24-adjusting expectations

This was a HIGH bar for me to clear.

My expectation was that I could move heaven and earth to graduate with a PhD in 3 years. Eminently doable, I smugly thought to myself as I signed up. Doing the program in 3 years means that I will graduate before I turn 50!

I’m not sure why that arbitrary number was important. After all, I will turn 50 with or without a PhD.

Also of importance was the fact that I wanted to clear the triple hurdle and get my third degree in 10 years. No matter that the world was on fire in 2020 and 2021. And I was a working hospital-based operating room nurse the entire time.

Who was I competing against?

Myself. That’s who I was competing against.

Because this will not set the nursing world on fire.

Oh, and yeah, 2024 was a horrible year health-wise for me. Horrible. Your forties are like a gift. This is heavy sarcasm.

Sometime in the past months, I came to the realization that the thesis will not be finished and defended by the graduate in May deadline of March 20th. There just isn’t enough time to do all the tasks.

Everything takes longer in academia. And I mean EVERYTHING. Through a series of pitfalls, and, yes the personal physical challenges, and the university challenges, it has taken me 6 months to start my pilot project and 2 months to complete it and finish the class. This process should have taken me 6 weeks to start the pilot project and 2 months to complete it and finish the class.

Okay. I’ve written before that age is just a number and time means nothing. Why was I so worried about the PhD being completed by a deadline I made up in my own head? I will finish this degree in my own time. I should just enjoy this dedicated writing time.

The take-home lesson is that plans may change. Some people might look at a change as the opportunity to drop the idea completely. They would not be wrong in doing so.

Their path is their own.

Your path is your own.

Paths may change. I know that my personal path has taken a few right turns and a couple of u-turns. And that is okay.

Whether you stay on the path or decide that it is not the path you want, the important thing is to keep learning. Being an adult learner is hard but remember the reasons you started on the path and the reasons to keep on the path. Even as it changes underfoot.

You might surprise yourself.

I hope you do.

School Me Saturday 12/14/24- CV reminder

A CV is a curriculum vitae. It is beyond a resume, which may cover a portion of your working and school life. The CV covers all the amazing things that you got to do, not only in your working life, but in your schooling life.

Writing your CV is important. It shows the ways you’ve changed in your working or schooling life and it also shows ALL the things that you’ve done in those lives. These can be awards, committees that you are on, or organizations and certifications that you have.

If you are still at school ask the writing center for help crafting your CV. Do not raw dog it like I did.

Just like you have a current and up-to-date resume ready to go at all times just in case, you should also be looking at your CV and adding things that you’ve done.

I recommend doing this yearly. Or when someone asks for it. I have several saved on the cloud, each named with my name and the year. But, Kate, why keep the old ones? Sometimes you want to reminisce who you were before all the work.

Personally, I update both the resume and the CV every year after I submit and receive confirmation of the clinical ladder. Seven years I’ve been a level 5 at my hospital. That is an accomplishment that makes me proud.

I was polishing my CV for a project not related to school or work when I realized there is a big chunk missing. I was a subject matter expert when the hospital system I work for was building out their EPIC. This means that I gathered with a bunch of other OR people and we hashed out the bare bones of what the EPIC should look like. I went back to the training computers when the build was complete and EPIC ready to release the system’s version to us so I could train other nurses and be the superuser for the surgeons.

The surgeons have never forgotten that I am the point person in the department with EPIC issues. It’s been 13 years and I still field questions regularly.

This was no where on my CV. Of course I had to add it. I also added the part about the subject matter expert and I also updated the non Dispatches from the Evening Shift writing that I do.

The moral of today’s story is when you get invited to do amazing things don’t forget to put it on your CV. Doing so shows that you are willing to take risks and also be involved in the hospital’s affairs.

Today’s homework is to bring up your resume and read it for completeness. Also get started on your CV. Be aware that this may take several passes. But it is so worth it.

Even if the only person you amaze is yourself.

School Me Saturday 12/7/24- last class blues

Someday, when you are nearing graduation, you will experience the last class blues.

The last class is a fencepost. Over the fence is post-graduation, and on this side of the fence is the last paper and the last test and the last lecture that you will experience as a college student.

It is normal to feel a bit sad after each of the lasts.

The last paper you are ever going to write for a class is happening soon or has happened. You might not care what grade you get. Or you might be haunting the Canvas page, waiting for the grades to drop. Both can be true. But the last paper is special.

The last test you are ever going to have to take in college is happening soon or has happened. Again, you might not care what grade you get. You might’ve calculated how many questions you can miss and still pass the test and the program. This last test can be special.

