Call secrets of the OR #1- Know call time is not your own

Instead of Best Kept Secrets of the OR I thought instead to start a new subset of Wednesday. This is going to be Call Sets of the OR.

I got the idea last night when I had a surgeon, a CRNA, and the surgical tech all tell me that the case we were about to start would horribly. I reminded them that we could not know that and I believed in the power of positive thinking. That thinking and speaking negatively might just create the very negative reality for us and the patient.

No wonder they called me Pollyanna Puke on the floor.

But that is another call topic for another time.

The very first call secret is one that I know that a lot of my fellow operating room people fail at.

And that is knowing that the hours you are on call is not your own. By that I mean that the hours are not yours to do with as you wish and you might get called in during that time. But if you are called in, you are unpleasant and drag your feet on everything.

That is no way to create a positive experience for the patient.

Look, having to undergo semi-urgent or emergency surgery, because that is what the call case make-up should be, is no walk in the park for them. The patient has to be NPO, dressed in tissue paper, have an IV, and have anesthesia. This might be run of the mill for us but maybe they’ve never had surgery before and they are scared out of their wits.

Or maybe they’ve had surgery before but it was years ago when they were a kid and all they remember is being cold and dressed in tissue paper and surrounded by people in funny blue clothes that are not their mommy or daddy and being held down and having to breath in a yucky gas and then nothing until they wake up in a too bright room with yet more strangers and their wrist or their ears or their tummy hurts. And so they are scared out of their wits.

It is rare to have a patient who is laissez-faire about having surgery.

The patients are who the call nurse needs to be thinking about while they are on call. And how to make their experience smooth and efficient.

It is a mind shift for sure.

Make it less I HAVE to go in and more I GET to go in.

Do I know how to make the mind shift? No. The only thing that I know is that the brain is kind of like a muscle. You have to work on changing your own mindset.

Frankly, it can take some time, and repeated calls.

Ultimately we don’t take call for ourselves. Some of us might take call for the extra pay, or to pay back a favor to a coworker, or so that a coworker will owe you a favor. A lot of people take call because it is mandatory. Those are the calls that I took, back when I was the evening charge nurse and scooping up all the calls. Because the person whose call it was didn’t want it.

So don’t make plans. Your call hours are not your own. At the very most make vague plans. And realize that a call from the supervisor can and will change them in an instant.

North Carolina is going Surgical Smoke FREE

dun-dun-DUN–dun-dun-DUNan–dun-dun-DUN-dun dun

This is the opening guitar riff of Smoke on the Water by Deep Purple. Go to YouTube and check me. You know that I am right.

It was 8 years ago that I recognized that other people, often with less years in the OR, would react to the shall we say unsightly odors of some surgeries. Smells would hit me later in a case than others. A surgeon and a tech would react to the smell of an appendix or open abdomen and it wasn’t until it was closer to me such as when I was collecting the specimen that the smell would make it to my scent receptors, and I would become aware of what they were talking about.

This was a very gradual awareness, brought on by what I assumed was a very gradual over- exposure to the bovie smoke.

Let’s talk about the effects of surgical smoke. It has been compared to smoking 30 unfiltered cigarettes per day. Surgical smoke also contains arsenic, smoke particles, people particles (live tissue fragments), e-coli, SARS-Cov-2 (aka covid), toxic gases, benzene and hydrogen cyanide. It can cause a decreased sense of smell, asthma, allergies, chronic bronchitis, chronic sore throat, and even chronic lung diseases.

Forthwith I became aware that my sense of smell had been altered by 23 years in the operating room. Many of those years were in heavy surgical smoke plume cases- total joints, plastic surgery, and open abdomens.

Surgical smoke is created by use of an electro-cautery device, most often a bovie. This piece of electrical cautery equipment was named after the Dr. William T. Bovie who developed the electrical cautery machine in 1926. This was used to stem the bleeding cause by incisions and surgery.

In 2018, Rhode Island became the first state to enact legislation to ensure that all hospitals and free-standing ambulatory centers used a smoke evacuator in the OR. Many other states joined them- Arizona, Colorado, Connecticut, California, Georgia, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio, Oregon, Minnesota, West Virginia, and Washington.

AND NORTH CAROLINA!!!

We make the 19th state that has elected to protect their nurses, scrub techs, surgeons, and patients.

Smoke free is a misnomer. It is a short hand way of saying that the surgical smoke plume is contained at the site of surgery with smoke evacuation.

