Call bootcamp’s next step- Epic optimization

I do a one on one call bootcamp for the operating room. I have done this for years, far longer than I’ve been in the call position. I also did a LOT of buddy call. Habit, you know.

I got an email about AORN EXPO 2027 in Philadelphia. This was an email looking for abstracts for podium presentations due at the end of the month. The abstract for poster presentation, the one I am most familiar with, is due on July 20.

A good call bootcamp takes about an hour and a half. I gauge the new nurse’s familiarity with call.

And then we begin and it is NOT with a call to the nursing supervisor.

I start with showing them the Call Preserver binder that is behind the OR desk. This is the book that I’ve mocked up that is basically a FAQ, with explicitly explained steps. I give them a copy of the “My pager has gone off, now what?” This explains, in detail, the different steps of being called in and what can be expected of them as the call in one.

Next, I optimize everyone’s Epic program for them. Together we move things around, hide other things that they’ll never use, and find the ER dashboard. This is also where I amaze them by adding two sections to their flowsheet section they had no idea of. These are the perinatal post-mortem for miscarriages or D&Es (within the bounds by our state law), or the hysteroscopy flowsheets that does the math for you. Of the fifteen nurses I’ve done bootcamp with zero have known that the hysteroscopy flowsheet exists.

I explain useful things that are within Epic and I explain to them. Like the Bedboard, an at a glance depiction of the hospital. We discuss what the colors of the different rooms and how to differentiate the different units. I highlight that this is the best place to look for beds if the patient is going to be admitted and why it is important to know what higher level of care beds are available. This is where I indicate it is useful to call the supervisor to “reserve” a bed in ICU, or, if the ICU is full, to alert them to the need for an ICU bed.

Other than that, I try not to bother the nursing supervisor. They have an entire hospital to keep up on.

I explain how to schedule a case on the Snapboard. If the surgeon has put it in. If the surgeon has not, we talk about how to create a case and the questions to ask a surgeon about the case. By this I mean instrumentation desired for a fracture, or robot availability.

We talk about what if it is a surgeon we’ve never heard of and what to do to make sure they have privileges to do a case at the hospital. Because if they are not credentialed to work at our hospital, via temporary status or courtesy status, it is technically assault if they operated at the hospital. Pearls are usually clutched in this part of the talk. We all want to take care of patients, including the docs on call. It is a paperwork issue, mostly, but I’ve had to refuse a surgeon or two when they didn’t have any privileges or status at the hospital.

Many of the things in the Call Preserver is how to deal with unfrequently asked questions. I update the book frequently, especially if there is a change in policy around anything to do with the hospital.

As the PACU nurses won’t be called until 30 minutes before they are needed by the call nurse, I explain to them about Quick Prep and why the 8 fields that are to be filled out are better than the 30 fields that ACU does when they prep a patient.

Our consents are now electronic and have been for over a year. I show them the iPads that patients use to electronically sign the consent. This usually yields questions about what if no one is there for the patient and they can’t sign the consent. This leads to a conversation about who can sign a consent legally for you in the state.

The Epic optimization takes about 1/3 of the hour.

All along the way, I am answering questions and giving them real world examples.

Tuesday Top of Mind 5/26/26- North Carolina House Bill 1232

To these 2 chuckleheads in the NC state house life begins at conception.

Who wants to tell them that 25% of those lives don’t make it through no fault of the carrier?

These 2 idiots propose a constitutional amendment to the NC constitution that declares “LIFE BEGINS AT CONCEPTION”.

Yes, the capital letters are mandatory.

This would mean that a fertilized egg that has not been implanted would be recognized as a legal person. And anyone who “willfully destroys” that fertilized egg could be charged with first degree murder. Which is a capital offense. Which means the death penalty is on the table.

Beyond that, there is a deadly force clause. Which means that “any person has the right to defend the life of another person, ‘even by the use of deadly force if necessary'”.

Right.

