Happy Nurses Week 2025 5/7/25

It is Nurses’ Week once again.

Funny how that happens.

This is the week that nurses and nursing are being celebrated.

If 2020 was the Year of the Nurse and Midwife that marked 200 years since Florence Nightingale’s birth, then simple math makes this 205th year. You see what I did there.

There have been other notable nurses besides Florence Nightingale. Many, many, many. The nursing theorists whose work guide us. The original nurses who worked to provide us with structure.

Clara Barton and her work on the Civil War battlefield come to mind. As does her star achievement of the American Red Cross.

Dorothea Dix was a contemporary of Clara (can I call her that?) and advocated for mental healthcare of soldiers. She also was concerned with the mentally ill poor people and helped established mental hospitals.

Margaret Sanger who worked as a nurse in the tenements of New York and founded Planned Parenthood. She was also instrumental in the birth control pill development. She, too, was probably sick of women dying in childbirth.

Mary Seacole was a Jamaican-British nurse who was a contemporary of Florence (can I call her that?). She was the first Black woman who authored and published an autobiography in England.

Lilian Wald was a nurse whose passion was for safer living conditions for the poor in New York City. She also started community nursing and was an advocate of nurses in public schools.

Harriet Tubman was a nurse whose concern was for the Black soldiers of the Civil War and the newly freed slaves. She is best known for being a conductor on the Underground Railroad.

This is not a complete list. In fact, this is a living list and being added to constantly.

Giants all of them. Today’s nurses stand on their shoulders and fight many of the same battles. Hygiene might be better. There are better medications and treatments but at the heart, nurses remain the same.

Our reason for professional being are the people who need us. Not just the patients, but the doctors and surgeons and people on the street as well.

I have been a nurse for 24 years and I wouldn’t do anything else.

After all, I have big shoes to fill. My mom, the nurse I want to be when I grow up, is still working after 52 years.

Post-it Sunday 11/17/24-all the hats nurses wear

The gown card reads “In the day’s culture it is not enough just to practice nursing, you must also wear different hats.”

This is a bit of a tricky one. I wrote this gown card at a nursing symposium on November 6, 2015. I know because it is listed on the card. I also know because I remember that symposium. It was one of my first in shared governance. I wasn’t involved in the planning of this one, but I was expected, as the hospital chair, to be present and participate. The theme for this one was “Batter up.”

No, not really. But it was baseball-themed, coming less than a week after the end of the 2015 World Series.

There I was, in a very new environment, soaking up all the excitement of the speakers and my fellow shared governance chairs. I took copious notes. Three gown cards full. And I have bitty handwriting.

Something the keynote speaker must have said struck me. It was probably about having to do all the things and be all the departments after hours, as a nurse on the floor.

While I was probably not the only operating room nurse in the room, I was definitely the only OR nurse on the team.

This was when I started to advocate the OR nurse’s inclusion in all aspects of hospital life. I was the first OR nurse they had ever had on the hospital chair level of shared governance. I volunteered for other committees, so many committees, so that the OR could have a voice in all of these committees, and shared governance meetings.

Nurses have to wear many hats. This is true. We have to be our own unit secretary at times, we definitely have to function as a CNA at others, and we have to pinch hit for plant engineering when things go wrong and no one is available to sort out the problem. We also have to be able to figure out the computer charting and also how to troubleshoot when things don’t work the way they should. We have to be able to fix or find another route for a piece of equipment that is definitely older than our nursing career.

While we are doing all of that, we also have to take care of patients. We have to make sure that the bedbound is repositioned every two hours, that the diabetic gets a blood sugar taken before they eat, that morning and evening pass medications are given. And for those of us who do not work the floor unit life, we have to make sure that every surgical case goes as expected. That ALL the equipment that is needed is available and ready, and we also have to find a workable solution when there is a failure. Don’t forget about making sure the proper instrumentation is available and sterile for each surgery, and if there is an instrument that is dropped where to find a replacement instrument because you know that what hit the floor is the only one.

No one nurse is better or worse than another.

We all wear the hats.