However, Governor Josh Stein just signed it into law. To go into effect January 1, 2026.

The hospital system I work for started mandating surgical smoke evacuation during covid. Because, as you may have noticed above, covid is carried by surgical smoke.

Did I write this legislation? No.

However, I have written, and spoke to surgeons, and written legislators, and called legislators, and signed petitions. Basically, we kept up pressure. I even used surgical smoke legislation in the Health Care Policy and Ethics class that I took fall semester 2023. This was when the NC legislature was waffling about it. I did presentations and wrote papers about the dangers of surgical smoke and the importance of going smoke free. I shared the papers and presentations with anyone who asked.

I needed this win today.

Oh, happy day!

Tuesday Top of Mind 6/3/25- News flash- We are going to die!

The title is referring, of course, to Joni Ernst, an erstwhile senator from Iowa, and her reaction to a concerned constituent at a Town Hall event.

The concerned constituent yelled “Someone is gonna die”.

They were, of course, talking about the long standing plan to cut Medicaid. The bill that has us all on tenterhooks and reacting to how awful it is has passed the House and is at the Senate.

Her reaction, which launched what seems like a million articles, was to say “We are all going to die.” I’m not lying when I say it is giving “let them eat cake” energy.

Her probably supposed to be a joke (maybe) landed with a thud heard around the country. I say probably because that is the type of person she appears to be. Laughing at someone else’s pain. Voting consistently to harm others.

Her response to the backlash was to release a video and continue to joke about how she didn’t know she was telling grown adults a truth. The video was in a cemetery.

She also outed the tooth fairy as not being real. As always she completely misses the point.

Yes, everyone dies. It is a fact of life. There is a finite number of days that each person is granted. You can try not to die by wearing your seatbelt. Or, I don’t know, getting vaccinated against known killer viruses. You can exercise and eat right but that does not forestall death. None of us made a deal with the devil.

Everyone dies.

It is in the manner of death that is important.

The concerned constituent’s point was less o, save me, great and powerful senator, and more people are going to die badly.

Because they will.

Without Medicaid people no longer will have access to even the bare minimum of healthcare. Things like A1c checks for diabetic control would be too expensive for people. Women will no longer get cancer checks such as a pap smear or mammogram. Why? Because they can’t afford it. Cancer will no longer be caught in a treatable phase.

People will die in agony.

Entire towns and cities will suffer as hospitals close. This has already started happening. Becker’s Hospital Review, something I read myself, states that there have been 16 hospital closures in 2025. This rate is up from 25 in all of 2024, and overclocks the 14 cited by OR Manager as closing in 2023. To do the math that is just over 3 a month since January 1st.

People will die.

From neglect, from delayed diagnoses, and from Congress not giving a fuck.

Yes, we know, senator, that everyone will die. But do you have to add fuel to the fire as we all burn to death? Yes, even you.

I know I would prefer not to be tortured to death. Because none of us are getting out of here alive.

School Me Saturday 5/31/25- Personal school dispatch

Well, I’ve not done one of these for a while now. In fact, I can’t remember the last one I did. And I find that is completely normal. After all, the not so stated plan for a PhD program is to remake you. It just might take a little longer.

In the beginning I was so energized and full of zeal to learn. What a difference three years makes. I am still energized about learning. I am still zealed (?!?) to learn about research.

Here comes the big but.

If I followed my learning timeline of what classes and when I was supposed to graduate at the beginning of May 2025.

Spoiler alert, I did not graduate in May 2025.

All of the core classes are completed. My pilot study has been completed. I even presented a poster based on the pilot study in April at the AORN convention and I am slated to present virtually at the hospital system research symposium in the beginning of June. I am also responsible for a virtual symposium presentation in November.

Yes, all based on the same research from the pilot. The last two are podium presentations where I have to actually talk to people. Maybe there will be a podium, if not I will pretend.

All of these different presentations, the poster and the podiums, is known as dissemination. Getting the information that I’ve worked very hard on for over a year out to the public. Well, other healthcare professionals.

Instead I had the most challenging health year of my life. Getting older is not for sissies. Midlife crap threw me for a loop. We don’t talk about that enough as women and I am so excited that perimenopause and menopause talk has entered the conversation in the mainstream. Perimenopause can cause a host of problems and I had most of them. Cutting to the quick of it, it certainly made my life hell in the last year and certainly knocked me for a loop. But that is a blog post for another time. And not the core reason my school plans got knocked a little awry.