Which makes all abortion providers liable to be assassinated because their killer(s) were only defending the life of another person. Meaning the fertilized egg that may or may not be in the uterus. And may or may not be more than 8 cells.

Every single health care provider would be at risk.

I’ve participated in abortions as the circulating nurse in the operating room.

And what about those 25% of concepted cells that fail to implant, or fail to grow, or reside in the fallopian tube where they are an active danger to the coman?

Would we then have marauders who are thugs sent out because someone was disappointed that there was a miscarriage?

Probably, we are in the South.

Eight people have been murdered in the US for providing abortion care. What about their rights?

Or does the miniscule, hard to see with a naked eye clump of cells trump all of our rights?

Is that it?

No, it is about control.

Because IUDs and other medication that work by limiting implantation would be on the chopping block in this insane bill.

So would birth control itself.

They will say that this is not about birth control or IUDs or IVF. Of course they will. Whatever to get this bill passed and in front of the largely unknowing public. And then it is open season on healthcare workers.

I did bring up the murder of a nurse and the attempted murder of a healthcare worker in a meeting of highly educated nurses this week. You know, the ones I wrote about last Tuesday? it was appropriate because we were talking about hospital safety. Yeah, no one blinked and they just went on to the next topic after saying that is why we have security guards.

Tuesday Top of Mind 5/5/26- Further bullshit about vaccines

News came out last month that the expected March Covid report would not be released.

Because of joint shenanigans at the CDC, the FDA and the DHS.

They don’t want us to know that the covid vaccine remains safe and is an effective way to not end up in the hospital if you contract covid.

The FDA is also actively blocking the publication of research findings that the covid and the shingles vaccines were safe.

Why?

Who the fuck knows.

Probably because the good news in the report that the vaccines are safe and effective run counter to their fairy/horror tale that they tell themselves that vaccines are bad. The same bullshit they feed to unsuspected people who just want to do the right thing for their families.

This is not the promised transperency.

I wrote recently about how we are not being told the entire story. How you need to read up on what is being missed or delayed or held back or misconstrued. How to find trusted sources. How to not believe what the administration wants you to believe.

Double that.

Hell, triple that.

If you need some sources that I’ve vetted and explored, just ask. I will tell you.

Read the studies that are being blocked yourself. Read the abstract, it contains most of the information that you are searching for.

Or read/watch other’s reactions to the studies. I particularly like Dr. Zach Rubin, the Unbiased Science, Your Local Epidemiologist, and even the Alt National Park Services page on Facebook.

Again, we only being served the pablum that they want us to eat and swallow wholeheartedly.

It might not be the truth.

They are suppressing the truth and the studies.

But these and other pages and substacks are trying to get the information out to us.

You know, so we can make our own decisions.

After all, that is what they say with their whole chests.

But you can’t make an informed decision with half of the facts.

Call Secrets of the OR- Do not assume that the case will be less than posted

There is a universal truth for charge nurses. MDs might be less than truthful to get what they want.

A surgeon might whine and complain and complain some more that they absolutely need to be out by 1400. Never the six cases.

I’ve written about that before.

It is usually about flights.

Of fancy maybe.

The inverse is the surgeon who spies a very very very very minute gap in the schedule. And bluffs the charge nurse that they can absolutely do a 2 hour case in 20 minutes.

Balderdash.

It’s giving desperate. It’s giving Druzilla and Anastasia as they chop off bits of their feet to fit inside the glass slipper. Because their mother told them to to snare the prince.

The only prince around here is the sweet sweet spare time that I imagine all surgeons desire.

99% of these cases run over. And tee time is missed. And TEA time is missed. And flights that never existed are missed.

Mostly because the doctor doesn’t want to wait.

I say put them to work. Give them a mop or a wiping cloth for the room that the last patient vacated 30 seconds before. Show them how to bag trash. Show them where to put the trash.

And watch their head explode when you say that the products used have a 10 minute dry time.

Most importantly, remind them that the consent for the surgery that you both know very well will take longer than the 30 minutes promised. That consent must be signed. And the H&P written.

