Dispatches from the Evening Shift Disclaimer Sunday 1/11/25

I usually do this on the first day of the year so I am a little tardy this year.

Happy New Year!

Let’s get down to business.

Every year I write this disclaimer. And add to it. And tweak it. And if I knew how to pin it to the blog start page, I would.

I began writing the yearly disclaimer to be able to point to my posts and say, see nothing to give away the patient here. You know, HIPAA. In case the corporation, that I work for and discuss my blog openly in meetings etc., tries to tell me I cannot write this. Not that they have, but I can believe they would.

I believe in protecting patients’ and staff’s privacy.

I do not include details that make it clear or easy to figure out which patient or staff member I am talking about. If I am talking about any.

I do not use names. And if I do, they are changed.

I change ages. I change gender.

I change details such as which limb is fractured. I change details such as which surgery is performed.

And the cases that I do talk about obliquely are changed in how time is perceived as well. The cases/people/staff may not be the same at the time of the surgery.

I definitely change aspects of time. By that I mean there is no relationship between the moment I write the post and the actual events that prompted it.

Some of the stories aren’t even mine, but even they are changed so as to be unrecognizable.

That being said, I change a lot.

So that, if you knew where I worked, you could not figure out who I was writing about or when.

I discuss issues that impact healthcare broadly.

And, after the events of the two past years, issues that impact women’s health. There has been a LOT to unpack here.

And covid. Can’t get away from covid. XEC is the newest variant and it is currently causing over 50% of the cases. People continue to die; not that we know it because they stopped keeping track years ago. And there is a new game in town, or should I write games. The bird flu that has made the jump to infecting and killing humans, and the human metapneumovirus which isn’t new but is making noise in China.

I do swear sometimes. But mainly to make an emphatic point.

I write themed days. Post-it Sundays which are from notes to myself, usually on a Post-it or a gown card. Monday I take off. Tuesday Top of Mind is the most political day of the week where I write what is weighing heavily on my brain. Wednesdays had been a free day that I wrote exclusively about OR things. This has morphed into the Best Kept Secrets of the OR where I divulge the secrets of the OR. Cookie Thursday is a Thing is where I write about the cookies I make for the department. This is a long-running morale project in the OR of homemade cookies or candies are brought in around 1400. This started as an evening shift things and remains so. FFS Fridays is the newest day that I write about things that begin with F, F, or S. This is the day that has the most swearing and I started it as a reaction to the 2024 general election. Buckle up, it’s gonna get weird. On Saturdays, I write about being an adult learner.

Phew.

I may miss a day here or there because 6 days is a LOT, even if the blog posts are shortish.

This month marks 10 years of Cookie Thursday is a Thing! I had no intention of baking cookies for so long, but it gives me a handy bookmark for my week. I also theme the months and this month’s theme is Favorites. Along with the departmental favorites, I also tell a story about CTIAT.

School Me Saturday 12/21/24-adjusting expectations

This was a HIGH bar for me to clear.

My expectation was that I could move heaven and earth to graduate with a PhD in 3 years. Eminently doable, I smugly thought to myself as I signed up. Doing the program in 3 years means that I will graduate before I turn 50!

I’m not sure why that arbitrary number was important. After all, I will turn 50 with or without a PhD.

Also of importance was the fact that I wanted to clear the triple hurdle and get my third degree in 10 years. No matter that the world was on fire in 2020 and 2021. And I was a working hospital-based operating room nurse the entire time.

Who was I competing against?

Myself. That’s who I was competing against.

Because this will not set the nursing world on fire.

Oh, and yeah, 2024 was a horrible year health-wise for me. Horrible. Your forties are like a gift. This is heavy sarcasm.

Sometime in the past months, I came to the realization that the thesis will not be finished and defended by the graduate in May deadline of March 20th. There just isn’t enough time to do all the tasks.

Everything takes longer in academia. And I mean EVERYTHING. Through a series of pitfalls, and, yes the personal physical challenges, and the university challenges, it has taken me 6 months to start my pilot project and 2 months to complete it and finish the class. This process should have taken me 6 weeks to start the pilot project and 2 months to complete it and finish the class.

