Monday Musings 1/9/23- why fight to keep those who want to leave

About a month ago I had the experience of teaching a newer nurse about call, call being something I know a lot about. I helped them optimize their screens in the electronic health record, showed them a bit about the EHR in the hospital, and explained the steps of how to get called in for a case, in effect everything that I wrote about in the What to do when you get called in series last spring. 

This is a nurse with less than 6 years of experience, who expressed interest in returning to school information, specifically going back to school to explore what else their nursing degree could do for them. Because the bedside was not where they wanted to be. I could not blame them, knowing that the last three years have been chaotic for a nurse, let alone a new nurse. And we already know that longevity is not in this generation’s DNA.

And a good percentage of new nurses leave the profession altogether in the first five years. I’ll give you a hint, what is 1 divided by 2?

Yeah.

Fifty percent.

17% in the first year alone.

And this is a problem. For the hospital, for the department, and for them and their family.

What makes a nurse who has gone through all the schooling, all the hours on the clinical floor, and all the hours in a specialty area want to leave?

How do we as the bedside nurses who remain, and the department, and the hospital make them want to stay?

On one hand, sure, go live your best life. 

On the other, why?

On the third, how are you going to figure out what you want to do?

All questions that these nurses should look within themselves to answer. 

I am loath to support a newish nurse leaving the profession, or at least the bedside. However, if a nurse is not committed to the wellness of others, why keep them?

Post-it Sunday 1/8/23-here is doctors binkie and little blankie

The post-it reads ‘if you see a surgeon showing their ass and acting like a toddler, imagine them with a pacifier or, better yet, light up shoes so you’ll have a light show to entertain you when they stomp their little feet in pique.’

Surgeons, sometimes they act like toddlers.

Especially when they don’t get their way.

Or “their” team isn’t available.

Or “their” room is in use during an emergency.

Or “their” instrumentation that they always use, don’t you know, what are you, stupid? is in use by another surgeon.

Hey, I wrote that book! It was part of an operating room kiddie book series that were decidedly not for children.

I titled it “Dr. Alexander, and the very bad, horrible, no good day”.

Much went wrong for Dr. Alexander.

There was a tricycle in his parking spot.

His team was on vacation and he had to work with those other clowns.

His scissors had been swapped for safety scissors.

He had to perform surgery in the janitor’s closet.

His day went so very, very badly.

And then he woke up! Clutching his teddy bear on a stretcher, sucking his thumb.

It was all just a bad dream.

It is comforting to think of misbehaving surgeons and administrators as toddlers. Well, I think it is comforting anyway.

And, with the new imagery of light-up shoes that a friend told me about, highly entertaining.

Doctors, sometimes they are just toddlers. Too bad we don’t have the power to put them in a time-out and take away their online privileges.

It is fun to imagine.

Irate surgeons stamping their feet wearing the light-up shoes. Threatening to hold their breath until they get their way. Threatening to yank their cases until they are told that insurance wants the patient to have surgery at this hospital.

You know, life in the OR.

School Me Saturday 1/07/23-synchronous vs asynchronous

The pandemic forced a more rapid shift away from brick-and-mortar schools. And classes.

This had been happening.

My BSN was done completely online in 2015/2016.

And, except for the clinical hours, my MSN was also done completely online in 2017/2020.

And all of the education hours that I have taken since 2009 have been online.

There has been a plethora of online degree places and colleges and universities have caught up to the public’s want for online education.

After all online lends itself to an off-shifter such as myself, to access classes and further my education. On my own time, and I can fit it into my own schedule. And I didn’t even have to drive anywhere to do them.

This is what is referred to as asynchronous.

This means that the class participants’ watches don’t need to be synchronized and people can do their own thing. You do miss out on the social aspect of physical classes, as well as the need to look busy when the professor is droning on. Pro tip, always write something, at all times, even if it is your to do list. It makes you look engaged. Of course, you have to follow along in half of your brain, so that you can answer pointed questions from the instructor but I’m like a ninja with this. I’ve been doing it since I was in middle school.

A synchronous class is a class that you actually have to show up for.

I’ve been to plenty of those.

People shuffle in, clutching their caffeinated beverages, and drop their school bags before sitting down. They chatter excitedly about what they did on the weekend. Or they grunt acknowledgement of greetings and close their eyes, preparing to get a few more minutes of sleep.

