Today I made a recipe I’ve done many, many, many times before. Without problem. With a small change in detail. Who knew it would cause such an impact.

The recipe in question is the fudgy cocoa no-bake cookies. You know, the peanut butter chocolate ones. Again, I’ve made it many times, not just for Cookie Thursday is a Thing but also for potlucks and even home consumption.

I don’t even need a recipe but I always double check for Cookie Thursday.

1/2 c butter

2 c sugar

1/2 c milk

1/3 c cocoa powder

2/3-3/4 c crunchy peanut butter

2 tsp vanilla

3 c quick oats

In a large pan, melt butter, add sugar, add vanilla and stir, add milk and stir, add cocoa powder and stir. Bring to a boil, boil for 1 minute. Remove from heat and add peanut butter and stir until melted. Add quick oats and stir.

Really the entire recipe is adding and stirring, with some time components thrown in. Although to be fair the order of ingredients is important,

This week I read an article about toasting oatmeal before use, it was supposed to bring complexity to the oats. 10-15 minutes at 300 degrees Fahrenheit. I can do that. Y’all know I like to experiment on my coworkers. I let them cool for an hour while I worked on my paper. And then proceeded with the recipe, with all the same things that I have done so many times.

No.

No, this was a fail!

Well, not a fail but not what I was expecting.

The mix was very crumbly and did not form up well.

AT ALL.

I was able to get 30 crumbly cookies out of it.

If you have ever had these cookies, crumbly is the goal, but only after you’ve bitten into them. I have no idea what happened.

The only thing different was that I toasted the oats for a few minutes. Maybe that made them dry as the desert and they sucked up all the ingredients and became dry, dry, dry.

Very odd. That’s what I get for having an Eggceptional month and trying something that I never had before.

The rest of the mixture would be a fantastic topping for something. I think I will bring a tub of greek yogurt and put out the cookies, the yogurt and the rest of the mix that would not form cookies.

Everyone knows that the crumbles are the best part of the recipe.

But odd, very odd.

We in the OR count 2 kinds of things. There are the instruments. And then there are the soft goods. By soft we mean anything that is not an instrument.

In this series, I have covered sponges, the real soft of “soft goods” and needles, a not-so-soft part. Today I will be discussing other things that are included in the soft goods that are not sharp.

I considered adding this next one to the sponge count post but it doesn’t count, not really.

There are things that are soft that are not sponges.

These encompass things that have different uses.

There is the KD, aka the Kittner, aka the peanut. It is essentially a wad of sponge that is used clamped into a tonsil clamp, aka the Schnidt clamp. Well, was is a misnomer. If you take it apart, it is an itty bitty half-inch strip of sponge material that is rolled up very tight. It is used for blunt dissection or teasing away the layers of fascia. The reason they are called peanuts is because they are the size of peanuts.

There is the pattie sponge aka the cottonoid. These are strips of material that is not a sponge that is used to blot blood and other fluid away from a surgical site, not always an incision. They come in a variety of lengths, 1/4 inch to 6 inches, and a variety of widths 1/4 inch to 2 inches. And they come on cards in a predetermined number. 2, 5, or 10. This is dependent on the size and what is ordered for the department

Sometimes, especially in cardiac surgery, it is necessary to sew in a bolster along a suture line aka the retention bolster. These are little tubes that the suture is sometimes fed through and then secured. They are designed to distribute the tension along a suture line. Think of it like belt AND suspenders. These are can be little- 3/16th of an inch in diameter and up to 2 inches in length. But they are on the table and must be counted.

Sometimes in surgery, you need a strip of soft rubber. This is also known as the Penrose and can be used to hold important things, like veins or the inguinal cord during an inguinal hernia. This can and has been left behind inside a body cavity and therefore must be counted.

There are soft silicone rubber strips that are used to hold vessels such as arteries and veins, much like the way the above gently distracts and holds away the inguinal cord. These are called vessel loops and are 18 inches long. They come in a package of 2 and mostly come in 2 widths, maxi or mini. Again, they go on the back table and must be counted. If they are cut because they are too long. Surprise, each piece is countable. In a package of 2, and one is cut, this becomes a count of 3.

