Advice for new grad RN entering oncology med surg floor?

Ruby Vee, BSN · Jul 14, 2018

Hi there, I am a new grad RN and have been assigned to work on the med surg oncology floor. I am a part of a new grad RN residency program that will take place for 14 weeks. If any experienced nurses could give me advice on working in this unique area, it would be much appreciated. Even though I have experience teching on this same unit, I would love to hear from others on key topics I should know about or be familiar with. I was interested in taking a palliative care course but my facility does not offer this (although they offer classes on caring for dying patients/family).
My main concerns here are communication when it comes to intense situations. I am afraid that I will say something inappropriate in front of the patient or family that would not facilitate comfort. The other thing is medication. Along with nausea and mouth ulcer meds, I'm well aware that that many hospice and cancer patients here will be prescribed a lot of pain medication. For instance, I am worried about pros and cons to giving them heavy doses of pain meds if the situation arises. Ethical dilemmas.
Anyway, if anyone can shed some light on some advice, I would love to hear it. Even though I have teched and did my preceptorship on this same unit, I am a bit nervous and excited to be entering my career as an oncology nurse. I love caring for this patient population despite the challenges emotionally and physically. I am also interested in joining any formal organization/associations. Any recommendations?
Thanks in advance!

Congratulations on your new job in oncology!

Many of your questions will be answered during your new grad residency -- along with dozens of other questions you didn't think to ask! You'll be expected to do homework, and you'll find the answers to questions you haven't considered as you're researching the topics for your assignments.

Having worked in oncology for five years, I am familiar with the ethical dilemmas regarding pain medication. My preceptors addressed many of those dilemmas head-on during my orientation. Others, I had to figure out for myself. The thing I had to understand and accept is that not all cancer can be cured. If the cancer cannot be cured, does the patient wish to be alert to interact with their family and friends? Or do they want to be kept comfortable at the expense of alertness? Often, you will get to know the patient before they come to this point and will be able to have this discussion with them. Other times, you may have to rely on the family's interpretation of what the patient would wish. If the cancer patient is to be kept comfortable, it may require enormous doses of opioids as patient tolerance increases. There are threads about this very subject, or you can start one of your own.

If you are sensitive and pay attention to the way experienced nurses communicate with the patients and families, you will learn much. You may learn what NOT to do or say, but you will learn. Your course on caring for dying patients may offer suggestions.

Good luck with your new career.

Buckeye.nurse · Jul 15, 2018

I second everything that Ruby Vee said. As far as formal organizations, the Oncology Nurses Society is something to definitely look into. They have a lot of online resources, as well as monthly chapter meetings in most decent sized cities.

Daisy4RN · Jul 16, 2018

Oncology is very hard because of the knowledge base you will need, and also emotionally hard because of very sick/dying patients. You should expect to see patients from every place in their journey, some starting out with a new diagnosis receiving chemo/radiation and hopeful, others at the other end who are dying and with no hope, it is important to meet them where they are at along that spectrum and provide the best care (physical, emotional, spiritual) that you can. It is extremely difficult at times but can also be very rewarding. Expect high emotions from patient and family and do not take it personally. You will learn from your preceptor/residency and also as you go. You will learn how to talk to patients to provide the best care to them individually, there is no one size fits all, just try to 'read' them as best you can, it will get easier as you go. Make sure and ask questions if unsure about anything because Oncology is very different with everything (diets, visiting, flowers, chemo/meds etc.) The only time I ever saw any ethical dilemma re: pain meds was MD not giving enough, there is usually no reason why we should not try to keep people as comfortable as possible (knowing that is what they want, RR good etc.). And always use the appropriate PPE for yourself when giving chemo, do not take shortcuts there! You will be fine, don't worry, it will all come to you with time. Congrats on the new position!