And then there is me, who gets there early, pulls out the text book and paper, prepared to take notes.

I really do take notes. And work on my to do list. At the same time.

I’m talented like that.

Do I still take notes like this in a PhD program? No, because now I type my notes, and have handwritten back up of any graphs that are created.

A word to the wise, asynchronous requires discipline and the ability to work on your own. However it offers much more freedom.

It is really to each their own. How do you learn best?

Cookie Thursday 1/5/22-chex mix

Yeah, I know. I did Chex Mix like a month ago.

But.

Let me tell you about the theme for January 2023. This month’s theme is going to be leftovers. This is where I will take some ingredients from 2022, that I still have, and use them. Sometimes I will remake the entire recipe, sometimes it will be the almost exact same recipe, with a change.

This week’s make is Chex Mix. I have tweaked the liquid part of the recipe, what is poured on the cereal, and baked. Why? Because I had 4 boxes left over from December. Some of my coworkers were remarking that they had to make sure they took their water pill that evening. Because some people need to watch their sodium intake.

Hell, all the people need to watch their sodium intake.

And that means you.

Modern food is way too salty.

Why?

To make it taste good.

The same reason they put sugar in things you don’t think require sugar. Because it tastes better.

Restaurants do it too. They put butter, or what passes as butter, on everything.

I rarely add salt or seasoning salt or celery salt when I cook. Just ask my husband.

It is the one cook’s stand for healthyish eating.

We should all be a little kinder to our kidneys.

And our livers.

And our brains.

I am choosing to start small. With a change that I know I won’t even register.

But my kidneys will.

Yearly Disclaimer- redux

Every year I write this disclaimer. And add to it. And tweak it.

And if I knew how to pin it to the blog start page, I would.

I began writing the yearly disclaimer to be able to point to my posts and say, see nothing to give away the patient here. You know, HIPAA. In case the corporation, that I work for and discuss my blog openly in meetings etc., tries to tell me I cannot write this. Not that they have, but I can believe they would.

I believe in protecting patient’s and staff privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about.

I do not use names.

And if I do, they are changed.

I change ages.

I change gender.

I change details such as which limb is fractured.

I change details such as which surgery is performed.

And the cases that I do talk about obliquely are changed in how time is perceived as well. The cases/people/staff may not be the same at the time of the surgery.

I definitely change aspects of time. By that I mean there is no relationship between the moment I write the post and the actual events that prompted it.

I change a lot.

So that, if you knew where I worked, you could not figure out who I am writing about.

I discuss issues that impact healthcare broadly.

And, after the events of the past year, issues that impact women’s health.

And covid. Can’t get away from covid.

I do swear sometimes.

But mainly to make an emphatic point.

Sorry, mom.

Monday Musings 1/2/23-Time

I’ve been saying since the pandemic began that time has become weird. Or perhaps it always has been.

Time, after all, is a human construct.

When we are little time seems to stretch and contract in rather predictable ways. Longed for things, such as birthdays or Christmas or the end of school, seemed to take forever to get here. And dreaded things, such as tests or doctor’s visits or the beginning of school, seemed to rush and get here so very fast.

Those kinds of time contraction or elongation happen as an adult as well.

Waiting for vacation, dreading tax season.

Waiting for the new baby, dreading when that child goes off to kindergarten.

Time. There always seems to be too much or too little of it. It comes too fast or comes too slow.

Its unpredictability is what makes it predictable. Expectable.

And then enter the pandemic.

Time has contracted or expanded in weird ways. Or just appeared out of nowhere. Out of time, as it were.

There was the wait for the vaccine. There was the end of the pandemic celebrations which, in hindsight, were premature. Now it is the wait for the newest variant. And the wait for the end of a pandemic that will probably end with a whimper.

I graduated with my MSN in 2020. That was nearly 3 years ago. I became a nurse in 2001. That was nearly 22 years ago. This year marks 30 years since I graduated from high school.

Why does it all feel like it happened yesterday?

Time, huh, what is it good for?

(apologies to Edwin Starr who wrote the song War)

Happy New Year 2023!

Happy New Year 2023!

I wrote 2022 review yesterday for School Me Saturday. And I’m not really the type for resolutions.

Instead, I’m going to give my wish list for 2023.

Last year my word for the year was hope. I hoped that the pandemic would end with a whimper. I hoped that 2022 was not as bad as 2021.

