The post-it reads “running to HR every time you are given feedback.”

And this doesn’t have to be feedback about your job performance, a la the yearly performance review. Although I have heard of it happening then too.

This is gentle correction of a dangerous situation.

Let us pretend the patient, who is on the table, is left unattended.

This is a recipe for disaster. A patient and a CRNA should never be left unattended. At the beginning of the case, at the end of the case, those are the times when it is crucial that at least three people are in the room. The CRNA, the patient, and the scrub tech. Or the circulating nurse. Never just the CRNA and the patient.

What if there is an emergency with the patient that the CRNA has to attend to? There is no one else in the room to summon help. A third person needs to be in the room at all times. The circulator needs a last minute supply that the surgeon has asked, again at the last moment. He wanders off to scrub his hands. The scrub tech also has to leave the room to answer nature’s call before being chained to the table for the duration. And the anesthesiologist, although notified that the patient is in the room, has not yet made an appearance.

This is an unwritten rule. Especially on the evening or night shift when there is only the team in the room. And emergencies do happen.

It happened in this instance. Again, the set-up is the CRNA is attaching leads and other things, the anesthesiologist has not yet made an appearance, the scrub tech needs to go the bathroom. But the circulator is getting a last minute requested supply.

The patient starts to de-sat, or has an allergic reaction to the pre-med. The what does not matter for this story. What matters is the CRNA has been alone with a patient in extremis.

After the patient has been stabilized and the surgery performed, both the circulator and scrub tech get a coaching about not leaving the CRNA alone with the patient. One of them goes to HR because they feel that the coaching was unwarranted. The other makes a mental note to never do that again. For the example set either role can be filled by either team member.

The point is that instead of internalizing the issue, and seeing the problem that could have arisen, one of the two went to HR because they were corrected. Do you see the problem?

This not the first time this team member has been corrected. And not the first time to HR. Too often what should have happened, the delaying of the quick bathroom trip because the circulator was out of the room, was not. Communication tools might have helped here to. The scrub tech could have told the circulator that they would get the item, whatever it was, on the way back from the bathroom. Instead of deciding to go at the same time, knowing that the circulator was not in the room.

Two take homes today.

1) be aware of why the other team member has to leave the room

2) don’t go to HR for every little thing

We are nearly to the next very exciting surge here in the US.

The covid roller coaster is climbing the next hill.

The covid roller coaster is ticking our way up to the next surge.

Tick.

Tick.

The roller coaster car seems to lose momentum as we near the crest to the next free fall and the coaster car is overcoming gravity more slowly. But it will overcome the pull of gravity and send us careening over the top. Some of us acting all cool like it is no big deal, some of us hanging on for dear life, some of us working to protect others who can’t or won’t protect themselves.

Is that not the pandemic in a nutshell?

Will this surge and this variant be the one that tip over the usefulness of the vaccines?

Is this where the virus has learned enough to overcome the vaccines?

And take us all the way back to pandemic square one?

Well, to be fair we learned a tremendous amount about this particular virus; how it is passed, how infectious each subsequent wave is.

Okay, not back to pandemic square one.

But it the virus learns how to circumvent the vaccines… Definitely back to square 3, before the vaccines.

Look, people cry out, look at the declining number of cases. The declining number of dead.

Yeah.

That ceased to be of consequence when states decided to pull back on reporting every day. Some still report every day, some weekly, a few monthly. All this does is decrease the usefulness of the data. And, don’t you know, there is more shiny things to think about and to react to.

Tick.

Tick.

Tick.

The theme for April is coconut cookies. Why? I have four coconut cookie recipes. Why else?

Coconut does not get enough love. Especially in a cookie.

I was going to kick off April Cookie Thursday is a Thing with washboard cookies. I had never heard of these cookies. They are a shortbread, with coconut milk replacing some of the butter, too much flour, at least in the recipe I am using. And a frosting, which I hate, with coconut “bubbles”. The cookie is meant to be striated, like a washboard.