That not so lovely reason is the 2024 election.

And the crap fall out from that.

Suddenly research was under even more stress, if not outright attacks from the people who find it more profitable to pretend not believe in it.

And then the attacks on the institutions who have massively contributed to our modern way of life through their research began.

Every day it felt like there was another strike.

And another.

I felt as if I had to bear witness to it all because someone has to be paying attention.

It was exhausting. Kind of like never ending bullshit torture akin to what I think being waterboarded feels like. Except it is shit decisions that have set the research community back many years. So many years.

All I could do was hold on and not give into the numbness that this crap is supposed to engender in people. Because that is their endgame.

I felt like we were thigh deep slogging through shit.

And then something flipped the mental switch.

I went from mad at the situation and the relentless attacks on research, on institutions to mad that they were making me doubt my path.

So what if research is a skeleton of what it used to be? I will be part of the resistance.

So what it publication is under attack and will no longer be the same. I will continue to write these dispatches.

So what if teaching jobs and professorships and colleges and programs and universities are retrenching their program offerings and job listings. I will continue to teach as I have, in small settings like the Call Bootcamp I run for new to the hospital nurses.

Because we are at war.

This is the “watch me” mad that fueled much of my other academic endeavors.

They think that they can make me stop? Through their pretend shock and awe campaign against the American people and institutions? Though unending waves of nonsense and threats and more threats?

It was a bad idea to make me mad to the “watch me” level.

Watch me resist this crap. Because I believe in science. I believe in research. I believe that colleges and universities. I believe in love. I believe that people have to right to own who they are. I believe in LGBTQIA+ rights. I believe that people have the right to read whatever they want to read, to watch whatever they want to watch. I believe that people are not pawns for the establishment.

You want me to fail because I am older? You want me to fail because I am a woman and that makes little men feel bad?

Fuck that.

Watch me succeed.

School Me Saturday 5/24/25- Graduation month!

With the staggered start times and the staggered lengths of programs of course graduation lasts an entire month.

No, not the graduation itself. That is a very busy day where you wait in the late Spring sun and sweat while listening to all of the speakers and watch the parade of students crossing the stage to receive their diploma. Depending on what level you are graduating at, you might hoist a beer to celebrate.

Whatever level of schooling you’re graduating from, congratulations.

This is the moment that makes all of the late nights and the late assignments (!) and the worry and angst worth it.

Being handed the diploma by the dean or principal is a momentous occasion and should be savored. Until they hustle you off the stage for the next graduate.

But for today, the sun is shining. Today the birds are chirping. Today the flowers are blooming. Today your family is beaming. And sweating a little because, did I mention it, it is nearly summer!

Graduation is a special time. I hope that you had special speakers.

Like the University of Maryland who was able to book none other than Kermit the Frog!

His speech was amazing. Do yourself a favor and google that right now.

Kermit spoke of finding your people and making connections.

This is easy to do at the high school, college and university level. Everyone is there to learn. No one is telling you what you know and what you are learning is wrong. Not so in the outside world.

However, the first point of finding your people aids you in the second point of making connections.

Even if the connections are with people who are decidedly NOT your people. That is what makes the world go around after all, the different species, and types of people.

After all, it is like Kermit closed with, making the rainbow connections is important. And he SANG to the crowd a snippet of his famous song “Rainbow Connections” from The Muppet Movie.

Find your people, make your connections, and I will see you on the other side. Maybe I will get to join you in December. Or next year.

Until then, keep your mind thirsty and filled with new information and don’t let the world’s events and bad crap allow you close off your brain. We need all the open minded people we can get. We also need people who are PAYING ATTENTION.

Best Kept Secrets of the OR- Frequently asked questions that new staff have part 1

Awhile ago I asked everyone I could in the OR to contribute questions that new nurses might have. And I was not disappointed.

During this limited series I am going by each person’s response.

The questions run the gamut from existential to practical.

For this first post in the series I asked myself what would be the questions I expect new nurses to have floating through their heads at least once.

I wrote down two questions that I know I had when I started in the OR.

The OR was different back then. At least for me.

It was a 3 room OR but we only had enough staff for two of the rooms. The big autoclave was only run once a day, maybe. The rest of the time we made do with flashing. That is the immediate use steam sterilization to those who don’t know. Being people who are keen to use acronyms where there has not been a call for one this is shortened to IUSS. Otherwise known as the flash.

Bear in mind that this was over 20 years ago and the policies that are in place now around flashing were not yet written.