Or, you know, make them answer the phone that is ringing every 5 seconds. You could do.

We’ve had Epic for more than 10 years now. That is a lot of time for the computer to learn average case times and also be more truthful about how long a surgery will really take.

Surgeons don’t like being told no. But the downstream patients will appreciate you not letting them squeeze in a case that is going to take 10 minutes max.

Notice how the time goes down with each iteration.

Yeah, so do the charge nurses.

Tuesday Top of Mind 4/21/26- One hand gives and the other hand looks through your pockets looking for loose change

Yes, this is a Princess Bride allegory. When Miracle Max says the only thing to do for someone who is fully dead is to go through their clothes and look for loose change.

It reminded me of something.

It reminded me of Joann fabrics. This was an amazing craft store that was bought by private equity and liquidated and sold. RIP Joann’s. My friends bemoan the loss weekly.

It reminded me of Party City, which met a similar fate. Of course they did.

It reminded me of the trouble that Red Lobster is in. Because of private equity.

Talk about going through their pockets and looking for loose change.

It also reminded me that in 2025, RFK Jr. and the department of DHHS cancelled five hundred billion dollars in grants. Some of those grants were for cancers.

Because they thought private equity would be able to do it cheaper.

Have they ever met private equity?

Whatever gave them that idea?

I bring this up because a positive mRNA story is all over the main stream media. They are heralding the use of an mRNA vaccine for pancreatic cancer. This is one of the most deadly cancers. You can’t turn on a television without it playing somewhere.

Don’t get me wrong. This is a big win, one of the biggest.

However, with the short sightedness of the DHHS, what other wins are going lacking? What other possible wins are dying on the grant tree?

We may never know.

How many people could’ve been helped?

We will never know.

There is a phrase that I use to describe a lot of hospitals- penny wise and pound foolish. To me this describes the entire situation. Don’t be too quick to save a penny, to lose a pound for the want of the penny.

But then, private equity and pharmacy benefit managers and hospital CEOs are only out for the money. It isn’t about the little people who could’ve been helped by a new kind of drug therapy. It is all about the cost savings. The savings isn’t for the normal everyday people; it is for the rich who don’t understand the concept of having enough.

Hooray for the positive news about the pancreatic cancer mRNA vaccine that has helped a few people.

What about the others who died in agony?

Wasn’t cost effective, was it?

Tuesday Top of Mind 4/15/26- Great, now there are known gender disparities for those who receive life giving care (CPR/defibrillation) in the field

I do not watch the Pitt. Many, many, many people have told me that I need to watch the most groundbreaking show that illustrates what hospital life is like on a crazy shift.

No thank you, I live it enough.

I mean, ER started my sophomore year at Creighton. It aired on Thursday nights and all the nursing students would critique it in class on Fridays. That is the goal post that I have in my head and nothing has measured up to it.

But in the latest episode of the second season of the Pitt that aired April 10th, a woman came in with chest pain and coded and nearly died because her paramedics (sad pouty face) didn’t want to disturb her bra.

I personally can handle exposed breasts/titties if it saves my life.

Just saying.

In the clips that I have seen of this scene, Robby (the head MD) asks the women in the room “Hey, ladies in the room, show of hands. Death with modesty or life with brief nudity? Death or Life? Look at that. Turns out women want to live”. He says this to what I presume is the head paramedic.

No bra, no matter what the cost, is worth a life.

It takes me back to my very first ACLS (Adult cardiac life support) instructor (before they got fancy and called it ALS [advanced life support]). She stood at the front of the class and told us that the first thing you do in a code is take your own pulse for a brief second. Now that you have ascertained that YOU are not dead you can help the patient who is.

I use similar phrasing when I run the Call Bootcamp for the hospital. I was asked if the responders from the hospital, from the ER and the ICU, need to put on bunny suits to enter the OR. I said no, the patient isn’t getting more dead. So there wasn’t any risk of infection.