The last lecture you are ever going have to pay attention in and take notes in college is happening soon, or has happened. Whether you are a prodigious note-taker or not, these will still be your last lecture notes. Use them well in writing the last paper or studying for the last test.

The ever-present what do I do with all these notes and textbooks will flash before your mind. This question has different answers for different people. Heck, I still have notes from 1993 and my first nursing school.

You’ve experienced all this lasts before with other classes. But this is different, isn’t it? These are the lasts of the program. Attention and solemnity is appropriate for these.

Some people are saddened by this inevitable end to an era. The era of your college student career, that is. Some people are not and are ready to party. Some people are in between. Some people just want to sleep for a week. All of that is normal.

The gate? The one that separates the college life or paper and tests and lectures, and the post-graduation life?

That’s graduation.

Until grad school, that is.

This might not be your path. You might be a one-degree and done person.

But never, ever, ever, stop learning.

School Me Saturday 11/30/24- Push on through (to the other side)

The song starts with a short cymbal warm-up.

Then the guitar starts laying down a beat.

Then the vocals.

“You know the day destroys the night,

night divides the day.

Tried to run, tried to hide.

Break on through to the other side.”

I am, of course, writing about Jim Morrison and the Doors and one of their best-known songs. It was the opening track on their debut album.

It is nearing the end of the semester. Perhaps you listen to music while you are studying. Or not. Perhaps you listen to music to wind down. Or not. But think about this song with me.

“Made the scene,

week to week,

day to day,

hour to hour.

The gate is straight, deep and wide

Break on through to the other side.”

I can take you all back with me to Peg Garner’s Advanced Placement English class in my junior year of high school, where I learned about poetry. In 1992. And how to analyze poetry. Because music is poetry. Or maybe they are complementary arts. I will let the philosophers decide.

However, music can teach us about ourselves. How to study, the cadence of songs helps here. It also helps if you are so familiar with the song that it ceases to be new and amazing and just becomes like elevator music. But you notice when it is gone.

Then a song like Break on Through (to the Other Side) speaks to you about endings. Because the semester is ending. It is nearly time to put up the books, and to put away the paper and pens and pencils. It is too early to worry about next semester; it is too late to worry about this semester. All you have to do is break on through. Finish the final papers, take the final tests. Do what you have to do to get through. Whatever it is.

Reflection is helpful here at the ending of one thing and not yet beginning of another thing.

Reflect on the semester and what went well and what didn’t. You can promise yourself to do better next semester.

Because there will be a next semester until you are finished with the degree program. And maybe even after that.

You might not be able to quit school.

But that is a problem for future you, isn’t it?

School Me Saturday 11/16/24- It’s here, the final push toward the end of the semester. Isn’t it hateful?

Depending on when your university or college marks the start of the semester you may be 13 weeks in or 10 into the semester. Considering a semester is usually 15 weeks, with an extra week for finals, you may be nearly there at the end of the semester.

Regardless of how many weeks, anything after 10 is practically useless.

Your grades are set, for the most part. Only a miracle can bring you up an entire grade. Only a disaster can plunge you into failing, depending on where your grades usually hover.

I think this is the hardest part of the semester. Students are tired. Teachers are tired. Administrators are tired. We are all tired.

This year is especially taxing because someone put a very pivotal election in the middle of the semester. While not all students are up on their politics, they are probably aware enough to pick up on the durm and strang that is at a boil at the moment. Reminder, the literal translation of durm and strang is that there is a storm and stress. The Germans really know their way around a phrase

And it took me 5 times to type durm and retype durm after the autocorrect that I didn’t ask for changed it to drum. FIVE times. No wonder we’re tired.

It is too soon to start planning your winter break and too late to “fix” your grades. But you should have bought your plane ticket home weeks ago. You know, for the best price.

It is too soon to start planning for the Summer semester. Planning for Spring? That started almost as soon as the Fall semester started. Planning for graduation? That started before your first class, dear.

No wonder we are tired.

And stressed.

According to the dictionary being tired and stressed at the same time means we are burned out.

Writing as a long-term healthcare professional of 26 years and a nurse for 23 years, my first response is no shit.

Writing as a long-term student who is on her third degree in ten years, my first response is no shit.

Take a deep breath.

This is where the mantra the only way out is through is useful.

Insert whatever mantra you use here.

Just keep swimming.

