Call Secrets of the OR- FOUR years I’ve been doing this gig

It was the beginning of December in 2021 when I started the night call nurse position.

Let me back up. In the spring of that year my manager pulled me aside. She knew that I picked up the vast majority of the call and she wanted to warn me that the corporation was doing a pilot call team position at a sister hospital. If the call team was successful, the idea would roll out to all the hospitals in the market and then the corporation. If that happened, all my call hours would go away. The pilot was successful and they were going to roll it out to the market hospitals.

When the position opened I took a deep breath and applied.

There were various reasons for this. It was mid pandemic and the dark scary 2020 was over and people were surviving and the schedule was open to all surgeries again. Vaccinations were in full swing in the population. It felt like time to breathe.

More than that, it felt like time to step back from being so involved in the hospital.

I could have stepped away from call and only done my 1430-2300 Monday-Friday shifts. Without every night and all weekend call I would gain 88 hours back. 40 of night call hours, and 48 of all weekend call.

That would have been good. I would get my nights and weekends back.

But the call that I enjoy so much would have been wildly reduced.

Call is my favorite. Have I mentioned that?

I had been working so hard for so long that I felt that I needed to step away from my workaholic tendencies.

I interviewed and received an offer. After a counter offer to keep the ability to maintain my clinical ladder, I accepted.

My new journey as the night call nurse would commence in 30 days.

It was time and this was a good stopping point.

I had been the evening charge nurse for 10 years.

I had been leading shared governance in most of its levels for 6 years. I had been on four hospital committees with their attendant meetings which was about 2 hours per week. I stepped back to 1 committee and from the corporate shared governance levels.

It was time for this workaholic to try to remember who she was without the hospital.

I have maintained the Cookie Thursday is a Thing and I am proud that there hasn’t been any store bought cookies for 3 years. Its popularity is waning and I have to consider what that is going to mean for the future CTIAT. But more on that in the new year.

Carving out a 50 hour workweek out of 128+ hours I had been scheduled was going to take some time to get used to.

But first a nap.

And then maybe I will look around and see what I can do with my new free time.

Since this all happened in the past I can tell you that I spent the next six months applying to a PhD program and I’ve been doing that for the past three years. But that is a story for School Me Saturday.

Being a recovering workaholic is hard. Especially one who jumped straight into another long term commitment.

I assure you that this is slowing down for me.

I regularly tell other operating room nurses that I encounter at conventions or online that I have the coolest job in the world.

And I still feel that way.

School Me Saturday 11/22/25- This just in, a nursing degree (any kind) is not a professional degree

This is more of a Tuesday Top of Mind topic but the intersections with education cannot be ignored.

In a slap in the face heard around the country, the Department of Education dropped guidance that a list of degrees would no longer be considered professional. Do you know how many nurses, registered or not, working in healthcare or not, are in the United States?

4.7 MILLION, according to the American Association of the Colleges of Nursing.

Yeah, you done fucked up and insulted 4.7 million people.

The so called professional degrees that were listed

medicine
pharmacy
dentistry
optometry
podiatry
law
veterinary medicine
osteopathic medicin
clinical psychology

The so called non-professional degrees that were listed

NURSING
physicians assistants
physical therapists
social worker
speech therapy
architects
accountants
educators

I first read about this on Wednesday and the everyone else had read about it and were giving their reactions. I held onto my reactions until today. They are in three sections.

The first is that this downgrade means that there is less money for all of these professions to go to graduate school. The “professional” degrees (see above) can borrow up to $50,000 per year, with a cap of $200,000. The “non-professional” degrees (see above) are limited to $25,000 per year, with a cap of $65,000. Massive difference, right?

They do know there is a nursing shortage, right? And the shortage is exacerbated by the severe shortage of MSN and PhD prepared nurses to serve as nursing school instructors. I fear this would only deepen this shortage.

It’s like only rich people can obtain graduate degrees. I mean people have the option go into crippling private loan debt. Things to consider. I would not recommend private loans for school. I know too many nurses who have been destroyed by them.

The second is that the “non-professional” degrees are, with the exception of the architect, mandated reporters. Being a mandated reporter means that the social workers, the health-care professionals (including nursing, duh), the teachers, the child care providers, and law enforcement are mandates, by law, to report child abuse or neglect. This definition comes from the childwelfare.gov.

I know that most people love their children and would never abuse them, but there are always those that will. And, as a mandated reporter, I have to report it. This is to save children’s lives.

The third section is that the “non-professional” degree workers are mostly women. And those in power love nothing more than to treat women as less than. This has been happening more and more in the last few years.

If women can’t get loans to go to school and the cost is prohibitive, I guess they will have to stay home and have ALL THE BABIES. Even though nurse practitioners and physician assistants make up the bulk of the rural healthcare that is available. According to an interview I saw with Dr. Jennifer Mensik Kennedy, the president of the American Nurses Association (ANA), if there were no NPs or PAs a patient in need of care would have to drive 90 miles for care. Each way.

I am not less than. I am a professional working registered nurse. I am not a doctor or surgeon’s handmaiden.

Ew.

