ENT/Allergy Nursing - what is it like?

iDeftones · Jun 21, 2013

Hi there! I'm an Allergy/Asthma RN from NJ. I signed in after a few years just to respond, lol!

In a nutshell: it's nice. :)

Really though, it all depends on the doctor(s) you work for--and that's true for ANY private practice. Allergists tend to be nicer though, because they're not so stressed out. When you go to interview, try to not just let them interview YOU, but also interview the people you'd be working with as well.

What will you do? Not too sure about the ENT part honestly. But re: asthma you'd do things like PFTs, resp. tx (usually with a follow up PFT) and teach about different drugs, how/when to use them, what to do in an emergency, etc. Re: allergy, you'll do things like skin testing (usually just scratches), intradermal injections (a "deeper" skin test), allergy shots to build up immune defense, and things involving food allergies such as monitoring a pt while they eat foods for s/sx of anaphylaxis, possibly blood draws (actually most pts are sent to a lab for that) and then again, teaching about the allergies, how to avoid them, how/when to use an epi pen/benadryl, phone triage for pts who don't know how to handle a runny nose (haha).

two grueling things: allergy seasons (typically spring and fall) can be nuts depending on the size of the practice, as well as camp/school forms. but you get VERY proficient at it. i used to be nervous for a few months but now it's pretty easy, and i sit a lot. :)

be wary of "shot farms." these are places that are very unsafe, where doctors allow too much allergy serum to be recklessly injected into people who can be severely allergic to the antigens you inject them with, causing anaphylaxis. but, if you get into a good place, it's so worth it! i mean the pay isn't as good as a hospital, but it seems like allergy is an up and coming field that may turn into a very nice niche of nursing care. and the doctors do really need you there to help their days flow nicely, imagine if they had to do everything i just listed AND take the pt's H&P?

just make sure you work for nice, responsible doctors with a good team, and you'll be very happy (if money isn't everything to you). pay is still pretty good, but not near hospital pay. don't work for anything less than $23-$25/hr, depending on where you work.

plf2323 · Jun 21, 2013

I have been working for an asthma/allergy/immunology practice for just over a year. I needed something with fairly regular hours and without too much stress. I have young children and could not do the day/night rotation and weekend thing anymore!!

This is what I do at work: give allergy shots, allergy testing (scratch tests and intradermal tests), oral challenges (patient eats increasing amounts of whatever you are testing for while being monitored), room patients (take vitals, review meds, document symptoms/problems), spirometry, immunizations (flu shot challenges, immunizations for immunology patients), nebulizer treatments, lots of teaching on things such as inhalers, epi-pen, allergy avoidance, etc. We also do a lot of phone triage and things like school forms, prior auths, prescription refills, etc.

Like the poster above said, it is not as good pay as the hospital but it works for me. Good luck!

HippyDippyLPN · Jun 21, 2013

I was an allergy LPN for 1.5 years and I actually really enjoyed it. We mixed and made all of our serum for our clinic so we were quite busy. Usually in the AM I would assist my MD with patients and minor in office procedures. Our docs only worked with patients half a day and alternated so that an MD was seeing patients all day.

In the afternoon I would do a couple different things. I would do triage desk a lot (prior auths, refills, reactions, etc) or I would have my own allergy injection schedule. I would have patients scheduled every ten minutes from 1 to 4:50 pm. We were still on paper so we did the math for how much of each antigen a person gets every time they came in within that 10 minute period (it is a little hairy in the beginning since it will take some time to become efficient). We also checked our injections against the last nurse's shot to avoid any mistakes. Or I would be on the testing station and could have up to 6 patients getting full sets. For us that meant they were getting a round of antigens every ten minutes based on how they reacted to the previous set.

During my whole time there I saw a few severe reactions but we had standing orders to treat it so it was put under control before any respiratory involvement usually. I also taught a class every Thursday teaching patients how to self administer their allergy injections. One afternoon a week we were closed to the public to mix antigen and make vials for people who do their shots elsewhere.

I liked it and hope to return one day, I was always busy, but in a good way!

readyforachangenow · Jun 22, 2013

Thanks for writing this post! I am more interested in this field now. That's what I love about the nursing profession abs why I want in it... So many options.

Marshall1 · Jun 22, 2013

I briefly worked this area..It was definitely stress free but very repetitive and at times boring - same patients, same procedure for allergy testing which can be a good thing or not depending on your interest level. The mixing of the serums for injections - I personally enjoyed it since it was attention to detail and patient dependent and gave me something else to do besides injections.. however, mixing medications for this area is not in the scope of practice for nursing - at least not in my state according to the BON rep I spoke with so in essence, when I did this, I was in violation of my license. The clinic I worked at was aware of this but was not willing to hire someone with a pharm. degree nor were the MD's willing to mix. The clinic I worked at also mixed for SLIT (sub-lingual) drops which are not FDA approved. I also did not know the Intradermal testing was suppose to be done by an MD & all testing on anyone 17 & under was suppose to be MD performed but this was not the case where I worked. This was a fairly new side to the clinic I worked at & for me, personally, there were too many boundary blurred things going on - medical assistants mixing meds, giving injections if an RN wasn't available... I'm sure in a well established practice & maybe a larger one, things would be worked better. There is a lot to learn about allergies, triggers, testing, etc. but make sure you know under your BON what you can/can't do legally & go from there.