Best Kept Secrets of the OR #9- It’s okay to argue with the anesthesiologist

In my first nursing school, straight out of high school, soaking wet behind the ears, doctors still had a mystique about them. This was definitely true in the Midwest, where I went to nursing school.

These weren’t the days of standing when the doctor entered the room, of giving up your seat or your pen when required.

However, the doctor, usually a man, commanded respect, just by the virtue of their degree.

Well, over 30 years later I know better.

Doctors are just human. Sometimes they make iffy decisions with the aim of getting off the floor sooner. Sometimes they are good allies against surgeons who want to cut to cut, not to save a life.

It is absolutely okay to push back on them.

Just like it is absolutely okay to push back on the surgeon, or the charge nurse, or the CRNA.

This is part and parcel of protecting the patient.

After all, as the circulator, you are the wall between the patient’s well-being and the rest of the team.

But, be a wall that has some flexibility in it. And don’t be afraid to call them on their bullshit.

They won’t like it in the short term, and you might get written up, but you will know that you did the best for the patient that you could in the moment.

For example, there was a critically ill patient that we worked on in the middle of the night years ago. This patient was in bad shape, tanking blood pressure, holding on to their carbon dioxide, and getting more delusional with it, sky-high heart and breathing rate. The kind of patient you just know, in the pit of your stomach, is circling the drain. Urosepsis in a big, bad way. The anesthesiologist was so focused on getting the numbers that they wanted for the pre-op they were standing in the way of actually helping the patient. I told them that the only way to start helping this patient was to let the urologist put a stent up the ureter and if we delayed any longer for a BS reason, they might not survive that. The anesthesiologist, taken aback, stared at me for a moment. After all, who was I to demand that they treat the patient, no matter the number. They opened their mouth to yell at me and glanced at the patient, who was deteriorating by the minute. Swallowing whatever vile thing they were about to spew they gestured to the CRNA and asked what was taking so long.

Eye roll here.

But confronting them at that moment was the correct course of action. It allowed us to get the patient to the room that much faster, to go to sleep that much more smoothly, and to get the stent placed that much quicker. We did take the patient directly to ICU, still intubated, after the 10-minute case. The patient was exhausted and would probably get sicker before they got better. Two days later, I was dropping another patient off in the ICU and I saw the uroseptic patient and their family in a room. They were looking so much better that they didn’t even look like the same person, who had been gray-faced, panting, and moaning in pain and delirium 58 hours before. When I stopped in the room, of course, they didn’t recognize me, but the spouse did.

This is an example when speaking sharply to the anesthesiologist was worth it. The shock of me being a patient advocate and telling them that the only way to cure the patient was to stop dicking around chasing the perfect number really worked in the patient’s favor.

Don’t be afraid to call an anesthesiologist an ass, or a surgeon for that matter. My job was the safe, TIMELY procedure for the patient.

And I stand by it.

Post-it Sunday 8/11/24-um, OR nurses should interview the patient BEFORE the CRNA brings them back

The phone note “Are OR nurses going out to see their patients prior to meeting them at the door of the room? Is this not a done thing?”

If so, why not? You get to meet a patient who has probably not had any mind-altering medications (ahem, versed) and can assess many things in a 2-minute conversation. You can allay their fears. And the fears of the family member, who you can also meet. Put a face to the person who is taking care of their loved one behind the double doors.

Most importantly you can quadruple check the NPO status. I have a story for this. Once upon a time, I was the last person to interview a patient. Anesthesiologist, pre-op nurse, CRNA, other pre-op nurse, CNA, surgeon. And she lied to them all. Why she chose to tell me the truth, I don’t know. The patient, who was in her 80s, giggled at me and whispered to me she had had chocolate cake on the ride in to the hospital. Case canceled.

You can establish rapport and assure them that there are humans behind the masks and the aforementioned double doors. There are people involved in their surgery beyond anesthesia and the surgeon.

I chose this topic to be a Post-it Sunday because I have heard that the newer nurses are not going out to interview. Instead, the focus is on starting the chart.

I have heard this from multiple people.

Um, excuse me?

I am deeply unsettled by this report.

This leaves the patient and the nurse and the hospital in a delicate situation. All it takes is the CRNA bringing the wrong patient to the wrong room and introducing them to the RN at the door. Per policy. The patients are sleepy because of Versed when they hit the doors to the OR.

Boom!

Clusterfuck of immense proportions!

Not to mention Lawsuit City!

I must investigate further.

School Me Saturday 7/6/24- beyond the rabbit

Happy conception day to Alice in Wonderland! On July 4, 1862, Lewis Carroll was on a river trip with friends, including the three daughters of a friend. Through the journey, Carroll told the girls the story of Alice in the Underground. This, of course, became Alice in Wonderland.

