Acuity staffing for Oncology

  1. 1 Hello!

    As a new grad on an intense oncology unit where I am seeing experienced nurses overwhelmed by how acute our pts are, I am wondering if this is the general trend on all onc units or it's just unique to my hospital. It seems we are treated/staffed as if we are a general med/surg floor (with one less pt), yet it feels like we operate like our own ICU in that we manage our most critical pts.

    Often you need to be one-on-one with a patient for a large block of time while not being able to round on your other pts. (ie, bedside bone marrow biopsy where the pt was oversedated due to extreme pain and therefore needed close monitoring and narcan is just yesterday's example that comes to mind).

    Most of our pts are direct admit, often coming in with intractable pain or severe dehydration, n/v, etc. Also, any one of our pts can have tanking BP's or go septic or bleed out at a drop of a hat. I've just floated to the other med/surg floors a couple of times and it feels like the pts there are more stable--work is just as busy but more manageable, and the stress from constant vigilance less sharp for me.

    I love onc and for personal reasons it's where I belong; but I don't think our unit is being staffed with adequate aid/RN coverage for the acuity of pts we are dealing with. Wondering if this is a general trend in all onc units as the arsenal of treatment for oncology has expanded and we treat more aggressively, and admin/staffing has not caught up to the trend....or am I just feeling/seeing things from a newbie's perspective and this is the case in nursing overall? If yes, I question my ability to give safe bedside care.

    Thanks!

    TR
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  3. Visit  Testa Rosa, RN profile page

    About Testa Rosa, RN

    Testa Rosa, RN has '4' year(s) of experience and specializes in 'Cardiac Step Down, Oncology, Med Surg'. From 'Northern California (Bay Area)'; Joined Mar '06; Posts: 342; Likes: 290.

    15 Comments so far...

  4. Visit  Aeterna profile page
    2
    I totally hear you! Then again, I'm also a newbie but I remember in my fourth and final year of school, one of my placements was on a hematology-oncology floor. The nurses called it "the ICU without vents" because they often had to care for some of the sickest patients.

    But oncology patients really can go down the drain fast if you don't watch them carefully. As soon as someone with a low ANC gets a fever, everything hits the fan. Then, there's chemo that you have to watch (rituximab, anyone?), blood products, etc. We also get people in directly from ER with febrile neutropenia.

    The floor I work on has an RN/RPN mix and we're also a general medical floor on top of an oncology floor, so we see pretty much anything barring surgical patients (although, we do occasionally see surgical debridements and amputations...) In general, though, oncology patients mostly end up being cared for by RNs, simply because of the higher demands and acuity (managing central lines, chemo, febrile neutropenia).

    Medical patients can be acute, too (i.e. our acute renal failure patients), but there tends to be less you must be extra cautious and vigilant about.
    ScarryBear,RN and Testa Rosa, RN like this.
  5. Visit  Testa Rosa, RN profile page
    2
    Onc = ICU w/o Vents! LOL
    ScarryBear,RN and Ted like this.
  6. Visit  Testa Rosa, RN profile page
    1
    bump*** *
    ScarryBear,RN likes this.
  7. Visit  msjellybean profile page
    2
    Sounds very much like my floor.

    When I float, I'm amazed at how stable the general medical patients are. During floats, I've had people ask what our floor does (they generally think we just help people die & give chemo) & when I relay how sick some of out pts are, they generally respond with, "oh! we would have called a rapid response on them long before that and had them moved to step down ICU."

    The especially terrible nights are when you have several neutropenic patients (one of whom is always getting blood products of some kind), several total care/comfort cares, & then a couple goofy people (be it sundowners or brain/CNS mets) who are doing all they can to fall out of bed.

    The staffing on my floor sucks at night, because patients "sleep."
    DavidFR and Testa Rosa, RN like this.
  8. Visit  Testa Rosa, RN profile page
    1
    Ms Jellybean: I know what you mean--there is very little understanding of what we do--it certainly isn't just giving chemo and helping people die. It's dealing with some very critical medical/surgical pts who are having a negative impact on several systems. Thanks for your reply. TR
    ScarryBear,RN likes this.
  9. Visit  kelischa profile page
    0
    Sounds like our floor too. Floating to other floors feels almost like a vacation. Love my oncolgy patients though
  10. Visit  SiennaGreen profile page
    0
    Agreed. We have the same ratio as the regular med/surg (1:6). It's crazy. It sounds just horrible, but my saving grace is that some of our pts are always DNR or Hospice. I get incensed by the 90yr old lady with metastatic disease, kidney failure, CVA symptoms w/altered mental status...and she's still a full code b/c someone didn't want to have the difficult conversation with the family. Or better yet...b/c the chemo is "working" and the tumors are shrinking...??? Really? BC the chemo is killing her in every other sense.
  11. Visit  SiennaGreen profile page
    1
    Gosh, I'm feeling this right now. We've had a really rough few weeks. Morale is very low. Multiple experianced RN's have left over the past few months, leaving our 30 bed unit with an uneven mix of new grads, new hires, and a handful of RN's with 1+ yr exp on the floor. Many foks are unhappy with the new day charge. I work nights and most of those folks feel overlooked because as someone else said patients "sleep" at night. (Yes, except when we're running chemo, blood, platelets, sundowning brain mets, falling, ammonia levels are climbing from liver failure, or their lungs are quietly filling with fluid from a malignent effusion.) Our staffing is 5/1 days and 6/1 nights with a tech ratio of 6/1 days amd 8/1 nights. It sounds manageable on paper, but it never feels that way. I'm actually grateful for our inpatient chemo patients, because they're usually the healthiest! I'm trying to grab a hold of some inspiration, some higher calling; but we're all down. Gotta admit, the calm of a nice general surgical unit sounds appealing in comparison.
    ScarryBear,RN likes this.
  12. Visit  Aeterna profile page
    0
    Quote from SiennaGreen
    Gosh, I'm feeling this right now. We've had a really rough few weeks. Morale is very low. Multiple experianced RN's have left over the past few months, leaving our 30 bed unit with an uneven mix of new grads, new hires, and a handful of RN's with 1+ yr exp on the floor. Many foks are unhappy with the new day charge. I work nights and most of those folks feel overlooked because as someone else said patients "sleep" at night. (Yes, except when we're running chemo, blood, platelets, sundowning brain mets, falling, ammonia levels are climbing from liver failure, or their lungs are quietly filling with fluid from a malignent effusion.) Our staffing is 5/1 days and 6/1 nights with a tech ratio of 6/1 days amd 8/1 nights. It sounds manageable on paper, but it never feels that way. I'm actually grateful for our inpatient chemo patients, because they're usually the healthiest! I'm trying to grab a hold of some inspiration, some higher calling; but we're all down. Gotta admit, the calm of a nice general surgical unit sounds appealing in comparison.
    Oh man, I can empathize! Our floor is also losing a lot of staff, and most of the ones leaving are the experienced ones. Our unit just has a bad reputation of being chaotic and crazy (there is some truth to that) so the only people willing to fill in job openings are new grads. I would say about 1/3 of our staff have under 2 years of experience, including me. It's scary, considering we have very sick onco patients on our floor, getting chemo and such! I mean, they're starting to look at me as an "experienced" nurse. I can give chemo and all, but if something goes wrong, I'd be lost!