Okay. I’ve written before that age is just a number and time means nothing. Why was I so worried about the PhD being completed by a deadline I made up in my own head? I will finish this degree in my own time. I should just enjoy this dedicated writing time.

The take-home lesson is that plans may change. Some people might look at a change as the opportunity to drop the idea completely. They would not be wrong in doing so.

Their path is their own.

Your path is your own.

Paths may change. I know that my personal path has taken a few right turns and a couple of u-turns. And that is okay.

Whether you stay on the path or decide that it is not the path you want, the important thing is to keep learning. Being an adult learner is hard but remember the reasons you started on the path and the reasons to keep on the path. Even as it changes underfoot.

You might surprise yourself.

I hope you do.

Post-it Sunday 12/15/24-Napoleon who?

The post-it reads “The shortest surgeons are the biggest assholes.”

That could be the complete post right there. It is truth. If we have all decided that this is truth, we have to unpack it a bit.

The question remains what level of asshole.

Because, yes Virginia, there are levels to asshole. It is nearly Christmas and that IS a Christmas reference. It refers to the 1897 editorial where Virginia’s question is answered.

There is the instrument-throwing asshole. These are the ones who decide that the instruments are not up to snuff and they are tired of complaining about it. Hence, the throwing of the instruments. This is also one of the angrier assholes.

There is the globe-trotting asshole. These are the ones who absolutely, positively need to add on a case and the case has to be done as soon as possible because they have a plane to catch. Do they really? Or is that a handy excuse.

There is the gotta make dinner with the spouse asshole. These are the ones who swan up an hour late and try to get finished with surgery in time to meet their spouse at a restaurant. This is a close cousin to the globe-trotting asshole.

There is the deity’s gift to surgery. These are the ones who decided that the rules do not apply to them and they can absolutely jump the add-on line. After all, do you not know who they are?

There is the my father will hear about this asshole. These are the ones who followed in daddy’s footsteps and became a surgeon. They are a short step away from deity’s gift to surgery type but there are enough of them I decided they needed their own subcategory.

There is the operate on holidays because they are a miserable bastard asshole. Yes, I’ve worked with one of these. They were not religious and called us out on every, single holiday, especially Christmas. And 4th of July. And Memorial Day. And Labor Day. And President’s Day (this is a real holiday in California). And Thanksgiving. And New Year’s Eve. And New Year’s Day. Why they were on call every danged holiday, I don’t know. At least we were guaranteed call-back pay.

There is the too smart for this room asshole. These are the ones who are convinced that they are the smartest one in the room. We’ve all worked with this one. They delight in the “Well, actually” put down and mansplain or womansplain or theysplain the ENTIRE case.

Of course, there are exceptions to every one of these categories. Sometimes a short surgeon isn’t an asshole, sometimes a surgeon really does need to catch that flight, sometimes the spouse will leave them if they are late one more time because they have been taking care of patients, but sometimes they are just assholes. No matter their height.

School Me Saturday 12/14/24- CV reminder

A CV is a curriculum vitae. It is beyond a resume, which may cover a portion of your working and school life. The CV covers all the amazing things that you got to do, not only in your working life, but in your schooling life.

Writing your CV is important. It shows the ways you’ve changed in your working or schooling life and it also shows ALL the things that you’ve done in those lives. These can be awards, committees that you are on, or organizations and certifications that you have.

If you are still at school ask the writing center for help crafting your CV. Do not raw dog it like I did.

Just like you have a current and up-to-date resume ready to go at all times just in case, you should also be looking at your CV and adding things that you’ve done.

I recommend doing this yearly. Or when someone asks for it. I have several saved on the cloud, each named with my name and the year. But, Kate, why keep the old ones? Sometimes you want to reminisce who you were before all the work.

Personally, I update both the resume and the CV every year after I submit and receive confirmation of the clinical ladder. Seven years I’ve been a level 5 at my hospital. That is an accomplishment that makes me proud.