HippyDippyLPN · Jun 22, 2013

^ very interesting! Even though I am no longer in allergy I want to see if my states BON has the same scope. We also did the SL drops that were not FDA approved, patients had to sign a waiver and pay for it out of pocket since insurance wouldn't pay for it. It seems each allergy clinic does testing and injections very differently from each other, I sometimes give allergy shots from other clinic to patients that can bring their own

serum in at the clinic I am at now, and every single shot has had a different way of increasing, how much, etc. you would think it would be more standardized.

readyforachangenow · Jun 22, 2013

Where do you look for that information for each state?

Marshall1 · Jun 23, 2013

I couldn't locate it specifically online at the BON site so I called them.

Ayvah, RN · Jun 23, 2013

mixing medications for this area is not in the scope of practice for nursing

Didn't you have a protocol signed by a doctor for doing mixing? Why then would this be out of scope?

I also did not know the Intradermal testing was suppose to be done by an MD & all testing on anyone 17 & under was suppose to be MD performed

I'm not understanding this, if you've got a doctor's order to do the testing and the doctor is in the vicinity for any problems that arise (anaphylaxis), and to interpret results, then whey would this be out of scope? And why is age really ever a factor when you've got a parent around giving consent? Pediatric/NICU nurses give injections/perform procedures on young patients all the time, so why would giving ID injections to children be any different/out of our scope?

Ella26, BSN, RN · Jun 23, 2013

Hi there! I'm an Allergy/Asthma RN from NJ. I signed in after a few years just to respond, lol!
In a nutshell: it's nice. :)
Really though, it all depends on the doctor(s) you work for--and that's true for ANY private practice. Allergists tend to be nicer though, because they're not so stressed out. When you go to interview, try to not just let them interview YOU, but also interview the people you'd be working with as well.
What will you do? Not too sure about the ENT part honestly. But re: asthma you'd do things like PFTs, resp. tx (usually with a follow up PFT) and teach about different drugs, how/when to use them, what to do in an emergency, etc. Re: allergy, you'll do things like skin testing (usually just scratches), intradermal injections (a "deeper" skin test), allergy shots to build up immune defense, and things involving food allergies such as monitoring a pt while they eat foods for s/sx of anaphylaxis, possibly blood draws (actually most pts are sent to a lab for that) and then again, teaching about the allergies, how to avoid them, how/when to use an epi pen/benadryl, phone triage for pts who don't know how to handle a runny nose (haha).
two grueling things: allergy seasons (typically spring and fall) can be nuts depending on the size of the practice, as well as camp/school forms. but you get VERY proficient at it. i used to be nervous for a few months but now it's pretty easy, and i sit a lot. :)
be wary of "shot farms." these are places that are very unsafe, where doctors allow too much allergy serum to be recklessly injected into people who can be severely allergic to the antigens you inject them with, causing anaphylaxis. but, if you get into a good place, it's so worth it! i mean the pay isn't as good as a hospital, but it seems like allergy is an up and coming field that may turn into a very nice niche of nursing care. and the doctors do really need you there to help their days flow nicely, imagine if they had to do everything i just listed AND take the pt's H&P?
just make sure you work for nice, responsible doctors with a good team, and you'll be very happy (if money isn't everything to you). pay is still pretty good, but not near hospital pay. don't work for anything less than $23-$25/hr, depending on where you work.

I also work in a Allergy/Asthma clinic. Everything iDeftones said sounds exactly like my practice. It is low pay (I make a little less than the $23-25 per hour )But its a start to my nursing career. I can only go up from here in pay. But it is essentially low stress and the hours are good. I like my coworkers. And I could not think of giving up clinic hours to go to nights, weekends, and holidays, even if the pay is better. It works for now.

I will be sure to not accept anything less than $25/hr in my next endeavor.

Cehurstrn · Jun 24, 2013

I appreciate your input and experiences. I am looking for something more regular because the hours I'm working currently are varied and the environment can be overly stressful. I can definitely deal with busy schedules because of the environments I have worked prior, however. I prefer it to be busy and I have learned to appreciate the down time. I plan to start my msn next year part time and I feel that even though this opportunity is primarily ent/allergy, I can still learn a lot and I can work with children again. I plan to do family np and I have had extensive psychiatric and behavioral health experience, including substance/alcohol abuse and detox, and I have worked with children to geriatric patients. I am looking forward to this opportunity if I get the position. Are there any certifications for this area of nursing?