Shinobi as a Counter-Culture


Even today, peers have difficulty with the basic concepts of resource management:


Work takes place within the confines of:


•Finite time

•Finite space

•Finite staff


We continually blur the edges of these definitive boundaries.


Important dichotomies that enable our thinking errors include:


•The concept of the Operating List as a manufactured vs. emergent workload pressure

•The concept of fatigue intoxication vs. work and home performance

•The concept of “I can cope” vs. “I am human”


Resource boundaries are definitive.


However, the staff overlay we set to roster the infrastructure resource and the way we blur the edges of workload demand means that we are more comfortable with eroding the limits of staff boundaries and endurance than we are with reining in workload to fit the human and infrastructure limitations.


Because of this, nurses desperately seek measures to support us in delaying the effects of our inevitable fatigue….


The mainstays of work performance enhancing drugs in hospitals are




and Chocolate,


Which are not so much niceties as they are Legal Tender in the effort to maintain physiological and psychological stamina in the face of overwhelming demand for our specialist services.


Challenges to physical well-­‐being generally occur in the form of challenges to endurance.

Factors include:


•10 hour shifts or longer


•Environmental ‘stark’ism


•Workload/ effort distribution


In order to consider them better, I have divided these endurance factors into couplets, since they impact on one another.


For example, the exertion required to maintain vigilance over a ten hour shift will take the same cognitive endurance as it would to drive a fully laden semi-­trailer from Melbourne to Sydney virtually non-­‐stop every work day.


The effect of the combination of vigilance and environmental stark’ism is to compound the cognitive effort required, and thus add to the summative fatigue.


Environmental stark’ism is the design feature used to reduce operating theatre bacterial load. It inadvertently increases auditory sensory input from reflected ambient noise and thus increases subconscious filtering.


Subconscious filtering is required to isolate at a subconscious level targeted vital inputs such as pulse oximeter sounds.


The irony is that subconscious auditory filtering produces fatigue even though you don’t realise you are expending energy whilst performing it.


Challenges to Physical Well-­Being:


Glucose Auto-­Regulation Brain metabolism and thus function depends on Glucose, one of the few molecules to cross the blood-­‐brain barrier


•At rest, the brain utilises 20% of all available glucose. However the brain has no ability to store glucose.


•When both physical and cognitive endurance is challenged by fatigue; the body and the brain have to compete for diminishing supplies of blood glucose.


•Auto-­regulation commences, and the brain becomes glucose-­selfish.


Cerebrally, memory and emotion regulation are the first affected by lowered brain glucose levels.


Under time pressure, work gets most frantic towards the end of the operating list, when the body’s reserves are at their lowest ebb.


•Once fatigue has occurred, timely and adequate recovery is needed to prevent chronic physical and emotional fatigue.


Given unrelenting workload pressure, and the fact that nursing is an intensely physical, cognitive and emotional pursuit, is there any wonder you feel fatigued at the end of the day?!!



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