I had my doubts for this cookie, based solely on the amount of flour in the recipe. I’ve been doing weekly cookies for a LONG time now and I know when the proportions are off. The results are edible but bland. Freshly baked but oddly stale tasting.

There is a new grocery store near the hospital. Time to see if there is a bought coconut cookie to be had. Because I am not sure I can serve up the cookies I made.

Nurses don’t get enough love. Especially in court these days.

The backlash against nursing has begun. I wish I wasn’t right about this.

No. This is not a post about going to the theater. Or the symphony. Or a museum.

According to http://www.justculture.healthcare it is the balancing of accountability and safety.

Not only the safety of the patients but the accountability and safety for the nurse.

It is learning from mistakes. Not stifling the reporting of said mistakes.

It is doing a deep dive into why the mistake happened, not blaming the nurse who caused the mistake.

RaDonda Vaught realized and reported her mistake immediately. As she should have. It was a lethal mistake with so many things wrong with it. A perfect example of swiss cheese model of errors that can harm a patient. What happened after that is on the hospital. But we are not hearing anything from the hospital.

Instead, they did not report it as they are mandated to. This was a sentinel event. A sentinel event is an event in which the patient died or was seriously injured. This poor patient and the events leading to her death was not reported in any stretch of a reasonable amount of time.

Was this a tragedy? Yes.

Am I sure that RaDonda Vaught is remorseful? Yes.

Every healthcare system and hospital that I have worked for stresses that there will be no blame. A mistake should be reported immediately so that what happened can be examined.

But I fear that the self-reporting will go WAY down after this. Should a prudent nurse report problems like what occurred? Yes. But no one wants to harm a patient. No one wants to go to jail.

However, convicting the nurse of negligent homicide makes all of patients, mine, yours, the hospitals, a little less safe.

Just for a wee bit of irony, RaDonda Vaught’s sentencing date is May 13, 2022.

The day after the end of Nurse’s Week.

The day after Florence Nightingale’s birthday.

Makes you hum in introspection. Makes you think.

It makes me think.

Edit 4/6/2022 0903 EST: Today news of a nurse being indicted in NC to an inmate death after officers dogpiled on him, held him down with his hands behind his back, ignored him while he cried out for his mother and said that he couldn’t breathe. She tried to help him, no charges for the officers.

Every nurse should be scared.

The scapegoating of nursing has begun.

When I took this call job it was the understanding that I would go back to school in the fall. Now that this is happening, I am also thinking of what I can do with my time outside of school and my new call shift. Apparently I have 40 hours a week, plus commute time, that I can play with.

There is only so many hours that you can read. Even if there is still a pandemic raging, with a new variant causing havoc. And doing housework is apparently a non starter and a mind block that I have.

I like to write. Freelancing may be good for me. But I have an interest with a limited audience group. But never said I couldn’t try.

I love the OR. All aspects. And I think that the hospital system is on the forefront of the new wave of call jobs. While I was at AORN this past month I spoke to every publication that I could: AORN, OR Manager, Outpatient Surgery. And I gathered business cards from everywhere.

I am going to propose an article, perhaps a column that encompasses why someone might want a call job, all the ins and outs of the call job. How it is a freedom of sorts, but not without drawbacks.

I also made contacts regarding writing for textbooks. This is my overall goal for my PhD and my after career when I can’t do active OR nursing anymore.

The goal for April is to reach out to all the publications, looking for interest in a writer. It remains to be seen if there is a market for such a thing.

All I can do is try.

The post-it reads ‘GuideStar shows salaries of non-profits’.

Of all the things I learned at AORN, GuideStar may be one of the most interesting.

It does many things. It is a blog. It is an accounting for all non-profits in the US. It breaks down how much money it has, how much money it has taken in through receipts.

Including its assets.

Fascinating.

I had no idea that such a thing existed.