This made me curious so I did a quick Google search. My search terms were are women less likely to receive defibrillation.

Spoiler alert.

Yeah, women are less likely to get bystander CPR and defibrillation.

Of course we are.

There are hits from the Duke University School of Medicine from 2024, from the National Institutes of Health in 2023. From Science Direct in 2026.

From the American Heart Association itself in 2024.

The list goes on and on and on.

Save a life, expose a breast.

That is the very very very very first thing I leaned when I took CPR in high school.

Expose the chest, make sure there are no barriers, or standing water.

It’s like a demented Little Red Riding Hood parody.

But grandmama, what pretty bra you are wearing.

Call secrets of the OR- Absolutely let the family speak to their loved one before surgery

Emergency surgery is a fraught time. Obviously it is out of the blue and most families and patients are not prepared for surgery “out of thin air”. They cry grandma and pop pop were just fine yesterday. Can’t you hold the surgery, just for them to get to their loved one.

This is a painful no.

There is so much that the patient and the family don’t know. The patient is in pain and scared, the family is scared and want to do everything they can for the patient. But what if the family is not in the hospital, or even in the same state?

You allow the phone call between the family and the patient.

Full stop.

Even if it is in the middle of the night, you allow that phone call.

Because not all surgery has the desired outcome, especially emergent surgery. This is most likely life or limb related. At the very least it is performed to stop the hemorrhage, to stop the infection, to repair the open fracture where the bone is sticking out of the skin so that the bone doesn’t get infected. Middle of the night surgery is not something anyone chooses. But it must be done.

Our duty as the call nurse is to be prepared for every eventuality for every case.

Our duty is to facilitate the phone call.

Not everyone is up to this task and would rather be in their own bed in the middle of the night.

This is not something the call nurse is guaranteed.

But that is why we do what we do. The call nurse is the umbrella over the OR team, the patient, and the anesthesia team. You have to know a lot and anticipate a lot for the surgeon and scrub tech, for the anesthesia team, and for the patient.

You have to be able to see all scenarios for every case. And respond in a timely manner to all of them.

But absolutely let the family and the patient speak before the patient goes back. You can spare a minute to let that happen.

Because we won’t know the outcome of each case until it is done.

Sometimes you have to persuade the surgeon that a slight pause for this conversation is in the best interest of the patient and their family. That family ties are some of the strongest in the world and they need this communication touchstone.

Because, even under the best intentions of the OR team and the case going perfectly, it might be the last time.

And that is a gift that we can give the family.

Tuesday Top of Mind 2/24/26- Disease round up that we have vaccines for but for some reason people have been lured away from them

Wow, that’s a long title.

But, hey, it gets my point across.

I will be writing about 2 diseases today. The big 2. Well, the big #1 and the self own #2.

By that I mean flu and measles.

Well, they are both self-owned by the anti-vaxxer crowd.

I will start with the measles, which is running rampant in South Carolina. SC has 632 CDC confirmed cases in 2026. This year alone. South Carolina is not alone in this. There are 117 confirmed cases in Utah, 64 in Florida, 35 in Arizona, and 24 in Washington state.

This is a complete self own by those who doubt medicine and think that some influencer on the internet knows better. Or that some idiot at the DHS knows better, even thought none of them have been through the rigors of medical school, internship, and practice. There are the stray quacks who have sided with the anti-vaccine crowd, for the likes and the attention. These quacks feed the confirmation bias that is rampant.

All together this makes nearly 1000 in 2026, on the FIFTY FIFTH day of the year. There were 982 on February 19th.

Nowhere to go but up.

As a super quick recap of measles cases since the advent of the second shot in 1990.