I was polishing my CV for a project not related to school or work when I realized there is a big chunk missing. I was a subject matter expert when the hospital system I work for was building out their EPIC. This means that I gathered with a bunch of other OR people and we hashed out the bare bones of what the EPIC should look like. I went back to the training computers when the build was complete and EPIC ready to release the system’s version to us so I could train other nurses and be the superuser for the surgeons.

The surgeons have never forgotten that I am the point person in the department with EPIC issues. It’s been 13 years and I still field questions regularly.

This was no where on my CV. Of course I had to add it. I also added the part about the subject matter expert and I also updated the non Dispatches from the Evening Shift writing that I do.

The moral of today’s story is when you get invited to do amazing things don’t forget to put it on your CV. Doing so shows that you are willing to take risks and also be involved in the hospital’s affairs.

Today’s homework is to bring up your resume and read it for completeness. Also get started on your CV. Be aware that this may take several passes. But it is so worth it.

Even if the only person you amaze is yourself.

School Me Saturday 11/2/24- minding your p’s and q’s and citations

As an adult learner, I have had to unlearn and re-learn so much.

I write unlearn because I picked up some bad habits when it came to writing essays as a high schooler. I would spend a lot of time thinking about the essay that was due. And then I would research what I had to do. I would finish the book if it was a book report. I spent a lot of time thinking about opening hooks and sentences and essay structure.

I still do a lot of my writing in my head. Even during my fourth degree. I am unsure why this is the way that I have worked, am working, and will continue to work.

Writing is my favorite, after all.

Much better than math. Or statistics. So many statistics classes. I am not sure if I’ve shared this before but I decidedly do not have a math brain. At least not a higher-level math brain. I mean, simple math, algebra, and even geometry are doable. But beyond that? Anxiety city.

This was supposed to be a post about spelling and citation errors.

Apparently, I am not in the mood.

Spelling errors and citation errors will tank your grade because at the collegiate level, they include that in your grade and absolutely will take points off for errors.

There are many different kinds of citations. Find out the citation style that your program uses and embrace it. Embrace it hard-core. This will only help you.

Also embraceable is the spell check. I cannot stress this enough. Nothing impacts a grade more than using the incorrect tense/spelling/contraction/conjunction in a sentence. It makes your essays hard to read.

As a former editor and a current reader, I can tell you that nothing knocks me out of a written article or paper than a spelling error. Or badly used punctuation.

But nothing gives me more glee than noticing an error in a school document, such as the syllabus.

Typos happen, acknowledge that this will happen to you and go on and write the danged essay.

Just be aware of spelling mishaps, and the stray badly written sentence. Your writing will be better for it.

School Me Saturday 10/26/24-Study Music: yes or no?

This past Wednesday I titled the post “Mister, are you tall?”

This was about one of the songs that I used to listen to at Creighton and my first nursing program. Dr. Demento’s songs made me smile and I found them easy to listen to while learning.

When I was writing the post (which was about height differences in the operating room), I vaguely remembered that there was a height reference in one of the Dr. Demento songs. I was pretty sure the song was “Existential Blues” by Tom “T-Bone” Stankus but I had to relisten to make sure.

This led me down memory lane. So many silly songs. So many not very politically correct songs. It was a great afternoon and I listen to a lot of songs while I was folding laundry. What a great afternoon. I finished folding the laundry and cleaned the kitchen while tripping down memory lane. I remembered some of the songs that I listened to while writing a presentation on 1993 Rawanda or learning anatomy.

The point of this post is to encourage all adult learners to find what inspires them to focus and learn.

There has been interest in recent years about listening. I am writing, of course, of ASMR. Which is defined as autonomous sensory meridian response. If you Google the term lots of information pops up. Some people find it relaxing and stress relieving to listen to.

Those people aren’t me. I find most ASMR content mildly infuriating. Kind of like how I find all stress balls infuriating. So ASMR is not for me.

It might be for you, which is okay.

As an adult I confess I don’t listen to music when I write or study. I am not sure when it got away from me.

On Thursday as I was preparing for a presentation I had to give Friday, I decided to listen to Dvorak. Specifically Symphony No. 9 “From the New World”. I wanted to see if it would work as presentatin preparing music. It is one of my favorites after all.

I found it distracting. I wanted to conduct.

