25- Call bootcamp

There’s this thing I do with new to the OR nurses or new to our OR nurses. It is called Call Bootcamp and I am the guru.

I’ve been taking all the call for so many years it has become my favorite.

And so I teach the new ones about how not to fear the call.

I call it Call Bootcamp. This is where the new nurse and I meet for about 60-90 minutes and talk about call. I also optimize their Epic situation to make it work better for them everyday. Not just on call.

I’ve done this well before the call shift. I used to buddy call with the new nurses and get them comfortable with call. I’ve done this for at least 10 years.

But I have never been able to justify the little call bootcamp on my clinical ladder. There isn’t a space for education items that are not posters or ANCC credited in person experience. That is my next step but it is a helluva lot of work and I have never dedicated weeks of my life to getting ANCC credits for the work.

The following is an attempt to get credit for the call bootcamps that I run. These are not part of my job description but rather are born from wanting to get a new nurse the best shot at a successful call shift.

1) How did you determine the date, location, and time frames for in-service? How did you communicate information to promote attendance?
This is a rolling in-service for new hires to the OR. These are one on one sessions that are not part of my role. When a nurse is deemed ready to take call for the department, the session is set though the assistant nurse manager. This is not expected in my role.

2) How was the need identified for this educational offering?
Surgery call is specific to the types of cases that you might encounter on call. Each time you are called in follows a pattern. This need was identified in new employees, many who had not taken call before. I was the natural answer to this need as the week call nurse.

3) Resources utilized?
None as I was available because of the call hours. The new nurses are paid for their time. Each call bootcamp takes 60-90 minutes, depending on their experience with call.

4) What is the objective of educating the team member?
The program objective is to familiarize new nurses to the call process at this particular hospital. This is done by a mock run through of a call case. From initial contact with the nursing supervisor, scheduling the case, picking up the patient/arranging for transport, picking the case supplies, doing the pre-op checklist through the Quick Prep tab of the operating room navigator, signing consents, doing the actual call case, when and how to call the recovery room team.

The new nurse and I walk through surgical services and talk specific to the OR things and specific to call things. Highlighted is the overhead call system, and the code button location in the OR. Specifics of code situations in the OR are discussed as well as where to find the department code carts. The silver anesthesia emergency binder is located and gone through with the nurse. In the PACU, the highlights include the Broselow cart, the Malignant Hyperthermia cart, the supply room and what might be needed from there. In the ACU, explanation of the pregnancy testing on all patients per policy and where the kits are, the supply room in the ACU is explained. The availability of the test tubes is discussed and demonstrated. The location of general ACU supplies are demonstrated. Matching Broselow band location is demonstrated, specific to pediatric patients, along with a discussion of how important it is for the responsible parent to have a band on as well. Tips and tricks specific to the call routine are discussed. I want them to be at least familiar with emergency procedures in the OR that can happen on call when there is a skeleton crew.

The Epic platform for each new nurse is optimized for the operating room. Specific to the OR flowsheets are added to the flowsheets (perinatal demise, and hysteroscopic use). Location of the code button hyperlink is explained but not demonstrated.

The Call Preserver notebook is highlighted. This is a step-by-step FAQ of specific OR things- including blood administration, how to schedule a case, how to put in a culture, what information is necessary to book a case, what specific orthopedic instrument sets are on site, how to use the iPads to do the surgical and anesthesia consents, how to run a code, and more. With a section of the supervisor has called me and I’m on call, now what?

The tour ends with the location of the call sheets. These are the pages that list who is on call for the day. In this hospital there is a call sheet for OR, PACU and Endoscopy.

5) Describe the benefits of the education to the unit/department?
Being on call is a scary proposition for new nurses. It is basically a mini shift, alone in the department with only the other call people and surgeon to rely on. This Call Bootcamp sets them up for success by answering their questions in a controlled environment when there isn’t a patient on the table, or a surgeon staring at you. I continue to offer support after the bootcamp by encouraging them to call me with any call question when they are in the middle of a call case if necessary. In the last week, I have received phone calls about specific supply locations, scheduling a case, and where the tonsillar bleed bovie was located.

By making myself available I alleviate their fears. Sometimes I do their first call with them. It is one thing if you are lectured about what to expect, it is another thing to actually do the thing. I iterate and re-iterate that I am always available for questions, should the need arise.

All of this stuff and there still isn’t a place to take credit for it. Shame.

Call Secrets of the OR- What to do when there is a screw up with the call sheets that you tried to head off and a day shifter got called in when they shouldn’t’ve

Well, that’s a run on sentence.

This exact scenario actually happened less than a month ago.

You see, for my 49th birthday my sister had gifted me tickets to see Cary Elwes (the Dread Pirate Roberts aka Farmboy aka Wesley from The Princess Bride) for January of this year. That was when his house burned down in the Los Angeles fires. Understandably the show was cancelled and rescheduled for May. And then that show was cancelled and the money refunded to my sister.

She asked me to pick another show. We ended up going to the Postmodern Jukebox when it was here locally. It was awesome.

But the show was on a Thursday. I calculated how many hours of PTO I would have to use to cover the show and the driving home. Four hours. I asked for 4 hours off. On the calendar that everyone’s time off is posted I made a notation over my name on that day that I only needed coverage until 2300.

I fully intended to take 2300-0700. Like the good little call nurse that I am.

