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.

I come to bury 25, not to praise it

Friends, Romans, countrymen, lend me your ears;
I come to bury 25, not to praise him.
The evil that years do lives after them;
The good is oft interred in their days;
So let it be with 25.

This is, of course, a knock off of Marc Antony’s speech from the Shakespeare play Julius Caesar.

Normally it starts ‘Friends, Romans, country men, lend me your ears. I come to bury Caesar, not to praise him.’

This after the Roman Senators, led by Marcus Junius Brutus, assassinated Julius Caesar by stabbing him. Having so many assassins makes it difficult to know who dealt the killing blow.

This was after Caesar had proclaimed himself the dictator of the Roman Republic.

And that is where I am going to leave it.

Draw your own conclusions.

The terrible, horrible, no good, very bad year of 2025 has died.
(apologies to Judith Viorst)

It lived for what seemed like more than the 365 days it was allotted and dragged on and on and on. Each day was seemingly more horrible than the last.

I broke down much of 2025’s crimes against the world in yesterday’s post. Yes, I know that the crimes were done by actual real live people but the year bears some culpability.

Today I want to celebrate 2026 and tell you how I bid good riddance to 25.

I threw 25 a wake.

A wake, according to Wikipedia, is a part of death ritual in many cultures. The rite allows for last interaction with the dead (25), and allows for thoughts and feelings to be expressed to the body. 25 left no corporeal body and so this all had to be done in absentia. Or the absence of a body.

To be fair, I waited until the year was well and truly dead before I celebrated its ending. I didn’t want to leave it any loop holes, you see.

I made all the lucky foods I could think of. I had grapes, I had mandarin (round food). I made collard greens and black-eyed peas. I had Lucky Charms. Sushi of the vegetarian type also felt right to me so I bought some of that too.

I made 2025 a casket, stickered with gold numbers. I had a voodoo doll, I had a Dammit Doll, I had a sage candle. I had a stuffed crocheted dumpster fire. Dot decided that it was hers and batted it off the table.

I arranged several of these around the little stickered casket and took a picture (of course). Did I write that I cut out flames to further bedazzle the casket? That part was a lot of fun.

The little casket only came in a pack of two so I of course had to make a 2026 one. I collected many good luck symbols to herald 2026. I had a Lucky Cat charm. I had an academic success sachet as I am still working on my dissertation and finishing my PhD. Too bad, the last year kinda derailed me as I thought, and still do, that my attention and writing skills would be better used in resistance.

I kept the voodoo doll and put it in the 2026 casket.

Only time will show if any of these had any impact on the world and the new year. But I had a lot of fun thinking about what to use to wake 2025, and also what to have on hand to prompt 2026 to be on its best behavior.

It gave me some sense of closure to list all the things that it had done wrong and it gave me a sense of hope to show 2026 the mistakes of 25 and a roadmap of what I would like to accomplish this year.

2025 was well and truly waked.

And 2026 has been given its marching orders.

Fingers crossed.

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.

School Me Saturday 12/13/25- Winter-freaking finally-break!

I know this semester has been, well, odd.

Hell this entire year has been odder.

So many changes on the federal level, including new intrusive FAFSA questions.

Including the grinch swiping away what little student loan relief that the Biden administration was allowed to do by the courts.

I mean, we all know who the grinch is, right?

Put that aside.

Things will still be bat-shit-crazy in the new year and the new semester.

Take a deep breath now, and count the good things.

Finals are done and your grades most likely in by your instructors.

Winter graduations and hoodings for graduate students have occurred. Including two of my cohort. Congratulations, guys, well done.

I’m not jealous at all. No, really I’m not. This is a process and I am just not as far along as them.

It is too early to plan for Spring Semester.

Christmas is over 10 days away.

Now is the time to breathe. And maybe nap. In fact, I hope your sleep is as good as Dot’s on her warming pad and window perch.

My winter hope for you is that you rest well over Winter Break.

Think about school only if you want to but don’t obsess about it.

Read that book you’ve been meaning to get to.

Watch that hot new movie in the theater before it is pulled.

As an aside, Hamnet was one of the best movies I’ve ever seen.

Watch that television show that you’ve been saving up for the end of the semester.

Wrap your presents (if you do them), ready your travel plans (if you are going anywhere), but be safe.

The crazy things will be there after the first of the year.

Take this time to re-center yourself and remember who you are and why you are on this journey.

And have a happy, safe, and restful holidays.

Spring Semester is just a breath away.

FFS Friday- FDA, blink twice if you are in trouble

Actually, don’t bother blinking.

We in healthcare KNOW that you are in trouble. As you have a bad case of the know nothings in charge of you and your vaccines and your medications.

Some of the Senators could have helped you out but they were too busy bending the knee to a wannabe fascist who is hell bent on wringing all the money they can out of their shitty decisions and actions.

You see, they are in their villain phase.

Where the only thing that matters is the green.

Of course, I write of money, moola, dough, loot, and bucks.

They are too busy stealing from us that they think that making us sick by not extending Affordable Care Act credits for those who need help with the astronomically skyrocketing costs of insurance, shields what they are doing by providing cover fire.

