

One of our surgeons almost had a bed dropped on his foot for that exact reason.

I am often greeted with blank stares as they continue to raise the head of the bed, and the OR table continues to rise as well.

You bet I speak sharply to them, using simple, declarative sentences like “Stop.” Sentences designed to make them, you know, stop.

I inform them that the bed rail is wedged under the OR table and the OR table is being lifted.

Often the OR table gives way to gravity and drops down with a bang, startling them.

I have this conversation on the daily.

At night my brain imagines what would happen if I didn’t have this conversation all the time.

I imagine that a coworker will need to go to employee health, or the ED for treatment for their broken foot.

And I would feel guilty if I did give a warning.

So I do.

Endlessly.

This was a cookie that one of my best friends had been begging for.

For a while.

She wanted anything blueberry.

I showed her the recipe I was thinking of.

Nope, not the right one.

I pulled out a lemon blueberry white chocolate recipe and made it.

Many people stopped me to say how good it was.

This month’s theme is Baker’s Choice.

And today I chose to make the lemon blueberry white chocolate cookie.

Sometimes it is worth a choice to make a friend smile.

It seems that all I’ve done with week has been talking through my disappointment with the call only tech on Wednesday and Friday.

I mean, a lot.

A lot.

Of course I teared up. I was so intensely frustrated.

It all started when the ANM noticed that we were going to have three rooms running past 1700 and only two techs.

I reminded them, gently, not nearly at the top of my lungs, that this was an unintended consequence of only having the call techs cover the Wednesday and Friday from 1900-2300.

That they were leaving evening understaffed, on purpose, twice a week.

And I also mentioned that I was a wee bit upset at doing all the work myself.

Which is what I was told.

That the techs would only come in if there was a case.

I was told by them this was the case.

I had printed out my blog post from that day, the one I was so incensed about, sat the ANM down and made them read it. Because when I am upset words are sometimes hard.

“Oh, no, no, no”, they backtracked, fast. “If you need them, call them in.”

I reminded them this was not the story I got when they informed me about this weeks ago.

And so I had been doing all the evening work myself.

And seething with resentment.

I also pointed out that this whole construct that they made was helping with productivity.

Because 12 hours a week was not being staffed.

“Oh, no, no, no,” they insisted. “That is not the case.”

Forgive me if I don’t believe you.

This weekend was rough for the general surgeon.

He said that he felt like he had whiplash, starting on Friday.

Starting with the quick prep and case for the ubiquitous appy on Friday.

Through to Saturday, waiting around for his emergent septic case.

Unbeknownst to me he had been waiting to get this case started for awhile.

The Saturday night septic patient case with me as his circulator.

To his Sunday morning case that took forever to get started.

He and I had a conversation that although I can sympathize with his feeling like there are two speeds for the weekend versus evening speed, I have no power to do anything.

For that, he would need to take it up with the manager.

And he did!

He said he didn’t understand why and how there seemed to be two different speeds for add on cases.

And then he said the kiss of death, “Kate can do it, why can’t they?”

Facepalm.

Dude.

I have enough trouble with these people thinking that I expect others to work at my gear, which is high.

How many times have I been told that “Kate, they aren’t like you. You shouldn’t expect them to stretch for that.”

Um, why?