I tried a different classical music, one that was recommended by a writing group member.

No go. My brain kept picking out the repeating parts and it would be jarring when the music didn’t follow pattern.

More evidence that working through a global pandemic and working in ORs for 23 years with its music has changed my brain.

The overall point of this post is to find something that calms your brain and lets you think and learn and write.

This might be silence.

This might be ASMR.

This might be classical.

This might be old TV shows on repeat.

Listen to whatever speaks to you in that moment.

As with so much of being an adult learner you get to choose what works best for you.

I’ll be over here in the office, writing in silence, listening to the taps on the keyboard.

I guess that might be a form of ASMR. And I found a playlist that was entirely cats’ purring. I bet that might work for some people too.

Keep exploring until you find what works for you. It might be dusty CDs from your own high school years.

Dispatches from the Evening Shift end of semester impromptu vacation

The end of the semester can bring up many feelings.

Too often the weeks and days leading up to the end of the semester are busy, busy, busy.

Final projects.

Final papers.

Final presentations.

Yeah.

All of those.

I was gonna contradict myself and say that there were no presentations. But there was one.

I would say the majority of my feelings are exhaustion.

I don’t want to read for school, I want to read for pleasure.

I don’t want to write for school, I want to write for pleasure.

In the past few days, I’ve mostly been reading.

A lot.

Like a lot a lot.

The Women by Kristin Hannah was the first book I read. It is about the forgotten women in Vietnam, the nurses. Oh, so good.

Maddening and tear-jerking all at the same time.

This country did those women dirty.

Oh, and I worked a few shifts in there too.

After my last 10 hours as an RA.

And it occurred just now that I didn’t turn in my last time card.

Oh, dear.

Okay, that isn’t what I said. But drat!

And it was due today.

Bother.

I’ve got to get that in.

Oh, and I’m on my fourth and fifth antibiotic of the Spring. Can I use that as an excuse?

Too late, because I’m gonna.

Tomorrow I will write another Dispatch from Wonderland regarding school life.

I can’t wait to find out what I’m going to write about.

Time card first!

School Me Saturday 4/20/24- personal end of semester update

On this palindrome Saturday I am going to be digressing from the Alice in Wonderland school series I have been writing and will be writing about myself and my program.

Why?

Because it is nearly the end of the Spring semester and it’s been a hot minute since I did an update.

Two weeks remain in the semester.

That is 2 more times driving to the university for my research assistant job. I did decline to work this summer for the department as I anticipate life is going to get very interesting and busy over the summer.

That is 2 more assignments. One in the qualitative research class and 1 in the measurement class.

As the qualitative, I should have seen the writing on the wall. I do not care for math. Especially the kind of math that is required for quantitative research. Statistics makes me itch a bit. You know? I am leaning into the qualitative sphere. And this is shocking to me.

Talking? To other people? Not really a strength of mine. But here we are.

For the third class, the directed research class, I was thrown off a bit by being sick for 2 months starting in February. I just feel like I got a slow start. But that’s okay. I am chipping away at it. Next week I will be presenting my directed research project, an observation project, to the corporate research council. After that, and after the blessing of the school IRB and the hospital IRB, I will dive into the observations and finish the class.

Thankfully, I am not the first person to have a slow start and there is a process for this.

For the rest of the summer, I will be preparing for and taking my preliminary exams. These are exams that separate the PhD student you from the PhD candidate you. These are also the threshold that must be crossed to begin dissertation work.

The exams are timed, kind of, and meant to be written over two weeks from home, or 3 days at the university. I will stay home, thank you, and write them from here.

After I pass the preliminary exams (I hope) I will start work in earnest on my dissertation project and my dissertation itself. As I understand I will need to have it completed and defended by March if I want to graduate in May. The directed research informs the dissertation project research.

I have had so much support from the university in this journey. And a journey it is. And support from family and friends.

I need a better answer to what are you going to do after graduation?

For the longest time, the answer has been write for publication. I might throw in some teaching in there too.

After the end of this semester, I will be a 3rd year PhD student. If you had told my younger self that I would someday be looking at and surviving a dissertation she would have laughed.

Oh, boy.