Forget bread and circuses, this administration is about social media lies and villainy.

Why? Because to be the lowest level they can be feels GOOD. To them at least. I would have sent myself to bed without dinner if I acted like they do. Lives are not their playthings. Did no one teach them manners as children? Or even ever told them no?

Today’s latest bullshit is a waving of a “possible” black box warning on the covid vaccine.

Yeah, that one.

The one that has saved millions and millions and millions of lives.

Worldwide.

This black box warning will be slapped on the life saving, lung saving, world saving vaccine by the end of the year, according to reports from CNBC and Reuters and CNN and other news sites.

I think this is a distraction. Of course all the news is covering it.

Of course all the healthcare workers, MDs, RNs, LPNs, CNAs, PAs, and the like are decrying it.

If true, this is big black coal letters the size of Mt. Everest BAD.

This kind of bullshit pulls the wool over the eyes of the people who don’t know any better.

And makes them doubt ALL the vaccines.

Makes them doubt healthcare.

Makes them doubt medicine.

Takes us back to when we were smashing rocks against other rocks and against each other.

I am not sure of their endgame, besides confusion, and lining their own pockets and those of their billionaire handlers.

Or are they spoiled brats who are gleefully pulling the stuffing out of America?

After all, weakening us makes us prey.

Well, I don’t feel like acting like prey. Wanna see my teeth?

We tried to warn you but you didn’t listen.

Tuesday Top of Mind 12/9/25- Empty stools in empty lab rooms

With apologies to Claude-Michel Schonberg, Herbert Kretzmer, and Cameron Mackintosh and the original singers of this adapted song.

I speak of course of Les Misérables.

All of the albums, the 1985 cast album, The 10th anniversary Dreamcast, and the 2012 movie soundtrack, have been on near repeat in my head and in my speakers since the first No Kings protests. I’ve written about it before but something about the failed revolution speaks to me in these WTF times.

My favorite song has always been Empty Chairs at Empty Tables when the survivor of the barricade, Marius, sings to the phantoms of his friends. It is hard to be a survivor of atrocities. I imagine it is harder yet to be among the survivors desperately trying to salvage what they can at the CDC. Because of the grant pulling and the firings and the August 20, 2025 attack on the CDC itself where a police officer died.

I was driving home from baking Christmas cookies with my mom when I started humming this song. I started changing the lyrics right then. I tried to stay true to the original cadence of the song and I changed some words.

Empty Stools in Empty Lab Rooms
There’s a rage that can’t be spoken
There’s a fear goes on and on
Empty stools in empty lab rooms
Now my friends are fired and gone

Here they talked of exploration
Of possibilities
Here they talked about diagnoses
And the diagnoses never came

From the laboratory in the hallway
They could see a germ defeated
And they rose crying Eureka
And I can see them now
The very science that they had worked
In the lonely lab at dawn

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

The lonely faces on the screen
Phantom shadows on the Zoom
Empty stools in empty lab rooms
Where my friends will work no more

Oh, my friends, my friends, forgive me
That I work and you are gone
There’s a rage that can’t be spoken
There’s a fear that goes on and on

What scientific advances won’t be made? What cancers will grow out of control because there is no one to stop them?

How people have to die because this is happening?

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.

Call Secrets of the OR 10/29/25- all call cases are emergencies

All call cases are emergencies. I admit sometimes they are emergency adjacent but still the case must be done. There are the rare exceptions when the call team did a total knee in the middle of the night and then discharged the patient because the surgeon, who was 5 hours late, insisted. That’s for another time.

All call cases are emergencies. To that end, it is okay to tell another department who has their gurney waiting outside the room when you go to pick up a patient that their non-emergent test is just going to have to wait.

Yes, that happened.

Another nurse and I were up on the 4th floor picking up a patient. We packaged the patient up. This means that we removed all the monitors, and replaced them with our own, we cleared all the stuff from the bed that wasn’t the patient. We unplugged the bed and told the family to follow us to the elevators and opened the door.

To be confronted by a worker from another department, ready with a gurney, to take the patient to their department for a non-urgent test.

Um, no you may not have the patient for your non-urgent test.

No, I don’t care that this patient is next on your to do list.

No, I don’t care that it looks badly to your supervisor if you don’t get the test done in a timely manner.

This patient is ill, ill, ill and requires emergent surgery to fix what is wrong with them. Well, not fix, but to remove the offending body part that was making them so sick.

No, we have to rush down to the OR and start the surgery.

No, you will have to do your non-emergent test on them after surgery.

No, I don’t know how long the emergent surgery will take. Surgical cases take as long as they take for the surgery.

No, I don’t care that this is the last thing on your to do list and you get to go home after the non-emergent test.

Sometimes you just have to say no and mean it.

Even if it means blocking another department from getting their hands on the patient for a non-urgent test that could wait until morning. But they don’t want to tell the hospitalist the non-urgent test wasn’t done.

Sorry for delaying this non-emergent test for a real, honest to goodness emergency surgery without which the patient has a good chance of dying.

Nah, not sorry.