I called the OR in the afternoon to check on the call sheets reflected that I would be on call after 2300. They assured me it was correct and to have a nice time.

My conscience was clear and I went off to enjoy a dinner out at a new to us restaurant and a rollicking good show. Side note, if you are sleeping on these performers stop. Check them out on YouTube right now. My personal recommendation is the House of the Rising Sun.

I was home at 2300, as planned, and reading, also as planned, when the PACU call nurse texted me at 5 to midnight that the nursing supervisor couldn’t get ahold of the call nurse.

But…but I’m the call nurse.

I checked.

I texted the PACU nurse back.

I called the nursing supervisor and got the surgeon’s name and number.

I called the surgeon and arranged for surgery time to be at 0100.

I called the surg tech.

I called the nursing supervisor back and told them that I had spoken the surgeon and gave them the time and that I was on my way in.

I got in to the hospital, changed, and scheduled the case. Just like a normal night call case.

Suddenly the OR core door opened and it was a day shift nurse. Called in to do the same case I was setting up.

whomp, whomp

The best laid plans.

I told them to go home. And that I would handle it and also handle the necessary conversations with the evening nurse I had spoken to.

They went home.

I picked up the patient from the ER and delivered them to the PACU nurse who was there out of time because they had been called by the supervisor before they texted me. Which was the thing that started the cascade of unfortunate events.

We did the case.

I had a long conversation with the new to the job nursing supervisor. I gave them point blank instructions to call me with any problems in the future.

The next day I had a long conversation with the person who had assured me the call sheets were correct. They hadn’t even looked at the call sheets when I called them.

aaaarrrrrrrrghghghghgh!

Next time I want a half shift off, I will call the supervisor myself to check the call sheets.

But kerfuffle aside the patient needed the semi-urgent care and the OR was happy to provide.

Oh, and I also spoke to the new to me surgeon as well and gave them the sitch about call at this hospital. I also encouraged them to call me if they needed to do another night call case in the future.

Call Secrets of the OR #4- Every call shift will end… Tomorrow!

The shift will end
Tomorrow
Bet your bottom dollar
That tomorrow
There’ll be sleep!

Just thinkin’ about shift end
Clears away the cobwebs
And the sorrow
’til there’s none!

When I’m stuck in a shift
That’s long
And forever
I just stick out my chin
And grin,
And say,
Oh.

The call will end
Tomorrow
So I’ve got to hang on ’til tomorrow
Come what may!

Tomorrow!
Tomorrow!
I will sleep
Tomorrow!
Sleep’s only a shift away!

Apologies to Martin Shaman and Charles Strouse for co-opting and re-writing their hit “Tomorrow” from the Broadway musical Annie.

As a night shifter, I know that sleep is very important. And some nights we don’t get a lot of it. But that is the nature of the call shift. Sometimes there isn’t a lot of sleep, and sometimes it is a full night of it. You have to be able to roll with the schedule.

The first thing my university advisor asks when she sees me is “How’s the sleep? Are you getting enough of it?” Yes, Dr. Advisor, I am getting enough sleep. I have data points to share if you are interested. Maybe I should make it into a graph for show and tell purposes.

That being said, and knowing that not everyone tracks your own sleep patterns, there are some things that can be done in your sleep environment to prepare yourself for good sleep.

Is the room cool enough? A University of Texas sleep specialist, Dr. Okeanis Vauu, reported that sleeping in a cool dark room is recommended. After all, our brain wants a cooler temperature while we sleep. This information is from a UT article on sleep after the spring forward time change.

But it is definitely appropriate for sleeping after a call shift.

The dark room during the day may be harder to accomplish. I have purchased black out curtains until I am blue in the face but they are never dark enough. Next I found and purchased black out blinds that you cut to size. I cut and installed these after the first month I was on call.

Instant bliss. Not to mention cooler.

In the summer, I also put up heavy curtains in the adjoining bath because of the afternoon sun that 1) heats up the small room, and 2) is blindingly bright.

My husband works afternoons/nights and is glad for the additional window coverings.

We don’t have children to get off to school or children at home. Unless you count the cat, who insists that I get out of bed by 0800 every morning, whether or not I’ve worked the night before. But I have heard that can be a barrier for some.

Sleep when you can. Some people can go right to bed when they get home and this is a good habit to get into.

Because you never know when the next case will pop up. There have been times that I’ve been home and in bed for 15 minutes and the darned pager went off again. And I head back to the hospital for another case.

Thankfully those kind of nights are hopefully far apart. And if it is a string of late nights just remember that day shift will be in a 0700 to relieve you so you can go home and sleep.

No bad pattern lasts forever. Some last longer than most but that’s call life.

I find it best not to focus on the sleep you’re missing but instead focus on the good sleep you will get the next day because you won’t be responsible for day cases. And the hospital won’t be ringing you up with add ons.

Remember, there is always a shift end. There is also a finite amount of time that the case volume can hurt you and stop you from sleeping.

These tips are coming from a call afficionado: make your room as dark as you can, and make your room as cool as you can. Fans are a good help here.

And take the afternoon nap when you are able to. Especially if the house is still and silent because everyone else is away at school or work.

Pay attention to your sleep hygiene and practices while on call. Well, any night really, but especially on call.

Call is only a sleep debt if you want it to be.