In 5 years we’ve gone from hero at the bedside during covid to non-professional.

I have called or written my representatives and the ANA has an online petition at RNaction.org. You better believe I signed that as soon as I heard about this travesty.

It’s like they want women in the home, having babies, and to cripple higher education. If only we were warned (this is heavy sarcasm)! Oh, wait, we were. This is all in Project 2025.

In simpler terms, to keep women dumb and in the homes so they can have all the babies. After which I guess we die?

Nice try and fuck all the way off!

Call Secrets of the OR 10/8/25- Call bootcamp

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This is your reminder that it is probably time to renew your nursing license or at least work on the continuing education units

I renewed my North Carolina nursing license yesterday.

North Carolina, like most other states, has a 2 year limit on their nursing license.

In North Carolina, there are many options for proving you’re still registerable. The requirement I chose is 640 hours as a working nurse. This translates to roughly 16 weeks of full time 40 hours per week nursing work. Which is roughly 4 months out of 24 months. To choose this option, you also have to do 15 hours of CEUs.

These requirements must have been fulfilled in the 2 years window.

Additional options include

national certification by a credentialing body recognized by the board of nursing
30 hours of CEU
completion of a refresher course approved by the board of nursing
completion of a minimum of 2 semester hours of post-licensure education. This is your MSN and BSN bridge and DNP and PhD programs
15 CEUS and completions of a nursing project as the Principal Investigator for a nursing problem
15 CEUs and authoring an article, paper, book
15 CEUs and developing and doing a nursing CEU presentation of at least 5 contact hours

Of course I am an over achiever and have completed 6 of the 7 options. The only thing that I haven’t done is the refresher course.

What can I say? I am passionate about being a nurse.

The hospital systems do a good job of keeping you on task for renewing your nursing license. But pull it out and check it anyway.

Mistakes do happen.

But, Kate, what happens if my nursing license has expired?

This is a big bad.

Like really bad.

Like being charged with assault bad. The reason of the assault charge is that you are not licensed, therefore you are practicing nursing without legal protections. Both for you and your patient.

There is a reason it is called Fitness to Practice and the entire reason behind the two year cycle.

It is up to you to keep current on education, hence the CEUS. No one wants a nurse who isn’t aware of the newest things that affect patients. Remember 2020? I do.

So check the expiration date of your nursing license.

But if you have questions about how to find free CEUs, I have loads of options for you.

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?

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.

Best Kept Secrets of the OR #25- Conference edition

I am an introvert who is also quite shy. That is a double whammy when it comes to being engaging in large groups. Especially people I don’t know. Even people I probably will never see again in my life.

That being said conferences are particularly hard. It is best that I am rested. Not well rested, this is a hotel that I am most likely staying in with its vagaries in bed comfort and light levels. The hotel that I just stayed in had a night light in the bathroom with no door to the bedroom. Low levels of light all the nights. Which isn’t exactly conducive to sleeping.

The operating room encompasses so much space in nursing. Goodness knows that the department encompasses a pretty big majority of the operating revenue. Goodness knows that running an OR is a very very very very costless enterprise. Never mind the human capital, the outlay for supplies and equipment is immense.

That being said, conferences are important. Not only to meet the people who are like minded and that you have loads in common with, but also to share experiences across the board.

Did I have fun at the conference? Sure. For a value of fun.

Was the conference exhausting? You bet. I suffered a fall at work just over two weeks ago and my left lower leg, knee to toes, is such pretty colors and shades of purple. The hotel was half a mile from the convention center and I walked it every day. Well, I limped it.

Except the morning it was raining too hard to contemplate it. This was also the day I was to do a poster presentation of my pilot study that I completed last year. The one about the pre-Wheels out behaviors of the operating room. So I had makeup on.

Every night I peeled off the compression socks and elevated my foot/leg. But the pain was worth it for the opportunity to present my own research and talk with the chapter that I belong to in the organization.

I made sure that my carry-on was mostly empty. Because conferences give out a lot of swag. By that I mean that conferences give away paperwork and pamphlets about their products. There is also a certain amount of toys and soft things that are given out. I don’t collect a lot of the pens that these companies give out but I pick up a few to give away to my coworkers.

The majority of what I bring back is education that I learned. I get to impart to my coworkers the latest and the greatest of nursing knowledge.

I also collected many colleges so that I can curate a binder for shared governance and to share it with, again, my coworkers.

The thing about conferences is that you are at the mercy of the weather in the host city. We were in Boston and it rained every danged day except for the day we arrived. That day was beautiful and showed off the city well.

Tuesday Top of Mind 3/25/25- Laughing in the face danger is so nursing

There is a well-known, little understood meme about Ralph Wiggins of Simpson’s fame sitting near the back of a bus and saying, with a chuckle, “I’m in danger.” I say well known because Ralph Wiggins is a popular character on the Simpsons. I say little understood because this scene is not part of the Simpsons. Instead, it is from a Family Guy crossover episode.

It is understood that Ralph is laughing in the face of danger. Or that he doesn’t understand the consequences of the danger he is in. Both things can be true

Why I am writing about this will become clear.