I’ll probably hear about this later from my manager.

Oh, well.

At least we saved that patient’s life.

School Me Saturday 9/27/25- AI tattles

A tell is something during a game, usually of cards, that indicates what is in your hand. Good or bad. Physical change or behavioral change. It encompasses a lot.

The use of AI, especially in a education setting, has tells as well.

There is the direct copy and paste of the output of a prompt. Warts and all. This is a glaring red flag to the people grading the assignment.

Try a little and reword some of the output.

But this is also a trap. You really should understand what the output says before you throw yourself on the mercy of the thesaurus.

Above all, know the difference in usage between lie and lay and lied and lain. Can’t forget their, they’re, and there. These three little words have forever stymied English speakers, native or not.

And is a giant AI tattle.

3 years into this AI game, universities and colleges are learning how to recognize and grade you accordingly. The university I go to has announced that any AI usage has to be on the university site. I imagine this is so they can keep on eye on who is doing what with what AI generator.

Publishing has also gotten wise to the AI slop that is out there. I have seen the stamp they are putting on some books. It proclaims that the book is “Human Authored”. I think this is smart but also vulnerable to copycat. The seal does have a seal number on it. I am not sure but I bet the numbered seals are searchable on the Writers’ Guild site. Nope, I just checked. They are not easily searchable.

The point is that if you cheat, someone, somehow is going to figure it out. That beggars the question Why cheat? in the first place. It is only your reputation and your admission to the university/college that is at stake.

Darn, I guess you’re just gonna have to do the assignment. With your own brain and your own fingers typing on the keyboard.

Darn.

Medical non-fiction podcast review 9/7/25- Dr. Death Season 1- Dr. Duntsch

I would be remiss if I didn’t review the medical non-fiction podcasts as well. There are some really well made ones out there. My favorites are from the Wondery studio.

This was a podcast that was recommended to me in 2020 by a certified registered nurse anesthetist (CRNA) as something I might be interested in. The first season that I am going to talk about was released August 2018 and ran through October 2018.

I listened to the first season avidly, aghast that an MD would be so negligent. But then I never thought of it again. Why? There was a little pandemic that also happened in 2020. Does covid-19 ring a bell?

Not to mention I graduated with my MSN in May of 2020. I used to listen to the recast episodes on my way to teach in January and February before the world shut down in March. And then I got a little busy. And then I went back to school in Fall 2022 and moved on to listening to other medical podcasts on my trips to the university.

Dr. Death is a story about the arrogance and

Dr. Death is about an orthopedic spine surgeon who left a trail of broken backs, death, and broken dreams behind him. He graduated from the University of Tennessee and did his training at the Tennessee Health Science Center. He only completed 100 surgeries out of the 1000 surgeries in a standard neurosurgery residency. He was hired by Baylor Regional Medial Center in Plano, Texas where he began to leave broken bodies behind.

He is the epitome of fail up. He would be invited to leave by a hospital and would leave for another hospital and damage patients and be invited to leave the second hospital. Rinse, repeat. Death and paralysis trailed in his wake.

No one had the presence of mind to stop his slow moving rampage until two surgeons who were called to repair the damage that Dr. Duntsch had wrought compared notes. They were determined to have charges filed against him. The filing of charges against another doctor is not a done thing. It is easier to have them resign and not care about where they go. This disregard for life at another hospital is a failure of the medical system and carried on far too long.

Of interest is that he chose neurosurgery, one of the most technical and prestigious of all surgery types, because it was considered the most lucrative. Of the 38 patients profiled for Dr. Death, 31 were harmed or 2 died as a result of his arrogance.

He is in prison for life and is not eligible for parole until July 2045.

Kudos to the two surgeons who were able to work with the Dallas prosecutor to stop him. Really stop him, not just pass the buck to the next hospital. Not just pass the buck on the next patient that would be harmed or killed. .

This was a very easy to listen to podcast. It was broken down over 7 episodes, although there are several additional bonus episodes that attached at the end of the episodes, from his appeal that he filed to the introduction of the actors that were in the television show.

About that, I had heard that there was a television show made of the first season that premiered in the time of the world is trying to kill us still of 2021. It ran until 2023 and is currently streaming on Peacock plus or available for purchase from Prime Video. But I don’t watch television and then I finished the first season of the podcast I removed it from my list and I had no idea that three other seasons had released. I will be listening to these. Dr. Duntsch, Dr. Fata, Dr. Paola, and Dr. Gumrukcu. I have some listening to catch up on.

But as a surgery nurse I have to question where are the nurses at the hospitals that kept failing him up? Were they part of the complainants that got him fired but not prosecuted? Did they just blink at his behavior and say “Well, that’s just Dr. D for you.”? Where were the scrub techs who can also voice objections? Granted, as the surgical team we don’t know a lot about patient follow up, except when the patients return for a revision. But surely question were raised among the teams.

This is also a failure of the surgical team. It is our duty to point out problems and mistakes that the surgeon might otherwise try to brush off.

I recommend this podcast to anyone who is a scrub tech or a surgical nurse. It is up to us to recognize and stop these surgeons when they are harming patients.