Hi, I am a new graduate who has been working in an outpatient hematology/oncology setting for the past 7 months. I am just wondering on how some of my jobs practices compare to other outpatient facilities. I am not oncology certified, I do not have enough hours to qualify for the test yet, nor am I chemo certified. I know to work in a hospital you would be chemo certified through them, but I am not sure how to do this on my own. I am responsible for mixing my own meds, which I administer without a pump.... when I first started and asked about why they don't use pumps, they said that they used to use them but they had more infiltrates that way. The meds are mixed under a hood, using gloves and a gown. The only time a dose is second checked by another nurse is when it is a 5-fu pump that will be going home with a patient (of course I can always ask another nurse if I am unsure about my calculations, or just have a question, but it is not required). I am wondering if this is how it is done in other facilities? Is what I am doing completely unsafe, and out of my scope? I feel like I may be being taken advantage of, given my inexperience by 1. how under compensated I am being, and 2. tasks that I am doing that maybe I shouldn't be. I don't feel that I am doing anything that I am uncomfortable with, but am I so new that I don't even know what I shouldn't be doing (if that makes sense)? I do work with several OCN nurses, and I feel like I am guided and have good resources with working with them. This all started because I went on an interview (I am desperately trying to find a hospital job with 12 hour shifts) and the nurse manager told me that she thinks what I am doing is dangerous... so my question to all my fellow nurses is, am I being dangerous and I don't even know it???
Quote from gvrn13
Thanks for you input… I was really wondering what other outpatient facilities do. I'm not sure if you still do outpatient, but you do make a good point about by my employer not requiring the chemo provider course, they are putting both me and my patients at risk. I wouldn't say that my training was inadequate though, maybe just not as detailed as it possibly could've been?? I shadowed an OCN for WEEKS, and when I did start mixing and hanging, she was shadowing me. Regardless, I will work on doing the chemo provider course. Being so new, in an office setting, it's kind of easy to be persuaded, and talked into what the standard is for that particular place. I feel like in a hospital, the training and standards are just such higher.. I do have an interview for the emergency department in a local hospital, and I am just hoping with everything I have that I get this job!!
I was on the oncology ward for 6 months before I took the provider course. During that time, I was not allowed to handle chemotherapy, much less mix and give it. I shadowed an RN on the ward for 1 month prior to the chemo course, took the 2-day chemo course (back then, it was taught in person), did a week of strictly clinic work with a preceptor, and then completed 3 observed chemotherapy administrations before I was allowed to give it alone back on the ward.
Suffice to say our definitions of "adequate" vary greatly.
While I have no doubt that you learned a lot while you were shadowing, there is a reason that in nursing school, you're taught theory before you're put into practice. There is a way things need to be done--a standard--and that's something everyone should know. A book (like the one we received at the chemo course) not only serves as a reference should you have questions once you're in practice, but as the foundation across the board for all nurses in a specialty. It sets the minimum expected standards across the board, not based on one person's arbitrary practice, but on researched, proven methods that will protect you and your patient. I'm not trying to discredit your preceptor, but understand that you need to take responsibility for your practice, and without a pulse on the basic standards of practice for your specialty, you're gambling your license and your patients on the word of another nurse. That is never, never, never a good idea. Trust no one but yourself and solid research.
I understand the pressure that's probably on you to perform to a certain standard, but you have a license now and the awareness of your own safety and that of your patients needs to come over what an employer/preceptor wants you to do, no matter if it's the crustiest old bat in the place telling you you'll be fine or your manager. There are worse things than being unemployed.
Last edit by SoldierNurse22 on Mar 10, '14