It was 2001 and I had fought mightily to get my senior experience in nursing school in the operating room. The school really didn’t want me to do it, they wanted me to be a good little med-surg nurse. Little did they no. But I finally prevailed. And I showed up for my first experience day as an almost graduated ADN nurse. This was it, the final hurdle.

Only to find there were no scrubs in my size available.

As an aside, most ORs provide the scrubs to the workers. Because no one wants to take home dirty scrubs and wash them in your own washing machine. Also because no one wants to bring in home germs (AKA outside germs) into our as clean as possible rooms.

But there were no scrubs in my size available. I wore scrubs that were two sizes too big. I just shrugged and rolled up the sleeves and pants.

My preceptor for the day was a ditzy blond who took me through the admittedly small department and introduced me to the unit secretary, to the cleaner, to the PACU staff, to the boss, to the charge nurse and, finally, to the surgeon who was preparing to start a case.

The surgeon looked down their long nose at me from their superior height and sniffed. To the preceptor they murmured that perhaps I could hug the wall. Or watch from the hallway.

The preceptor just laughed and said that I wouldn’t cause any trouble.

They led me into the room, explaining all the lights and colors and sounds as the scrub tech opened supplies while watching me.

For those who do not know, the OR can be overwhelming at first. It is cold. It is bright. It is loud. I shrank back into my too big scrubs and just watched.

My preceptor positioned me next to the window. Yes, the OR had a window. Mind blowing to me all these years later. They left to interview the patient and check with the anesthesiologist and told me to just watch the scrub tech.

They left the room after warning me not to touch anything blue.

The scrub tech didn’t say one word to me.

My first question to myself, after I was finished being overwhelmed with the noise and the cold and the light, was “Where do I stand?”

After all, I didn’t want to interrupt the scrub tech or the surgeon or the anesthesiologist or the patient.

All these years later, knowing that where do I stand was my first question in the OR, I am careful to reassure any tourists I get in the OR (these are what I call the outsiders in the OR) that if they accidentally touch anything blue we could fix it as long as we know.

I have other rules for the newbies. But that is the first one. Stand where you aren’t going to touch anything blue.

School Me Saturday 5/17/25-Preparing for a fall college fair

It’s been a minute since shared governance put on a college fair at the hospital.

There are a myriad of reasons so go ahead and pick one.

The pandemic. The four bulwark members were on zoom meeting for over a year.
Lack of interest by hospital members. We were too tired, too demoralized by watching the public ignore common sense protections. See reason 1.
The Great Resignation. This hurt the hospital in so many ways as people sought to make more and go to travel nursing or people left the profession all together because of, you guessed it, reason 1.

But now the units are bulking up their shared governance presence and interest. Even though some departments are still hurting for staffing they survive.

Seems like the perfect time to stage a comeback for the hospital college fair.

At one of the last college fairs we did, there was an overarching theme of “What if healthcare isn’t what I want to do for the rest of my life?” There were a few requests for colleges and trade schools that were not healthcare related.

Fair enough. Because not only do we have nurses and techs and CNAs who want to further their education, they also might have husbands and wives and children who want to do so as well.

I want to make this fall’s college fair at the hospital the most inclusive one yet.

Nursing schools will be represented.

But so will schools that have something other than nursing.

I have to start calling and emailing places soon.

Just as soon as we have a firm date. You know, other than “fall”.

Ideally it would be just before or in the of tuition reimbursement application window. Those dates I know.

Wish me luck. I already informed the president of the hospital that this was something shared governance was hoping to host in the fall. I also laid out the reasons for inviting not healthcare related school. They were fine with it although they would prefer that the team members stay at the hospital.

Again, fair. But we have to allow those team members who want to fly to fly.

You know?

Best Kept Secrets of the OR #24- There is always one

This can apply to many, many things.

There is always that one surgeon who demands perfection, except from the people they like. The one who tirades and demands and threatens but only if you are not their chosen ones. You know, the ones who flatter the surgeon and know which side their bread is buttered on. And then use that access and favoritism to get what they want.

There is always that one team member who rides the clock like it is their business. These are the ones who go home late “because they were doing X”. Even though no one asked them to do X and another person had been assigned to X but the first person perhaps overrode the second person who gladly gave up X. Go home means go home.

There is always the one surgeon who asks for something that they’ve used for twenty years that only came out two years ago. Reacting and dealing with the insanity of this is what keeps us young.