All or some or none of these can be on the back table. Both the scrub and circulator have to be aware of what is on the table. Yes, all of it. In many ORs, there is a large whiteboard that is visible from the field that is used for counting. Yes, yes, people will say that the whiteboard is too far from their seats and they’d rather keep the count on a clipboard.

Yeah, no. Don’t do that. The entire room needs to be able to see the count in real-time.

When is a routine a habit?

According the Oxford dictionary, a habit is a settled or regular tendency or practice, especially one that is hard to give up.

When is a habit a routine?

According to the Oxford dictionary, a routine is a sequence of actions regularly followed.

And what happens if something causes a deviation from whatever term you choose?

It is my routine when I am called in for a case to follow a series of set steps. Get dressed. Get in the car and drive to the hospital. Get changed into scrubs. Schedule the case. Pick the case. Get the patient. Prep the patient. Call PACU nurse in. Do the case. Stay with PACU nurse as the second nurse.

Or not. If there is another case, this opens up another set of subroutines.

Okay. I guess that is my answer. How I function when called in is a routine.

But the question remains what happens if something causes a deviation from pattern?

Entering the conversation: pattern.

The answer is sometimes I lose my place, especially if it is a call from the supervisor, not the surgeon.

Threw my entire routine off.

Add in a nurse I was doing buddy call with. Also a disruption in routine, but a normal one.

Maybe the best example is the call case is like a juggler, keeping all the balls in the air.

There are a lot of details to keep in the air.

Don’t drop one.

That is the only thing on the post-it. “Zoom gremlins”.

This past week, I queued up all the pages I was going to share at a meeting I was leading. All the pages: the agenda, the minutes, the emails that I had received that were bullets on the agenda. ALL of it.

Only to have Zoom fail when I tried to start the meeting. I had to move to a different platform without all the pages I had prepared. There may be something to the gremlins in the machine.

As the world has been shifting more and more to online platforms, I think it is an excellent time to call out the pitfalls of the entire process.

There is the digital divide. Those who have access and those who don’t.

This is a huge hurdle. And one the government is trying to bridge with the new laws from last year. But it is a deep divide.

There is also a generational divide. Both my parents are active and engaged users of technology. But many older adults are unable to be active and present online.

There is the income disparity between those who can access technology and those who can’t because they are just trying to keep their heads above water. And make sure that they and their families are clothed and fed and have a roof over their head.

The earthquakes that shook Turkey and Syria this past week strengthen the argument. Lives, homes, and stuff were wiped out when the earth trembled. And now millions of people may be on the other side of the digital divide than they were 8 days ago.

All of it can be taken away in a breathless moment between then and now.

And those of us on the have it side of the divide must help those who do not have the technology, the Wi-fi, the electronics that make this new world that has been created through the use of the stuff that we have to engage with it.

After all, how would we cope if it all went away? In an instant.

Also why I don’t care any longer for superhero movies where the end battle destroys an entire city.

The professors give you their email addresses for a purpose.

And that is to reach out to them if you have any questions. Or to tell them that you are not going to be in class.

This is a hard one for me.

Our theory professor and our philosophy professor last semester talked about speaking to my classmates, either via email or in person, frequently.

This may be a generational thing. Probably not, as I think we are all Gen X or Millenial in the cohort. This may be a function of how we were raised, or what other schools have instilled in us. The only time I went to an instructor in my ADN program was when I was called to the office to explain my stellar score in the computer test that was supposed to tell us our likely NCLEX results. Not the NCLEX, a preparatory pre-test. And the teacher wanted to know why I scored the highest in the class. Had I cheated?

Well.

Of course not. But this conversation left me convinced that I was being watched, and judged at all times.

Probably explains a lot about my BSN program and how when I was struggling with Econ and Statistics in the same quarter I didn’t reach out. I didn’t because I didn’t want to be judged for taking two very hard classes in the same quarter. Wrecked my 4.0, that’s for sure.

And Generation X, who was largely left to our own devices, does not like judgment. Or being watched. Even if it will ultimately help us.

