Merry Christmas

Working at a Level I Trauma Center, the surgery department is manned 24 hours, seven days a week, including holidays.  Yes, that means someone either picks Christmas or gets stuck working it.  Tonight I'd like to say thanks to those who had to work today.  Because of these men and women, people are still getting the care they need.

Merry Christmas...

From The Archives: "To My Favorite Residents"

LTC has surgical and anesthesia residents rotating through our department.  Like anyone else on staff, there are good ones and some that are...  Well, let's just say that there is room for improvement.  They were accepted into the program because of their medical knowledge and potential.  However, there is more to being a good surgeon than just knowing what to do with instrumentation.

To My Favorite Residents
from the archives of "Livin' Large"

How do I like thee? Let me count the ways...

1. At the beginning of your rotation you actually introduce yourself to the nurses and techs instead of, like a gunslinger, busting into a saloon as the "new sheriff in town."


2. You ask kindly if I wouldn't mind answering your pager because you're on call. And you apologize profusely since it is my least favorite thing to do when I'm circulating.


3. You don't stand there just watching while all 5 feet of me is struggles to hold a 300 lb. patient steady during a spinal. Not only do you help, but you refrain from short jokes - well, at least most of the time.


4. You help me get the cart out of the room after transferring a patient to the OR table so that I can quickly put the safety strap on, help the anesthesiologist with the monitors, and provide comfort to the patient.


5. When you're on top of completing the H&P (history and physical), initialing the surgical site, and ordering appropriate medication prior to me picking up the patient from holding, you help me keep things moving along.


6. I'm impressed when you take the time to answer a patient's and his/her family's questions.


7. You take patient care seriously by doing a thorough job closing the surgical site and putting on the dressings without getting blood all over them.


8. Instead of answering your pages or checking your e-mail, when it comes time to transfer a patient from OR table to cart, you're ready to go.


9. You don't purposely drop stuff on the floor (unless you really have to) 'cause you know someone else has to pick it up and I'm not your mother.


10. Ultimately, you understand and appreciate that it takes teamwork to give good patient care in surgery.

Because of this...

....I don't mind answering your pager even when it goes off 10 times during a procedure.

....I will share my lunch with you when you haven't had a break and there's no food left in the doctor's lounge.

....I will provide positive feedback with the surgeons you work with.

....I will remember your glove sizes and pull them so that you don't have to worry about doing that for every case.

....I will save certain items that you need for learning/teaching purposes (within reason, of course).

....I will show you the respect that you give me.



Thanks to all my favorite surgical residents... I know you'll do great when you're finally on your own!

Infection Control

What happens when a hospital discovers a spike in surgical site infections?

I can't tell you what happens at other hospitals, but at LTC, a task force is created, the troops are rallied, and all out war is declared on the whatever varmint is causing the trouble.

Task Force One consists of every hospital bigwig that has a connection to surgery:  Hospital President, Medical Staff Director, Chief of Surgery, Director of Infection Control, Presidents of various specialties (all surgeons), Manager of Environmental Services, Director of Surgical Services, the OR Manager, and representatives from Pharmacy and Anesthesia.  Somehow I (yes, little ol' me) made it on the list.

Over the last few months, we have had meeting after meeting creating a strategy to tackle this issue.  Data collection and analysis is, of course, part of the search for the root cause.  My mission, which I have accepted, is to oversee audits on aseptic technique.  We want to see how well our staff, surgeons, residents, anesthesiologists, and ancillary staff (perfusionists, etc.) follow protocol.  I won't be doing this myself because everyone minds their P's and Q's since I'm management.  Just put a big sticker on my forehead.  Seriously.  People shouldn't do the right thing because I'm management.  They should do the right thing because there is a human being's life and well-being at stake.

Instead of making my own observations, I have asked two nurses to secretly audit certain rooms.  It has only been one week, but so far I think it has been quite challenging for them to be discreet.  Should they be inside or outside the room?  How long should their observation time be in order make this data valid?  Should they observe an entire procedure?  Honestly, I'm not sure how we can collect meaningful data.

I think I should channel Tom Cruise in Mission Impossible and rig microscopic cameras in each operating room.  Perhaps I could hang out above the ceiling tiles and get a bird's eye view.  If only I could...

We will try again this week.  Stay tuned...