Let’s get started.

Dissertation topic

On Wednesdays we wear pink. Deliberate Mean Girls Reference.

On Wednesdays, I write about the operating room Not so weird, considering Dispatches from the Evening Shift started as an OR blog. And then it became an operating room/nursing/post-it notes to me discussion/Tuesday Top of Mind where I discuss politics and things that are top of my mind/Cookie Thursday is a Thing/School Me Saturday blog.

Yeah, I know that the topic of my dissertation might be more of a School Me Saturday post but this is very operating room-centric. I just felt like it fit here best. And I’m doing an Alice in Wonderland theme for School Me Saturday for a few weeks.

My idea for the dissertation project that will take me nine months to do and write the damned dissertation (name of a dissertation service I’ve seen) is solidly in the OR.

Not to go too deep into the details but the OR is consumed with turnover.

This is not when people leave and new people are hired. While that is also called turnover, this is not it.

Turnover refers to the Wheels Out to Wheels In time. This is the length of time that elapses when one patient leaves the room (Wheels Out), the room is cleaned, the equipment is brought in, the next case is opened and counted, and the next patient enters the room (Wheels In).

There are industry standards. There are goal times that the hospitals strive to meet. The industry average is 26 minutes.

And I am over here doing 10-12 minute turnovers. Often in the same room, always with the same team, and always without anyone but us to clean the room/get the equipment/open and count the room.

The question is why.

Why is the evening night team so efficient?

So efficient that several doctors remarked on it. One of them went so far as to suggest they were going to schedule all of their cases after 1500.

The thing is… I don’t know.

Being a circulator is a job in a solo. We don’t know what the other circulators are doing.

This leads me to the pilot observation study that I will be doing as soon as the IRB allows.

It is my hypothesis that there are tasks that can be done to potentiate a faster turnover.

These are simple tasks.

Make sure there is no trash on the floor.

Make sure all the linen is in the linen bag.

Make sure all equipment is away from the OR table.

Make sure that all extra supplies are either put away in the room or readied to be taken out of the room.

Make sure all the suction cannisters are prepped for removal.

Be thinking ahead to the next case and the equipment that might be needed.

Be thinking ahead to the positioning requirements of the next case.

In other words, prepare to room to be left.

I only know what I do. I don’t know what other circulators do.

Hence the pilot study.

The pilot study will be in one hospital during the day shift.

The big dissertation study will be controlling as many variables as I can and observing in other venues. Such as a bigger hospital. Such as an ambulatory surgery center. Such as the night shift. Such as the weekend shift.

The thing I’ve learned about the dissertation during my program is to keep it simple.

There are many downstream effects that an efficient turnover can do. Keeping to the scheduled times. Getting people out of shift on time. Decreasing overtime costs.

The end goal is to create a checklist for pre-Wheels Out activities.

But that is NOT the dissertation goal. That’s for later.

Because creating a checklist and getting it validated can add 2 years to the dissertation time.

I don’t have time for that.

Remember. Keep it simple. This is not the best work I will ever do. This is not the most important work I will ever do.

The dissertation project is just enough. Because although there is a degree at the end, it is really about the journey.

Cookie Thursday 3/28/24-the ApocaPEEP

This is the final week of Well, That Was Easy March. And the week before Easter.

At this time the surgical schedule is kind of hit and miss. It all depends on where the doctors’ kids go to school and where their spring break falls.

This is also the fourth day of my new antibiotic (third one!) and I needed an easy make.

Enter the PEEPS.

For those who don’t know, the peep candy is a marshmallow body that is covered in sugar crystal, with two itty bitty wax eyes.

You either love them or hate them.

Me, I love them. I am enabled in my love for them too.

I long wondered if I could use the peep in a rice crispy treat. And you totally can!

But as I learned in the execution, you have to choose your peep colors carefully. I used what I had; pink, yellow, and blue. Eh, it was all I had. I kind of expected the end result to be gray.

Nope!

Very much in keeping with Dispatches from the Evening Shift and its war tone, where healthcare is a war and we are all on the frontline, the peeps turned out camo? Blotches of pink, yellow, and blue.

Very cool.