Of course, to get more in depth information you need an account. I did a cursory look at the CEO of the company I work for. It would not divulge how much the CEO made, without an account.

But any non profit is searchable.

Including the university I will be going to in the fall.

A company that you want to do business, and is a non-profit is searchable. It is a rabbit hole that you can use to direct your giving.

Money does many things. It eases the world.

I will say that looking up non-profits is a little bit addictive.

I would like more information of what are assets and what are receipts.

To be clear, this is merely a snapshot of the non-profit.

It does not tell the entire story.

But it does tell a story.

It gives you information and data to make your own decision.

Okay.

Deep breath.

I chose a PhD program.

I had FINALLY gotten all the various PhD nurses’ letters of recommendations submitted to South Carolina.

And then nothing.

So I chose the UNC-G program.

Both schools are equidistant from my house.

The kicker was that the program in South Carolina’s grant was in beta.

This means that it could go away at any time.

Although a decision won’t come down for North Carolina grant program until May, at the earliest, I decided to go with North Carolina.

Because state pride, right? At the very least, state residency.

And my husband was hesitant of me driving to South Carolina. Why 70 miles South is problematic and 70 miles North is okay, I don’t know. Something about the highway construction.

I submitted to the program yesterday that I intend to enroll. And immediately after I submitted to be a research assistant, which has a stipend that will mostly pay for school. And, as my husband pointed out, looks good on a resume.

Since some scholarship programs need an enrollment to qualify/apply, I panic applied to a bunch more. After the decision had been made.

Because you never know.

That means I have 4 months to whip my house into shape.

Based on past performance I need someone to kick my ass into gear.

A friend came over yesterday and we weeded and container planted a quarter of the front.

Today after the sun goes to the back, I will do another quarter, including the front two flower beds. I am allergic to something in the front. Not poison ivy, but something. Long sleeves it is.

It’s a start.

Comfort month concludes. And we still need a lot of comfort. What is more comforting than frosting? Were you the kind of kid who ate the frosting first? Because frosting. Or were you the kind of kid who denied yourself, just a bit, knowing that the end would be sweeter? Because frosting. Or were you the kind of kid who ate it all together, because frosting can enhance cake and you knew it?

Because however you ate it, frosting was comforting. The inspiration for this week was a honey cake, a babka, that is of Ukranian origin. They are still going through the last time of their lives and they deserve a little comfort. Top off the honey cake with a bit of frosting.

And think good thoughts for those going through hard times.

Because frosting makes the world better.

Unless you’ve been under a rock in the last week, or have your head down in your pandemic hole because you’re still working all the hours that are, a jury found a nurse guilty of criminally negligent homicide last week for a medication error. The medication error that sadly ended in a fatality.

Most nurses that I know, and I know a lot, are in shock.

At any time that could be us on that stand, in that courtroom. Receiving a guilty verdict for something that should never gone to trial.

I can guarantee that RaDonda Vaught did not become a nurse to kill a patient. All of us live with the fear that this could happen at any time. We work with powerful, dangerous medications every day.

We, as nurses, did not become a nurse to be the scapegoat for the hospital’s system bad policies. Or to be convicted for the swiss cheese effect. This is where the system of errors

This will have a chilling effect on healthcare.

On nurses.

Errors will still continue. That’s what makes them errors. They are unintended. Hospitals will still have bad policies that do not protect the nurse.

Nurses will take extra care around medication errors

Let us pretend that there is a patient S. S for seizure. He feels terrible and goes to the ER. Patient S is not a patient not in the system because he was new to the hospital he presented at and normally went to the other hospital system in town. Patient S promptly had a seizure. Because he was not in the system, he was not in the Pyxis (which is the medication dispensing unit). And they were unable to get medication to help him. Because that was an override medication. No nurse is going to override for that medication after this. Because RaDonda Vaught’s story teaches us that we can go to jail for that. Could he die from a seizure? Absolutely. Could he die from not receiving the Valium that would stop the seizure? Yes. No nurse I’ve talked to will override the medication now.