And actively asking for help?

No, thank you.

But I am learning the higher I go in school, that it is important, and expected for us to reach out if we are having issues. On anything.

This is completely out of my experience.

There is nothing wrong with asking for help.

There is a lot wrong when recognizing that you need help from the professor and struggling in silence.

I hope when it is my turn to be the professor that I remember these growing pains and can recognize and help struggling students.

After all, my job will be to guide them on the path of graduation, of helping them be the best nurse they can be.

Maybe another mantra (you know how I love those).

Teachers are there to help us succeed. Nothing is gained by letting us fail.

Okay, I changed my mind. This is definitely generational. Those of us who grew up and went to school in the 1980s need help with this.

It can start with an email. And the willingness to ask for help.

Eggceptional cookie month continues. This week I made eggless oatmeal raisin cookies. The recipe replaced the egg with 1/3 cup of milk.

But, of course, that isn’t the whole story.

For this recipe, I used my hand mixer. And it is a good thing too. Because this dough is THICK. It’s bad when you can smell the motor in the mixer, and hear it struggling.

There are 2 c flour, 2 c sugar, 3 c of oatmeal to 3/4 c butter and a 1/3 cup of milk. That is a 7 cup to just over 1 c of liquids.

Yeah.

Not enough liquids to solids ratio.

I doubled the milk and it went much smoother.

Yes, that is a pun.

My mixer still struggled, though. After all, it is as old as my marriage. Got the job done.

And today is the in-person portion of the hospital’s annual mandatory education.

There are about 3 hours of preliminary computer-based learning before that.

And when I went to sign up, there were ZERO spots left for today.

The thing is, today is the only day I can attend. The other day is tomorrow and I have classes in another town all day. Can’t miss class.

And Monday is a possibility, but I have research assisting all day.

I have to crash to in-person education.

It is the only thing to do.

Besides go to a different hospital for the same content.

I don’t have time for that. I have real-life education to do. And I’ve worked for the corporation for 17 years, not much has changed.

Continuing on to the next item in a “soft” goods count, needles.

Needles come in many different iterations.

There are sharp needles.

There are even dull needles that we use to access and filter the fluid in a vial that you break open. Yes, those exist, always take precautions. The glass shards can end up in the medication and then injected.

There are curved needles.

There are straight needles.

There are hollow needles; those are called hypodermics and a way to inject medications into the human body.

There are port access needles that are used to access surgical ports. There are different reasons that patients have these; sometimes chemo related, sometimes accessed for surgery because there are no usable veins. If they are on the back table because the port is put in during surgery, it is countable.

There are angiocaths that are used to start IVs. Sometimes we use the soft IV plastic, and not the sharp needle, especially in irrigating in a delicate area. Yes, they are on the field and are countable. Both parts must be counted, the sharp pointy part and the soft plastic.

In short, if it is on the field, it is counted.

Especially if it is sharp and can hurt patients, or people who get randomly stuck because they are bagging the trash and cleaning the room and someone left a needle on a hypo.

Don’t do that.

In the OR, our driving force is safety.

Safety for the patients.

Safety for the surgeons.

Safety for the OR staff.

Safety for the cleaners.

Police your sharps (that means keep an eye on them and dispose in a puncture-proof container made for them).

And there is the needle book that is used to store the used needles in, on the back table after they are used. So they can be counted. But that is another lesson. Stay with the class now.

When I am calling for a patient, the first thing I ask is if they have a family member at bedside. There are a variety of reasons for this: comfort for the patient, the person that the surgeon needs to speak to immediately after surgery is present, if the patient is confused, or has had medication that means they can’t sign their own consent, well the person at bedside most likely can.

Of all the reasons, the last is the most important.

And also, if the surgery is a dire one, they won’t be separated from their loved one until we are ready to head back. And if the surgery is dire, they probably can’t sign their own consent.

Have I called for a pause when the loved one arrives late to the hospital and fetched them so they could say goodbye to the patient.

You bet I have.

And I’d do it again.

Hell, I have done it again.

Does this delay the inevitable in the case?

