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
    efiebke likes this.
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  4. 15 Comments so far...

  5. 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.
  6. 2
    Onc = ICU w/o Vents! LOL
    ScarryBear,RN and efiebke like this.
  7. 1
    bump*** *
    ScarryBear,RN likes this.
  8. 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.
  9. 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.
  10. 0
    Sounds like our floor too. Floating to other floors feels almost like a vacation. Love my oncolgy patients though
  11. 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.
  12. 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.
  13. 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.


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