We all wear all the hats.

But we are nurses first.

School Me Saturday 10/12/24- mentoring the younguns

This afternoon I was at the grocery store. My cashier was a young bubbly sort who waxed rhapsodically over the brown sugar I was buying. I told them I baked cookies weekly for the operating room department that I worked for. Therefore, I need a LOT of brown sugar.

They were equally enthusiastic about the operating room. They thought that must be so cool.

I assured them that it was. And being an operating room nurse was amazing.

Even if, or because of, all the patients are under anesthesia.

They confessed that they were looking at nursing as a career.

You know, after they graduated from high school. In 2 years.

The thing about being a nurse is that we always feel the need to give back, to give advice on nursing as a possible career. Or to offer encouragement when it is needed.

They asked about my schooling, and how long it took to become a nurse.

I said that was a complicated question.

My ADN took about 2 years. Plus six months on prerequisites.

My BSN took about 18 months.

My MSN took about 2 years.

And my PhD, well, I was in the third year of the program.

They looked astonished by this outpouring of information. And a bit intimidated.

Reining it back, I encouraged them to give serious consideration to becoming a nurse. And the best way to start is with an ADN degree. And that not all nurses did all the other schooling.

The ADN is the foot in the door. Whatever they did after that was icing on their cake.

They said they had always wanted to work with kids. I smiled and said that kids need surgery too.

They grinned and told me to have a good rest of my day and that they would think about what I said.

I didn’t want to tell them that my nursing license was old enough to drink.

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.

Post-it Sunday 6/9/24- Don’t be fooled

The gown card reads “Don’t act like you think I’m a moron and I won’t act like you think I’m a moron.”

Look the people who work in the OR and are nurses and doctors are very smart. They have to be. We deal with the intricate workings of the human body. We have to know every part of it, and the mechanism of action of each of it. Not only that, but we have to know all about medications and their actions on every portion of the body.

There is a reason for such a steep learning curve for new OR nurses and techs. There’s a lot to learn. Not only that, you have to learn to anticipate what the surgeon wants. There is a reason that I reassure lap appy patients that if the surgeon falls out (passes out) during surgery the tech and I could band together to finish their surgery while we wait for assistance. It makes them laugh and relax. I once told a surgeon that I tell people this and they laughed and said after 23 years they would hope so.

The point is don’t discount anyone’s intelligence. No one; from the orderly to the circulating nurse.

There is also a soupcon or even a heaping cup of misogyny in there.

There is a prevailing “wisdom” that nurses are nurses because they aren’t smart enough to be doctors. I usually don’t respond to that. Who else is going to carry out the orders and question them when they are inappropriate? Many a life has been saved by a nurse refusing an order as written. Many a license to practice medicine has been saved by the same thing.

Some of us don’t want to be medical doctors and never have wanted to be one. Someone has to watch out for the patients and protect them from everyone else.

Let’s make a deal, you and I.

Don’t act like you think I’m a moron, and I won’t act like I think you are one.

Okay?

I’m glad we’ve had this talk.

Oh, and leave the patronization at the door, will you.

It just clutters up the workspace.

Tuesday Top of Mind- March 19th Certified Nurse Day

I know I just wrote about how recognition can be cringey. Especially for an introvert.

However.

Touting your accomplishment is not cringe.

I’ve been a certified nurse operating room (CNOR) for 15 years now. I just renewed!

When you are in a specialized area such as the operating room, emergency room… heck, all hospital areas are specialized and all have their own certification.

But what does certification mean?

It means that the nurse

To me, it means that the nurse cares enough about the processes of their care and their patients, to study hard, find a certification test, often pay money out of their own pockets to take the certification test. Yes, it means an additional set of letters after your name, but all the certified nurses I know say it is not about that.

They speak to their dedication to the art and care of nursing and this has caused them to want to be certified. It is not about the money. It is about showing everyone that you are proud to be a nurse. It is also a declaration of what kind of nurse you want to be.