There was a bulletin released last week, on March 18 about the danger in hospitals.

Do you know what I am talking about? It’s okay if you don’t. So much crap is thrown at us every damned day by the administration and various ill-intentioned groups. Often young men who don’t have their entire pre-frontal cortex completely formed yet who are susceptible to rhetoric.

Hint, hint, part of why we are in this mess with this administration that is acting illegally every day and no one in the other 2 branches of government are doing diddly squat.

The American Health Association (AHA) and the Information Sharing and Analysis Center (ISAC) issued a joint bulletin warning of a potential terror threat that targets hospitals. These hospitals are not named, just that it is to be multi-city terrorist attacks, in mid-sized cities.

This information is from “chatter” from ISIS-K groups and the likely methods noted are likely to involve vehicles and explosives. At level 1 trauma centers. You know, the ones most likely to be able to handle such a mass casualty event.

My hospital system has already taken steps in the face of this bulletin. And my hospital has already done the

After covid and working through a global pandemic is this supposed to scare us nurses?

Um, have they met us?

Nurses are the ones who wade in where angels fear to tread.

We care for all who come through our doors.

Is this horrible and could a lot of people die?
Absolutely.

Will we as a society meet the challenge?
Absolutely not.

Will nurses save us?
Yes. Yes, we will.

Are nurses laughing in the face of danger, while also acknowledging that we are in danger?
Always.

Sunday Post-it 3/16/25-LOL

The post-it reads “Alpha numeric spelling is just coding.”

This post-it got me thinking about coding in a couple of different ways. What is meant by coding? It is a communication style that seeks to with hold information that might be damaging or incomprehensible to the non speakers. For example the anesthesiologist can say that they need an ABG, CBC, BMP, PT/PTT, T&C and a lollipop, and I know that something bad is happening or has the potential to happen at the head of the table.

I was kidding about the lollipop.

This spate of orders makes me wonder if there is unanticipated bleeding and the patient is not doing well. In response, I would look at the suction canister to see if I can see what they are seeing, and I would offer to get the tube colors that they need as a way to confirm the colors that they need. I would also glance at the back table/mayo and offer the scrub tech additional lap sponges if I see they are down to one or two. I would nudge the red lined kick bucket to be more accessible for the scrub tech.

I would also ask if the patient needs a higher level of care. By that, I mean does the patient require ICU or a transfer to a tertiary hospital. This is code

My next step is to call the supervisor to request an additional set of hands or the ICU bed or to get the ball rolling on the EMTALA paperwork. Which is the Emergency Medical Treatment Act and Labor that allows the emergency treatment of patients.

All of that from the sudden request for lab tests. But, to be more specific, those lab tests. The 17 letters tell a story.

Yes, but… Talking in medical code, AKA the acronyms that you know are near and dear to the heart of all medical personnel, is also done to protect patients. After all, little pitchers have big ears. This means that there is always someone who is listening. And being human they often will take the worst inference of what was just said. AKA the patients will jump to conclusions that aren’t true. And panic.

Parents do this too. Parents can spell out a word that they know the child will react to. Such as B*A*T*H or I*C*E*C*R*E*A*M.

Pet owners do this as well. Such as spelling out the word R*I*D*E or V*E*T.

Both times it works until the kid or the pet can work out is being spelled.

Are we coding in these instances so that the kid or the pet doesn’t become too excited?

I am writing this post because I caught myself coding a social media post the other day. I didn’t care how other people perceived the post but I wanted to share the information for those who are also frustrated by the current atmosphere.

And there I go again! AARRGH!

I think I need a N*A*P.

Post-it Sunday 2/9/25- table height

The post-it reads “Height of the OR table is important.”

Height of the OR table is important and can be changed for a variety of scenarios.

When a tall person is intubating the patient, the OR table is high.

When a short person is intubating the patient, the OR table is low.

When a tall surgeon is working, the OR table is high.

When a short surgeon is working, the OR table is low.

You with me?

When a patient is on the fracture table or the CHIK table and the hip is being worked on, the table is high. Not only is that for surgeon comfort, but it is also so the C-arm, which is an x-ray machine, can clear the table in order to take pictures.

When a circulator is prepping a patient’s leg, the table should be low. This is for leverage and also changes the fulcrum of the balance of the weight of the leg. This also improves the circulator’s reach to ensure that all the skin is prepped.

I have always known this was important but I didn’t realize that other specialties do this too. Which is odd, because of course they do. I came to this realization when I was in the dentist’s chair going up and down, depending if it was the dentist or the hygienist working on my mouth.

Talk about your flash of the obvious.

Imagine me not even realizing of course it would be the same, even when they are sitting down.

But the number one thing to take home is that after the patient has been moved to the in-patient bed, the head of the bed should never be raised until it has been moved away from the OR table.

Why?

Because I’ve seen OR tables get tipped, a lot of degrees, by the head of the in-patient bed that is being raised.

Heck, I’ve also heard the cysto table groan as an anesthesiologist was raising the head of the patient bed after we moved the patient. And those tables weigh a ton and are not to be moved.