    It also sucks because it takes time to get people trained to administer chemo, so there are only a few nurses left who are certified. As a result, there may be only one or two nurses on the floor who are chemo certified and if there are a lot of patients getting chemo on that day, the chemo nurse(s) get hit hard. I once heard of a day where there were only 2 chemo nurses working and one had 2 patients getting chemo and the other had 3! It sounds so unsafe. It's no wonder people are leaving.

    I myself am starting to polish up my resume to send out as soon as winter starts thawing out (I definitely don't want to move in the winter; too cold and too snowy!). I wanted to stay a while longer for the experience but I'm scared of everything I described above.
  13. Visit  BBQvegan profile page
    0
    Where I work, we have 16 beds on an our Oncology Med-Surg unit. I have been a nurse for almost three years and have seen our staffing go down down down as the patients get sicker and sicker. I am at the end of my rope. I am ready to go work as a waitress! I have had enough! I cannot effectively take care of patients as they deserve. We are assigned 5 or 6 patients per RN and we almost never have a tech on the floor. We are doing everything at all times. We are lucky if we get a tech. The day shift is usually no better.

    Sunday night two weeks ago, I had an unbelievable patient assignment. I had 5 patients, no CNA. Our charge nurse had 6 patients. Just three nurses were the only staff on our 16 bed unit. I gave 4 chemo drugs to two patients, three units of blood to one of them, multiple IV antibiotics, one was neutropenic. I had a patient receiving tube feedings where all meds were crushed. I had another very confused 90 year old patient with a broken hip. Three of 5 patients were high fall risk. I was so angry when I left work in the morning. It was the last straw.

    The next night, our charge nurse was so busy (we had 3 admits coming all at once at change of shift), she had not seen most of her patients yet at 9:30 pm when our shift started at 7 pm! Well, we heard a loud thump way in the back corner room where a patient fell on the floor. She was naked and had not been seen for hours. We had no tech to help answer call lights. The patient's bed alarm was not working! I was so angry then, too! This job is making me completely frustrated and depressed. I cannot believe I worked so hard to become a nurse for this!!
  14. Visit  nursechris1 profile page
    0
    I can't believe the patient safety issues that are created in health care. I work in an outpatient infusion center. Our administration has decided that we can reduce to 1 nurse and a med tech in the infusion area. we have been slow, but it varies from 4-8 patients/day lately. Point is, that it is unsafe to have only one nurse working. When I need someone to double check chemo or blood, I am going to have to call the nurse from the clinic side to help me. If she is doing a new patient assessment, I could have to wait a long time. I was really mad the other day and had a melt down. I hope I don't get fired. I got to work and didn't think we were starting this 1 nurse thing yet. I found out I was working alone, I had 5 chemo infusions and a blood transfusion before noon. They ended up calling in our only pool nurse, thankfully she was available. I would like to find another job, but I live in an area where there is one hospital here and one in the next county. I have worked home health/hospice and oncology for a large portion of my 18 year career, so it's been a long time since working acute care. I love where I live, and I would be very sad if I had to leave the area.
  15. Visit  Ted profile page
    0
    I see that this is an old topic started about a year ago, but this comment caught my eye:

    Quote from Testa Rosa, RN
    Onc = ICU w/o Vents! LOL
    Could not agree more!

    It has been about 13 years since I left the hematology/oncology/BMT floor so a lot may very well have changed since then, but that "regular" medical floor took patients from other hospital's ICUs! They were sick, and that was before the chemotherapy was started. Honestly, I have no idea to what extent the acuity is on present-day heme/onc floors, or to how present-day heme/onc floors manage their patients, but I can't image things getting any easier in 13 years. (It seems that the acuity seen on almost any hospital floor is increased throughout recent years.)

    My first seven years of nursing was spent on that heme/onc/BMT floor. In many ways, it was a great experience. There are times when I miss working on that medical unit. Honestly, though, it would take me some time to get up to speed in managing 6 or so patients as ill as they might be on that floor.


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