Hey there! Huge Congrats!
I did my senior practicum in BMT too & LOVED it. It's not for everyone, but it was definitely for me. I remember it being a steep learning curve because, as you mentioned, we really hadn't learned much about BMT during nursing school
Now I work as a Pediatric BMT RN. We usually have no more than two patients, sometimes we share 1.5:1, 1:1 (and in really serious cases 2:1!) but on adult units it can be 3:1, and on mixed BMT/Heme/Onc it might be closer to 4:1 or 5:1 (but I think 5 is too much if blended with a BMT patient!)
Here's a taste:
Folks get super
sick on BMT -- we "condition" them with very high-dose chemotherapy (Imagine the equivalent of 1 years worth of chemo given over 6 days) that ablates the bone marrow, then we infuse them with either donor stem cells (allogeneic) or their own cells (autologous, sometimes called a "rescue") -- then we manage the symptoms of the high dose chemos et al while they grow their new marrow/immune system back. Those who receive cells from a donor source take a lot longer, and require immunosuppressive drugs for life so they don't reject the transplant.
It's an incredible process, and very hard on the patients. During my senior practicum, my preceptor told me "we basically bring them to the edge of death and back again..."
With no WBC counts, they are prone to infection, their bone marrow is essentially non-existent so they need multiple platelet and blood transfusion (or FFP, Albumin...) until their counts are back up. Antibiotics/Antivirals/Antifungals are the norm. The chemo can be cardiotoxic, hepatotoxic, and can fry the kidneys, so knowing those systems are important. Knowing all the systems is important...and signs those symptoms are shutting down. Managing, pain, fevers, nausea (look up antiemetics), fatigue, mucositis, GI issues/weight loss, emotional support, the process of being in isolation for weeks to months..."those walls can close in fast"
Review general heme/onc w/ a focus on blood diseases (leukemias, sickle cell). We also transplant SCIDS babies (born without immune systems to start) and some others...what you'll see really depends on the hospital.
Review the process for transfusing blood products (probably won't be able to touch blood or chemos while your precepting, but you'll see plenty) also managing transfusion reactions. Know your antibiotics, antivirals, antifungals. Research working with severely neutropenic populations & practicing impeccable hygiene/precautions. Learn about mucositis, pain interventions, all pain narcotics. You'll learn a of critical care. We are categorized as an ICU but we don't do vents. Review signs of sepsis, infection, signs of bleeding problems (read up on hemophilia), topical skin lotions (some of the chemos burn/irritate the skin and it can peel right off), incredible wound care, working with CVCs & Ports.
I remember being intimidated by the amount of lines to manage. We frequently have kids on PN + Lipids + Heparin + Dilaudid or Morphine PCA, sometimes lasix or insulin drips...then add on their antibiotics, or blood products, and various IV meds -- and you have to double and triple check what's IV compatible with what...that can be quite a juggle! But you do get used to it.
While you are there, you will have great opportunity to practice your head-to-toe assessment and monitoring vitals signs. I'm sure you've heard throughout nursing school how important these two skills are. On BMT these two skills are SOOO important. Sometimes the slightest change in your baseline assessment can indicate a serious change in condition and these patients can crunk out fast. We've had kids who were up talking & playing and within 30 minutes were going septic! There's an art to getting reliable temps and BPs on our patients. Even changes in weights or abdominal girth can indicate big issues. Look up Veno-oclusive disease & hemorrhagic cystitis.
Some of what I love about BMT is there is a big emphasis on "team nursing" -- so much of what we do has to be double checked by other RNs at the bedside (Chemos/Blood Products/Drip Changes/Narcotic PCAs) so everyone works together a lot. You also work with patients for such an extended period of time that you really get to know them well. I love the psycho-social support aspect, personally, and with the kiddos we do so much to keep things fun and interesting and developmentally appropriate. I love the critical care aspect also (nerd alert!) and really do a lot of review and education regularly.
I also like that most of our patients can still talk and interact (no vents!) and most of them have central lines so we aren't doing a lot of poking (alas, I have zero IV skills working on BMT). I also like that there is so much teaching involved. You really have to enjoy developing relationships with people and being creative in educating them about their "new normal" post-transplant
What I don't like about it is sometimes all the interventions in the world don't seem to ease the suffering and I go home some nights feeling like I didn't provide any relief despite throwing my entire arsenal of interventions at them. Sometimes patients really break down psychologically, and if they react to medications they can hallucinate, or they don't make it through treatment...dealing with grief, and the dying process is also important to review -- and therapeutic listening/communication. Losing patients is so, so challenging and you have to learn really good coping and self-care methods to avoid burnout.
Remember to take care of yourself. Set healthy emotional boundaries. I find working with this patient population makes me recognize how magical every day is, and to not to take anything in life for granted. I really give thanks on a regular basis, and take full advantage of my days off!
That's probably more than enough...
At the end of the day, just try to soak up as much as you can! Ask questions, keep a notebook handy, and look up everything. I hope you have an enjoyable experience. It can be incredibly difficult work, but also deeply rewarding.
And I forgot the mention: BMT nurses are a super unique kind of wonderful -- often a bit type A, but extremely compassionate and fantastic colleagues.
You're going to learn so much! Enjoy the process & good luck!!!