There is always that case that looks like it will run over and that makes you sweat bullets and frantically plan to get the team out on time. You end up calling the call team in only for the case to finish 15 minutes before the end of shift. And now you have the call team there and nothing for them to do.

There is always the one team member that drives you incandescent with rage. That’s it, that’s the end of this instance. There isn’t anything to do about that one team member. We all have our trials. If it makes you feel better you are that team member for someone else.

There is always the one policy that infuriates the department. Until you realize why the policy was created. Hint, it usually has to do with safety, both staff and patient.

There is always the team member who works in the background, quietly. They are not the squeaky ones and they don’t cause the drama. These are the ones that should be cultivated and celebrated. Be aware they may not enjoy much being made of them.

There is always that one patient who you always remember, long after they are gone. It is memories like this that keep you in nursing.

School Me Saturday 3/29/25-Suddenly, all at once

Spring Break is over. I hope you had fun because now is when the real work begins.

But, Kate, I’ve been working hard all semester, in all of my classes with readings and lectures and papers and quizzes and tests.

Oh my.

I know. Trust me, I know. But think of Spring Break as the 7th inning stretch.

Yes, I know that I am mixing my metaphors here. Or I will be very shortly.

The end of the semester is barreling down upon us. Which means the projects that most classes have been working toward for weeks will be due soon.

This makes students panic. Knowing that there is a large amount of work to be done and a suddenly, all at once, finite amount of time to cram the work into.

Don’t panic.

Of the several universal truths from The Hitchhiker’s Guide to the Galaxy by Douglas Adams, the most important is DON’T PANIC.

You see if you had read the book, you’d be at least smiling now..

Another universal or, in this case galaxial truth, cheating is not the answer. Just ask Zaphod Beeblebox, the hapless leader and President of the Galaxy. Because 2 heads are not better than 1.

The biggest takeaway from the book is that it is not the answer that matters. Anyone can give you an answer, especially since AI has entered the chat. Anyone and anything can give you AN answer.

It is knowing that the answer is not the right answer is where the true learning begins.

Deep Thought spent several millennia thinking on the meaning of life. Their answer was 42. And it did not expound on what is the meaning of 42. To be clear, the meaning of life and the semester is not to get a 42. By any measure that is a failing grade.

True learning is not knowing the answer to the random question but WHERE and HOW to find the answer. Because that will survive the memory reset that so many students do at the end of the semester.

That is what the professors want you to know.

FFS Friday 3/2/25- Fra-gee-lay

If you grew up at any point past the 1980s you are familiar with this pronunciation.

In A Christmas Story, the dad, AKA Old Man Parker, is unboxing a prize that he had won filling out punny word puzzles from the newspaper. The clues all resolved around a play on words around a lady’s knee. The prize, as we all know, is a woman’s leg, in fishnet stocking and garter, with a gold satin lamp shade.

This is the big prize that he has won.

Some prize. He was expecting a bowling alley to be the prize and get the leg lamp instead.

Anyone else feel bait and switched by the events after January 20th?

Like a bomb has gone off in our administration and we are shaking apart at the seams. And the gleeful spoiled brats are shaking the tree to see what will fall out?

We know they are uncaring about the chaos they have wrought. As long as they get their tax break it will be worth it. No matter that those of us will get less than nothing.

Beats a poke in the eye with a sharp stick, we will console ourselves.

As a society we are on edge, unable to concentrate? Near tears at most times? Unsure which executive order will be the one that will bring us to our knees. Or fully rend the fabric of society, leaving the worker bees to pick up the pieces and bear the entire weight of the now changed world while the lords are in their counting house, counting out their money.

Yeah, that is by design. And part of the entire plan that we told you was the plan but so many of you believed it when they denied it. How is that working for you now?

As a society we are feeling fragile. At least some of us are. The ones with empathy. Is that word even allowed anymore? It is one of the No-No words for research or public institutions because it hurts a white man’s feelings of superiority.

Worse yet are the ones who are gleefully watching the destruction, the fires that they set dancing in their eyes, unaware that the conflagration that they have started will consume everything, including themselves. It’ll be worth it to them, owning the libs.

It begs the question, what kind of fragile?

Fragile like a man’s ego?

Paper thin, will punch down at anyone or anything that displeases the ego?

Or…

Fragile like a bomb.

Thick outer shell, maybe filled with pieces that are intended to hurt whatever has triggered it.

Yeah, we’re all feeling a little fragile these days.

We must chose; fragile like a man’s ego or fragile like a bomb?