No one.

Will Patient S receive substandard care for not being in the system? Probably. Until all the systems kick into place to release the medication under his name.

You can’t have it both ways. Horrible that Patient S is suffering. Horrible that the nurse is powerless to stop it.

Here’s what I know.

Nurse RaDonda Vaught was stripped of her nursing license in July 2021. After the board of nursing declined to rescind it before.

She was convicted of criminally negligent homicide in the death of Charlene Murphey March 25, 2022. Something the family didn’t even want.

She has yet to be sentenced to jail.

She lives knowing everyday that she caused the death of a patient.

Was she stupid for overriding the medication?

Yes.

Was she stupid for not looking at the medication vial? At the paralytic warning sticker on the vial? For not realizing that the vecuronium was in powder form and needed to be reconciled? Unlike versed which is a liquid.

Yes.

Was a criminal conviction warranted?

No.

Should it even have been sought?

Hell, no.

A root cause analysis should have been done at the hospital level. Changes could have been made. Improvements could have been made. And the patients kept safer.

The system in that hospital allowed this to happen. She reported it right away. The hospital did not. The hospital has not said much about the entire thing.

And the ADA said that “RaDonda Vaught PROBABLY didn’t intend to kill (the patient) but she made a knowing choice.” The word choice of ‘probably’ makes me mad.

So very mad.

None of us became nurses to PROBABLY take care of patients. No. Full stop. We became nurses to take care of patients to the best of our ability.

Like a human. Taking care of a human patient.

Nurses are people too.

District Attorney for Nashville, TN is Glenn Funk. He is up for what purports to be a tough re-election.

He needed a win.

That’s how I see it.

Me, I wonder why the medication was in the radiology department AT ALL.

This could be happening to any of us.

No sooner than we got home at the wee hours of Thursday morning then I got an email from AORN. I am talking 0330 here; after driving 10 hours through the night. Best way to travel.

Well it felt like immediately upon returning home, but in actuality was 1600. What? I had to sleep. And do house fairy stuff including a trip to the library and to get the oil changed in the car. Duly masked of course. I had just been somewhere the positivity rate was classified as moderate.

However, the email I received from AORN was that there had been positive cases among the attendees. Oh, you mean those attendees that ignored the please mask sign? That had no respect for social distancing? Those attendees.

Of course I wore a mask and followed social distancing guidelines. If I felt a place was too crowded, we left. Walking the streets we wore masks.

With a quick glance around the conference floor there were maybe 30 of us who were masked. Including some intrepid soul who was wearing 2 masks, one of them an N-95. There was ample room to spread out in the seats during all the ceremonies: opening, house of delegates x 2, closing. All of them.

Even during our breakfast because we had a bunch of no shows.

But immediately upon closing of the conference, and maybe before, people were testing and being tested.

I feel fine. But I know there is a subset of people who have no symptoms at all.

More importantly, my canary in a coal mine husband who usually gets things first and who I was in very close contact with all week, has no symptoms.

I did my due diligence. And quarantined in the house, or wore a KN-95 mask out. And tested at 5 days post exposure, as the CDC instructed. That put my last exposure at Wednesday afternoon at 1600. Therefore I tested on Sunday at 1600.

Negative.

But some people who were at the convention were definitely ill. Several members of my chapter tested positive. Every one of them alerted the rest of us who had been in close-ish contact with them.

A few of us remain negative.

However, this serves to illustrate my point that I have been making all along. This was a group of vaccinated and boostered individuals. Who are nurses and should know better. Perhaps they should have kept a mask on a wee bit longer.

I believe this is our next normal.

Sporadic infection clusters.

If you need me, I’ll be chilling at the house, between shifts. And going early to the store when I need groceries. Or late. Whatever gets me face to face with less people.