1990- 27,808
1991- 9,643
1992- 2126
1993- 312
1994- 899
1995- 308
1996- 492
1997- 141
1998- 100
1999- 99
2000- 85
2001- 116
2002- 44
2003- 56
2004- 37
2005- 66
2006- 55
2007- 43
2008- 140
2009- 72
2010- 63
2011- 220
2012- 55
2013- 187
2014- 667
2015- 191
2016- 86
2017- 120
2018- 381
2019- 1,274
2020- 13
2021- 49
2022- 121
2023- 59
2024- 285
2025- 2,281

This is a big, big deal. The United States is on the cusp of losing its Measles Elimination Status. Elimination status is when there isn’t continuous domestic growth of a disease for 12 months. The United States earned its measles elimination status in 2000.

How far we have fallen.

So called social media influencers have a lot of blame to shoulder. Yes, I blame them and the mommy groups who are just out for a buck and no where to be found when your child gets sick.

Our World Data has a nifty graph which is where I got the information. Link is at the end of the post.

The second thing I notice about the number spread? 2020 was a bang up year. I wonder what else happened then? We all know what happened in 2020.

The second so called winter disease that is also sickening and killing people is influenza. Also a disease whose vaccine is readily available and safe, safe, safe. No matter what the influencer that is only out for a buck would tell you.

There have been 71 pediatric deaths from the flu this season so far. In the 2024-2025 flu season there were 280 pediatric deaths. 90% of those children were not vaccinated for influenza.

A quick side note, this season’s flu burden is the highest that we have seen in TWENTY-FIVE years.

Yes, pediatric flu deaths are down, a bit, so far for this year. But even 1 death is too many.

Again, this is a problem that a certain subsection of the cash hungry influencers have gifted us.

I know I speak for many, many, many, many other healthcare professions when I say stop it. We are tired. It has been a long fucking 6 years. Let us rest. And stop killing your children.

https://ourworldindata.org/grapher/number-of-measles-cases

Call Secrets of the OR- Call shift is great until you can’t find a supply at 0200

Job is still cool.

There are still a lot of positives. This is a post about the second negative- when day shift makes a massive floor move, ignoring why the rooms are set up nearly identically, and gets rid of half the shit that isn’t used every day but when you need it you need it.

Yes, the rooms are set up nearly identically. I am referring to the supplies in the supply cabinet.

But, but, we never do general surgery in room 1, it is an ORTHO room.

Wrong.

You have never done a general surgery case in room 1.

Lots of us have.

In the before times, long before you were a nurse/tech/surgeon at this hospital, room 1 housed the robot. And even then the cabinet was identical to room 2, room 3, and room 4.

This is the before times when the hospital only had 4 operating rooms. You wouldn’t’ve recognized it.

The cabinets were all set up to be identical.

And that was so that any case could be done in any room by anyone.

This is to decrease the amount of out of room time a nurse might spend during a case. Any case but especially a call case or an evening case when we don’t have the wherewithal to scream out the door for “somebody” to get us something.

By wherewithal I mean other people.

In the daytime there are lots of people rushing about cleaning rooms, turning over instruments, opening rooms, giving breaks, giving lunches, helping out.

Yeah, no such luck at night or even during the evenings.

I count that as a positive for evenings or nights. It makes you think on your feet and prepare your room better for the case at hand.

When I train people for the evening charge role, this is big selling point that I make. No managers, no charge nurse besides yourself, nobody is around.

When I train people for the call nurse role, this is a big selling point. No one is immediately around to help. There are people you can reach out to in a pinch and I’ve written about that before.

Day shift is just too… Too busy, too loud, too many people. All wanting to go home unless they want to ride out the clock.

Nights/evenings get it. It is mano a mano with the OR team. Except it isn’t a competition with the OR team, it is a competition with the reason the patient needs surgery in the middle of the night.

But I digress.

Day shift has all the time in the world to make changes to make the OR in the image of their last hospital.

Things get moved. A lot.

Things get deleted from stock. Things that are rarely used but are used all the same and is the only thing to work for scenario X. A lot.

The now 9 rooms are siloed into specialties.

But not every case is that specialty and not every case “fits” in that room. I do except the robot room. The robot room is highly specific to the specialty and the robot. I agree with this. But the rest causes me to run at night.