To the certified nurse, nursing is not about the paycheck, of putting the hours in and stamping that time clock, or working or not working that overtime. Or getting everything done so you can get off the floor, off the unit. It is about caring and wanting to see the best outcomes for your patients.

That is why I am and have continued to be a certified nurse.

Post-it Sunday 3/17/24-Recognition can be paralyzing

The post-it reads “Being recognized is hard.”

I didn’t add anything else to the post-it so I can only guess at the meaning.

Being recognized when you aren’t prepared for it is hard. It is paralyzing.

Years ago a patient approached me at the bookstore. I remembered them as being a patient several weeks back. They asked me if I was a nurse. I said that I am. They asked if I was their nurse.

This is where it is paralyzing. At least for this OR nurse.

Most of our patients are asleep. Even if I do the pre-op check-in and check-list with them I am not expecting to be remembered. There is a reason that the only Daisy nominations for the OR people are us recognizing our own.

I remember this patient. I remember that the outcome was not necessarily positive. But I couldn’t come out and say that.

Instead, I said, “Yes. I remember you. How are you doing?”

Taking the pressure off of me as an OR nurse and them as a patient. And recognizing them in return was a good thing. Perhaps they didn’t feel alone after their surgery and especially during. They had a hand to hold and a calming voice as they went to sleep and as they woke up.

I don’t think all OR people are awkward. But enough of us are. I definitely count myself in that number.

Because being recognized out of context can be weird. And paralyzing.

I hope that the patient is continuing to do well. I haven’t seen them in the bookstore in a while.

Cookie Thursday 2/15/24-cracker toffee with chocolate on top

To recap the theme of the month is Tracie’s Favorites. This is sadly the last Thursday that Tracie will be at the hospital and the fourth cookie on her favorite list is cracker toffee with chocolate on top. This is also called Christmas Crack, or Cracker Crack but I like Cracker Toffee with Chocolate on Top as a name.

Let me tell you a little about Tracie. She’s whip-smart and has seen some shit in her life and is one of the most caring nurses I know. And she’s leaving us. Insert sad face here.

She let me poach her from the pre-op staff. There was a patient with an injury and a surgeon who wanted to fix the patient but the patient had had pizza about 2 hours before. It is the same old story, surgeon didn’t want to wait, patient needed surgery but it wasn’t urgent enough to compel anesthesia, or the surgeon didn’t declare it an emergency. It’s been a long time, details are a bit fuzzy. It was decided that the patient could have surgery IF it was local anesthesia only.

Well, on call there is only the OR nurse as the only nurse in the department. A local only needs 2 nurses, a monitor nurse to monitor the patient’s vital signs and talk to them and keep them calm and a circulator to do all the OR things. I took a chance and called one of the recovery room nurses on the off chance she would want to be the monitor nurse so we could help this patient.

Tracie agreed to be the monitor nurse. I think it was the exposure to the OR, talking to the patient while keeping them calm, and watching the surgery over the drapes that hooked her into the OR. After that case, she talked to the manager about training her as an OR nurse. I am very glad she did. One summer there were 9 babies born to the OR staff over the course of 4 months. This meant that there were 9 people out on maternity leave, staggered over that time. She and I tag-teamed and did ALL the call for the summer. I took the night call and she took the day call. It was grueling but we got through it.

She has been my best cheerleader in my academic endeavors. I went back to school for my BSN, and she said what about getting your MSN and teaching. I had already been thinking about it and she helped me make the decision. When I said I was thinking of going back to school for my PhD she thought I was crazy at first and has been supporting me in this decision the entire time. Through the onerous PhD application process, the interviews, the recommendation letters, through it all.

I’ve heard about her life and her husband and her kids for years. Basically watched the kids grow up through her stories and pictures. Talked at length about her retirement plans in 2025. And we talked and supported each other through the freaking pandemic. She and I both worked the entire time, because someone has to be the OR staff in emergencies.

Tracie, there will never be another OR nurse like you. It is exciting for you that this is your last week in the OR at this hospital but also sad for us, no matter what certain people say. Let’s just say there is a reason that she is leaving the department and the hospital and I don’t blame her.