Angry OR Bird

Sometimes it is really a challenge to control your emotions when you are part of the OR leadership team that is charged with improving a culture that needs a great deal of improvement.  If only they can make a nurse version of this video...

And while we're on the topic of Angry Birds, I invited my colleague, AngryORBird, to contribute to this blog.  She probably needs to vent more than I do!  Hopefully, we will hear from her soon...

From The Archives: "It Only Takes Five Minutes"

Once upon a time, I used to have another blog.  It was called "Livin' Large."  I took it down when I was starting to really burn out from the stress of my old job.  With a little time, I found my way back to being a nurse blogger.  There are some posts that give an important perspective on what it's like to be a surgical nurse.  This is one of them.


It Only Takes Five Minutes
From the archives of "Livin' Large"

I've be told by nurses from other units, "You're so lucky that you're in surgery --- your patient is asleep." (FYI - they are referring to the amount of interaction I have with patients.)

Huh? Who me? Lucky?!?

Honestly, I don't think they understand what I do. That's OK... I know it's hard to think about what other nurses do when you're up to your eyeballs in your own specialty.

In the operating room, nurses (specifically when you're the circulating nurse) get plenty of time with patients and their families. Enough time to make a connection, that is.

There was one day when I was pulled out of my normal service - orthopedics - to circulate in a general surgery room. All the cases for the day happened to be patients newly diagnosed with breast cancer.

My scrub nurse and I set up the room for the first case --- a complete mastectomy. I went to the holding area to pick up my patient, "Gloria". When I walked into her room, I gave my usual toothy grin and introduced myself.

"Hello! I'm Molly... I'm one of the nurses in surgery."

Gloria was flanked by her two daughters, one who is a nurse at the connecting children's hospital. The first thing that came out of the peds nurse's mouth was, "Thank God - a friendly nurse!!!"

"Gee thanks..." I said, wondering what kind of interactions they had prior to my arrival.

I did my usual assessment, asking the questions that at least two or three other people had already asked her. Then I did my Julie McCoy thing, explaining all the stuff that would happen --- giving her warm blankets, putting monitors on her, etc. I promised Gloria and her daughters that I was going to be in the room the whole time.

"Any questions for me?" I asked.

No questions. After I announced that it was time for some hugs and kisses before we left, the tears began to well up in all three ladies' eyes.

I thought, 'Aw man... Tears??? Please don't... Oh please... Geez. Here I go...'

My tears were threatening to appear. My heart was breaking as I witnessed this scene: the daughters who were so scared, worried, feeling so helpless and their mother trying to be so brave. What could I say to make it better? Nothing...

I promised to take good care of their mother and reassured them that she was in good hands with her surgeon and the rest of the team. The daughters were grateful that I was going to be in the room with her, they told me. It took everything for me not to cry.

Maybe for some people it takes a few days to make a connection, but for me it only takes five minutes.

Sandwich

I never thought that, after having experienced leadership in Corporate America, that I would ever end up in a leadership position in nursing. Why? Because I know how tough it is to serve my customers, the people that report to me, my bosses, and somehow still be happy with myself. In the end, I usually feel like I'm in the middle of a panini being firmly pressed on a hot grill.

So here I am, Assistant Nurse Manager Panini, trying to take each day one at a time. It seems like I can never do enough for people; somehow I have to convince myself (on a daily basis) that I am doing OK. Despite my best efforts, each day is a battle. I should be wearing fatigues!

When I make my rounds, I am often met with complaints about trays, equipment, or the latest policy change. Missing an instrument? Send out the search dog --- that would be me. On a really bad day, there are five alarm fires to address with me, in front of an angry surgeon, trying to do some service recovery.

My co-assistant manager and I realize how many hats we wear during the course of our day. Teacher, psychologist, clinical engineer, housekeeper, artist, cheerleader, principal, and mother are roles that we morph into and out.

There are days when I am completely worn out --- when I can't listen to another complaint or hear another sob story. There are time when I wish the questions and requests for help would stop pouring in.

"You wouldn't have a job if there weren't problems," says a popular motivational speaker.

He's right, but sometimes I wonder if this job is good for me.

A couple of months ago, I watched "Stress: Portrait of a Killer." Needless to say, it scared the crap out of me.

Isn't it ironic that, while I am in the business of healing, I'm wondering if my job is killing me???

I'm just saying...

Nurse Panini signing off for now. Tomorrow is another day.