No.

Does this delay the case?

No.

Does it give the patient who is about to undergo emergent surgery a measure of comfort? Absolutely.

And I will continue to call for a very slight delay so that the loved ones can see their patient before they head back for emergent surgery. Or I will hold the phone up to their ear so the patient can hear their loved one.

I do not regret it. One bit.

The gown card reads “holding up a mirror to the actions of nursing will allow open transparency in healthcare. We have to do it ourselves, no one else is doing it for us.”

No idea what prompted that gown card.

But it holds true every day.

The nursing profession must continuously put a mirror on the actions of the profession. This will lead to openness and honesty in healthcare. And this can only be a good thing and lead to safer patient care.

Do we all want the same things? Safe patients, safe employees?

Yes. Well, most of us.

But it is not ingrained in some of the healthcare workers that this is a job, yes. But their actions lead to more than a paycheck. For too many healthcare workers, their job is only to get paid. No more, no less.

It begs the question, has something been lost in healthcare today?

If we don’t ask the hard questions now and show these paycheck-only healthcare workers that nursing is so much more than the paycheck, what does nursing become in the future?

Everyone who has ever been in the healthcare system, as a nurse, as a worker, as a patient, should be concerned about this slide.

I know, I know it is February and I had this planned for LAST Saturday and then the pay for diplomas news came out and Operating Nightingale. Obviously, I had to talk about that.

Anyway, it makes more sense to do the monthly report of my personal school journey after the month has ended. Sue me.

The Spring semester has started! In fact, this is the fourth week, well, we are one day into the fourth week. And statistics is still continuing. Think happy thoughts for me.

The new PhD class I have this month is Theory Analysis in Nursing. I had to do a theory class for my MSN but this one is completely different. Then I had to choose a theorist to write be part of the scaffold of my final project. Now, we are taken all way back to what is theory, the metaparadigm, and how nursing knowledge is constructed. Heavy stuff. My brain feels very full after this class; to say nothing of the deep reading for this class. As expected this is a very paper-heavy class. That’s okay. I like writing papers.

And I know I have been calling it a cohort class. That is incorrect. The proper term is cognate. These are graduate level classes, meant to be taken in a field that I find interesting and that I might be able to use in my dissertation. I took a financing longevity class last semester. Not sure how I am going to be using that in my dissertation but I learned a lot.

The cognate class for this semester that I choose is Informatics in Healthcare. The OR is so very technical and information-driven. I hope that the work I do with Epic and continue to do on the advisory committee will help with this class. And this is a full semester course. We’ve already had a quiz and a discussion post. And a group project to go. Again, think happy thoughts for me.

And then panic-inducing class- Statistical Applications for Nursing Research II. Math just does my head in, you know. Project in this class as well. And the first homework assignment is in. You’d think I would have good recall since the last class was only 8 weeks finished. You’d be wrong! If you don’t mind me, I am going to be reviewing ALL of the first class lectures and my notes for the rest of the week. And working on my project. And doing statistics crunching using SPSS. AND preparing for the presentation of my project. And doing more homework.

Oh, boy! It’ll be okay.

On the scholarship front, I submitted my grades from last semester and a copy of the tuition statement to the hospital for my tuition reimbursement. Hopefully, I’ll get that next paycheck. I also submitted the same grades and tuition statement to AORN for the scholarship I had from them. I got an email that I should expect a check in two weeks. All of that money will go into a savings account in case I cannot teach after graduation and I have to pay back the grant money. Fun fact, I thought I had a 3.0 GPA, but apparently, I had a 3.4 GPA. I’m not complaining.

New semester, new opportunities for scholarships. I submitted another application for another AORN scholarship. I also submitted another scholarship application for the White Rose scholarship which is for the healthcare market that I work in. If I win the scholarships, that would be lovely. The money would still go into the saving account with the rest.

The first semester of the month is always busy. It doesn’t help that the call job has had some very long nights this last couple of weeks.

That’s the round-up for the first month of the new semester. Busy, busy time. But only one class is planned for summer. And it’s ONLINE. Score.

Mantra time- the only way out is through