Alice is beset by curiosity. That is what prompts her to follow the White Rabbit, who is the representation of time. Or rather time slipping away.

University, or college, or classes above or even in high school, represent time. This is the time that the student has to devote to learning a new skill, or learning about themselves (as discussed in a previous dispatch), or finding a new profession. Or just exploring for exploring’s sake.

All of this takes time.

For me, I first started nursing school in 1993, after I graduated college, got hurt, and rehabbed myself back into a different nursing school in 1998. This was the time that I lost because I was injured. After graduating in 2001, I did not return to another nursing school until 2015. That doesn’t mean I had stopped learning. It just means that my learning was in a different realm. I learned how the OR and how to be an OR nurse. Fifteen years ago, long before I considered returning to school, I studied and tested for my CNOR. I passed 15 years ago today.

However, this time was not wasted even though I wasn’t actively participating in formal education.

Adult learners should never stop learning; it keeps the mind sharp and nimble.

To keep my CNOR I need to do 135 hours of continuing education over 5 years, 100 in the OR. Nurses especially have to continually be learning. To be licensed in their state requires some form of continuing education. The number of hours depends on the state.

Not everyone wants to go back to school, and go back to school, and go back to school. However, every adult needs to keep learning.

What form that takes is up to you.

Learning is never time wasted.

School Me Saturday 5/18/24- Brown v Board of Education

No, this is not an Alice in Wonderland School Me Saturday.

This is to celebrate the 70th anniversary of the landmark education case that was the Brown v Board of Education. This was to end the forced “racial” segregation of the black students and the white students.

This has been hailed as the start of school desegregation. And is known as a very good thing (literary reference).

Now, some people definitely thought this was a bad thing. They rioted and threw several fits over the very idea that the schools be desegregated.

They are still fighting. In my home state of North Carolina, the super majority legislature decided that it wasn’t fair that wealthy parents have to pay the entire cost of educating their precious children in a private school and they decided to start a school voucher program that does allow some disadvantaged students to attend a private school but mostly is a give away to the wealthy. After all the school voucher program, which is already out of money and holding their hand out for more, doesn’t cover all the cost of the private school. The parents of those who win have to pony up the rest.

It does further the interest in undermining public education which has been on the wishlist of those who don’t like public education. You know, the ones with the test scores, and the oversight. Especially the oversight.

I wonder how that will go.

As I tell my fellow operating room folks there is a reason for a policy and a rule. This does away will all the rules. Except for the ones that you can break with impunity because your daddy or mommy has the money to buy you out of whatever scrape you find yourself in.

I also wonder what Supreme Court Justice Earl Warren would make of the rollback of our rights.

I bet he would be disappointed in the current Supreme Court.

With their Originalism and their desire to control women.

By what means necessary. After all, have to ensure the continuation of the White Male Race, even if they have to steal a uterus to do so.

Apparently this School Me Saturday was School Me Saturday and Top of Mind Tuesday all in one.

Oops.

Brown v. Board of Education happened 21 years before I was born. The effects have been widespread and those who dislike it have been determined to undermine it.

Same shit, different decade.

Dispatches from the Evening Shift end of semester impromptu vacation

The end of the semester can bring up many feelings.

Too often the weeks and days leading up to the end of the semester are busy, busy, busy.

Final projects.

Final papers.

Final presentations.

Yeah.

All of those.

I was gonna contradict myself and say that there were no presentations. But there was one.

I would say the majority of my feelings are exhaustion.

I don’t want to read for school, I want to read for pleasure.

I don’t want to write for school, I want to write for pleasure.

In the past few days, I’ve mostly been reading.

A lot.

Like a lot a lot.

The Women by Kristin Hannah was the first book I read. It is about the forgotten women in Vietnam, the nurses. Oh, so good.

Maddening and tear-jerking all at the same time.

This country did those women dirty.

Oh, and I worked a few shifts in there too.

After my last 10 hours as an RA.

And it occurred just now that I didn’t turn in my last time card.

Oh, dear.

Okay, that isn’t what I said. But drat!

And it was due today.

Bother.

I’ve got to get that in.

Oh, and I’m on my fourth and fifth antibiotic of the Spring. Can I use that as an excuse?

Too late, because I’m gonna.

Tomorrow I will write another Dispatch from Wonderland regarding school life.

I can’t wait to find out what I’m going to write about.

Time card first!