Well.

There are good things, past me, and bad things.

The pandemic is struggling on, and new variants are being discovered. But for the most part, the vaccines, if you got them, decreased the number of hospitalized and dead. Decreased mind you, not stopped.

This year my word for the year is wish.

There are different types of wishes. There is the one that you get after blowing out the birthday candles or wishing on a star. There is the type that you are hoping against hope against a diagnosis or a horrible situation. I see that one a lot as an operating room nurse.

According to the Merriam-Webster dictionary, a wish is to have a desire for something unattainable. And that is very appropriate for the pandemic. And for a world where there are active wars.

It is going to be hard to cap it off and transition to endemic disease. But I hope we can do it as healthcare workers. As society.

I wish, I wish, I wish.

happy new year.

And 2022 is a wrap!

Instead of School Me Saturday today I want to discuss the year that has just passed. More specifically, the year that has just passed with Dispatches from the Evening Shift as a focus.

In the past year, there have been 266 blog posts written by your truly.

TWO HUNDRED SIXTY-SIX. I think that is amazing.

In the past year, I wanted to redouble my efforts for the blog. And I think I have hit that goal.

There have been many things that have happened in the last year.

51 Cookie Thursdays is a Thing.

56 weeks in my new role as the call nurse.

Consistent themes for 3, sometimes 4 of the weekly blog posts.

Hell, let’s just break down the highlights, using the handy dandy schematic I made myself.

January

New year, new gig. The weekly themes of Post-it Sunday, Cookie Thursday is a Thing (CTIAT), and Monday Musings were all active. Covid was on my mind as we were in yet another surge. This is the month that the United States marked 850,000 dead on 1/15/22. And I was deep into applying for PhD programs.

The CTIAT theme of the month was Boozy cookies.

February

Covid continued to surge. Notably, there were 890,816 covid dead on 2/1/22. That is nearly 41,000 in two weeks. And Russia invaded Ukraine on February 24th. This was definitely a bleak month.

The CTIAT theme of the month was cheese.

March

This month I went to my first in-person conference, masked, in New Orleans. And in the car on the way home, my husband and I discussed the RaDonda Vaught case. And this was almost immediately after the J’Accuse blog post where the nurse is often the scapegoat of the medical profession.

The CTIAT theme of the month was Comfort. Didn’t we need it this month?

April

I wrote about Just Cause and what it means in a corporation and what it should mean for nursing. And my favorite post of the month was a breakdown of what the pandemic had stolen from me. Among others. Notably I chose a PhD program this month.

The CTIAT theme of the month was Coconut cookies.

May

Inflation reared its ugly little head. Not only in the hospital itself with continued supply chain issues but the pressure of the cost of the travel nurse.

Oh, the US marked the 1,000,000 covid death.

The CTIAT theme of the month was Inflation baking. I am the sole baker of CTIAT. It is my baby, and my baking supplies that are used. This was an effort to show my coworkers that yumminess can be had on a budget.

June

I started a many parted series about What it Means to be Called In. Here I broke down the steps, from the phone call to the ride home that the patient undergoes for a call surgery.

And there were physical assaults on healthcare providers in a variety of states. People died.

And then the Supreme Court overturned Roe with the Dobbs decision. Yes, I am still incensed at this.

The CTIAT theme of the month was Inflation Baking, which continued. The price of butter specifically was immense.

This was a crummy month.

July

Laughter has always made me feel better and I started a short-lived theme day of Friday Funsies. And I realized I am just not that funny. The Nursing Mantra was a post that I am particularly proud of.

The CTIAT theme of the month was If You Want a Woman to be in the Eighteenth Century so Badly… This month I made exclusively 18th-century recipes.

August

This was a month of many school posts. The PhD program started. We finally got to London.

The CTIAT theme of the month was No Heat.

September

A new theme day was added. This was School Me Saturday where I wrote about school-type matters. I also began limiting myself to writing about my personal school story one time a month.

There were rumblings and the beginning of discussions on a Twindemic, flu and covid.

The CTIAT theme of the month was Baker’s Choice. I had recipes I wanted to try that didn’t fit any theme.

October

The themes from the year continued: covid, and attacks on healthcare. There was a shooting at a maternity ward in Texas where 2 nurses died.

The CTIAT theme of the month was Spooky Cookies.