And don’t get me started on the dismantling of the identical suture carts that had been in every room. The suture on these carts are basic suture that every specialty might need. And an emergency sutures like 3-0 silk for a stitch to stop bleeding.

This entire post boils down to “If you move it/delete it/there has been a change in supply” tell the night shift call team. Because how else would they know except for when a surgeon asks for it in the middle of the night?

The operating room recently changed out some of the GI staplers. And didn’t tell us. Which led to me running around like a chicken. In an emergency.

I am not asking for much. A friendly “hey they got rid of X and replaced it with Y” would’ve sufficed. Instead of making the call team look like idiots at 0200.

Yes, yes, there are communication papers everywhere. In the elevator, at the desk, in the year binder. But did you write it down? So that the call team could read it and be prepared?

No?

That’s what I thought.

Pretty, pretty please stop making changes to the OR supplies and not cc-ing the call team with the information.

With sugar on top.

That would really help us give better care to the patients. They deserve a circulator that is present for the surgery, not off fetching and carrying because you couldn’t be bothered to inform us of changes.

TTYM.

Tuesday Top of Mind 12/30/25- Nursing homes to no longer require nurses on site 24/7

Fun fact I bet you maybe knew, I started as a CNA in a nursing home.

I worked nights in a small 4 wing nursing home. There was the acute wing, for people who had just had surgery and were getting better or who just needed a little more time to recover from their injury/illness. And then there were 3 other wings that had 12 rooms each, with only 1 room being private. The other rooms either had 2 patients or 4.

That’s a lot of patients.

I worked nights and it was the four CNAs, one for each wing, a registered nurse for the acute side and a registered nurse for the rest of the hospital. Yep, that is over 100 patients for the sub acute registered nurse to chart and to medicate and to declare death and to call doctors’ offices if there was an emergency overnight.

This is per shift.

I worked 4 nights on with 2 off at the end of the stint.

Not good for the bank account as there were some paychecks that always ended up a bit short.

But the point is that there were at least TWO registered nurses onsite per shift. I believe day shift had more because of med pass.

There has now been a federal staffing rule change from the 2024 federal staffing rule that Biden’s administration put into place.

The Biden’s staffing rule for nursing homes was that
1) there were at least 3.48 hours of nursing care per resident, per day, with 0.55 hours from registered nurses
2) at least 1 registered nurse had to be onsite 24 hours per day, 7 days a week
3) these were the minimum standards for Medicare and Medicaid certified nursing homes. Nationwide.

In late 2025, HHS and the Centers for Medicare and Medicaid Services issues an interim final rule rescinding these mandated staffing levels. Including the hours per resident per day and the 24/7 nursing requirement. But wait, there’s more, they left the assessment and planning expectations in place

This was touted as a savior to the rural and tribal nursing homes due to the, you guessed it, nursing shortage. Folks, there has been a nursing shortage for as long as I can remember. But HHS ran the numbers and realized that 100,000 additional caregivers, CNAs, LPNs, and RNs, would be needed to fulfill the 2024 staffing rules.

There was pearl clutching I am sure.

By the owners, who didn’t and don’t want to hire additional workers to fulfill the 2024 staffing rules.

This is a gift to the nursing home owners.

Registered nurses are expensive. Because they are the front line between their patients, numerous as they are, and HHS. They recognize medication errors and mistakes. They recognize when a patient is not acting as expected and may be having a heart attack or a stroke or sepsis because of a UTI. They do the daily dressing changes and are expected to assess the wounds to ensure healing

Who cares about the disabled person, or the elderly person who will no longer be expecting the minimal level of care? This is a roll back of safety standards. The RNs will be replaced with cheaper staff. No shade to the LPNs but they are different job classes with different job roles. And assessment? Is in the registered nurses’ toolbox.

And if an elderly person dies because of the lack of supervision? Not the nursing home’s fault, they cry.

More savings to HHS and an increase to the profit margin for owners.

It isn’t about the people who have lived entire life times in the beds, it is about the bucks in their pockets.