November

Oh, and now there is a third disease that is weighing down the hospitals. Flu, covid, and RSV.

But seriously, the hospitals have barely had a break in nearly 3 years.

The CTIAT theme of the month was Fall cookies.

December

What to say about this month? I asked if you were happy, I invited a surgeon and an anesthesiologist to whip em out and compare lengths while they were fighting over room choice. Oh, and the holidays, everyone’s favorite. With a full hospital and an over-full OR schedule.

The CTIAT theme of the month was Holiday cookies.

But it wasn’t all bad. We got through.

I survived my first year as a call-only nurse. AND my first year as a PhD student.

My hope for the new year is that there is a marked decline in the number of covid deaths. Currently, the US stands at 1,092,670.

My hope for the new year is a decrease in inflation or a decrease of the impacts of inflation on the costs of goods.

My hope for myself is to continue to be a PhD student. And a writer for this blog.

Let’s raise a glass to next year, and sage smudge this year to get rid of bad juju.

Cookie Thursday 12/29/22-pomegranate chocolates

This is the last Cookie Thursday is a Thing of 2022.

And CTIAT is always about experimentation. I was given a pomegranate and I wondered what to do with it. The first thing I did was de-seed it, wearing gloves, and set them aside.

And in my pantry, I had melting wafers, vanilla and chocolate. Except I couldn’t find the chocolate ones (I blame my husband and the desire for sweets he knows he should not have. I used my double boiler and melted some chocolate chips to use instead.

I laid the white chocolate melting wafers onto a cookie sheet and stuck them into a 250-degree Fahrenheit oven for a few minutes.

I took the melted chocolate chips in the double boiler and dolloped quarter-size circles onto another cookie sheet.

Moving quickly, I pressed a couple of pomegranate seeds into the melted chocolate. By the time I had finished with the chocolate, the white chocolate was ready to come out of the oven. And I repeated the process.

Once pomegranate seeds were pressed into each chocolate wafer or dollop, I set the trays on the front porch to cool.

We’ll see if this works.

If not, I have another batch of Chex mix in the oven.

This Cookie Thursday is about using what is available and not going out to buy different chocolate wafers to fulfill the vision. And this is something that is needed in all hospital settings.

It is not about not having what the surgeon thinks they want in any given situation. It is about being mentally flexible enough to give the surgeon what they need in a particular instance and within what you have.

Last week an ENT surgeon wanted a certain clip that he has used at other hospitals to stop bleeding. The hospital where he was doing a hemorrhage case doesn’t have what he requested as they rarely perform ENT surgery. Okay. Let’s think about what else can be used in the hospital you are now, instead of pining for what we don’t have.

Boom, we came up with another solution and used it. The bleeding stopped, and the patient was safe. Even not having exactly what the surgeon wanted.

What else can be asked for?

Spoiled for choice

Let us take a random body part of which there is only one in the body.

Such as the appendix.

The removal of the appendix is called an appendectomy.

I talk about appendixes a lot because they are the largest percentage of afternoon and night cases.

The goal is to remove the appendix.

It is up to your body type and makeup and the surgeon’s skill level to determine which way to remove it.

There are lots of ways; or rather, there are two ways with lots of approaches.

The decision tree looks like

APPENDICITIS

REMOVE?

YES NO

OPEN LAPAROSCOPIC ANTIBIOTICS

If open is chosen, you make an incision, tie off the appendix and cut it out and close.

If laparoscopic is chosen, there are many other options. Which scope? Which stapler? Which trocars? Which sizes of trocars? Which suture? Which electrocautery device?

The combinations are endless. In my hospital, there are 2 and a half trocar types. Of which there are at least 6 sizes from which to choose. There are 3 types of scopes and 2 types of degrees of bend to the scope, and three sizes of scopes. There is an upteen number of suture combinations. There are 2 types of staplers, but the second type has at least 2 different sizes of staplers and about 8 stapler heads. There are three different types of electrocautery devices, with the third with 4 different options in this hospital.

The point is, there are lots of decisions to be made.

And the circulator in the room is required to remember the surgeon’s on call’s preferences.

Higher math for OR nerds.

Or the surgeons are spoiled for choice.

But woe betides the circulator who does not remember what the particular call surgeon uses.

And please believe us when we tell you that something is on backorder.

And just imagine all the options in all the surgery specialties we have.

Mindboggling, isn’t it?