Any allergy nurses out there?

Oedgar · Oct 21, 2008

Hi.

I worked in an allergy office for six years. I have been home with kids for the better part of 8 years now, but I would still love to chat.

jennrrn · Oct 21, 2008

Too funny, this is my first job after being home with my kids for almost 8 years. I used to work in a recovery room. Definitely did not want to go back to the hosp., did not think I was ready. My daughter goes to school with the office manager's daughter so that is how I got the job. I just work two days a week, but there is only myself and one other nurse that work together. She is full time. We pretty much do everything, allergy testing (adult and peds), vial making and giving the shots. My only real experience with asthma kids was in the recovery room and we either gave racemic epi or albuterol TXT's. Lots of stuff to learn. Did you ever do shots when there was no doc in the office? Also did you make your patients carry an epi pen with them after their shots? So glad I found someone with a similar background. Also I am not very good at this website yet. I've been on it for over a year, but I think this is my first reply :)

Oedgar · Oct 21, 2008

Hi, Jen.

I worked with one other nurse who was also fulltime. We did the puncture testing, but our doc did the intradermal portion of the testing. We also mixed vials, gave shots, did PFT's, gave albuterol, Xopenex treatments, and the very occasional epi shot or DepoMedrol IM. We did give injections when our doc was not in the office. However, we were in a building with other doctors offices, so there was always a doc nearby. Also, the ER was a short walk away, connected by a covered walkway. We instructed the pts to wait 20 minutes after injections, but some people just chose to leave.

I left that office fulltime after my kids were born, and had several years at home with them. At the end of last year, they were in a desperate situation. Both of their regular nurses were very sick and the doc asked the office manager if I had perhaps still kept my nursing license current?

I had kept it current, so I spent a few months back there doing PRN and enjoying it a lot. After a few days getting a little re-training, I was pretty comfortable. Not much had changed, except for a stubborn new PFT computer, and a new medication called Xolair.

But now that doc has retired, and the new doc doesn't need me. That is probably the only place I am comfortable working since I have not worked in a hospital since 1994. That job was on a Peds/Pulmonary floor, so I had a lot of asthma kid experience. That was back when they used to give Theophylline drips. Do they even use that anymore? I am probably really making myself look old. :wink2:

jennrrn · Oct 22, 2008

Hi there, we both do the intradermal testing and we do a multi prick test for the peds. I read the intradermal ones usually without any problem, but do have the Doc look at the multi test for the kids. I'm not sure if it is because he is an ENT surgeon and not an allergist that he lets us do more. We do the PFT's also with a pretty sensitive/picky computer program. I'm still trying to learn all about those. You just don't deal with all these things in the hospital. I actually had to load the whole program on the computer and learn how to get it up and running. Not like in the hosp. where you could have some IT guy do that. So much more work in the doc office on top of the nursing. I really like it though. We pretty much run the allergy area on our own and just go to him with questions. . I do like working there, but would love more training. He is so busy, he brought on another ENT surgeon to his practice and they opened a second office about 20 min. away. They are taking vials there with them and giving some shots. Not enough patients yet to bring a nurse over there. Did you ever get any outside courses or was it all on the job training? We pretty much tell our pts if they are sick not to bother coming into the office for a shot. If they sound at all wheezy we don't give a shot. Did you ever to peak flows before shots, we do not. Also, how long did you keep your allergy shot vials. We give 10 doses and then discard due to insurance coverage which is fine for a weekly shot pt. But some patients are on q3 week shots so that could be 5 months. Those vials are mostly concentrates so I am assuming they would be good for 6 months. Did you make up intradermal testing boards? Hope I am not boring you with all these questions :) I feel like I'm attacking you with questions. Thanks, Jenn :)

Oedgar · Oct 22, 2008

You know it's funny. I did not know the multi-prick test even existed for kids, until after I'd left. Even then, the doc still had us doing them one by one! It was very difficult with children. On one of the days I worked early this year, I had to do testing on a developmentally disabled child. But the mom was very nice, the child was trying to cooperate, and we got through it. Seems like being a mom myself helped me take care of the more fearful peds patients.

We kept our vials for six months. It might be different now, since I think they might be billing differently than my early days there.

We would not do shots on anyone who had fever or was wheezy. We often checked peak flows on our asthmatics before shots, either because the doc wanted to keep an eye on them... or they had symptoms.

We did make up intradermal testing boards. It was based on the same antigens every time. He just made changes in strength based on the puncture test results. Also sometimes he added a few things like cat or dog, or had us remove them if that was not an issue.

I got all of my training on-the-job. I came from a big-city teaching hospital, and was burned out within a year. His other nurse was a wonderful, kind lady who'd been with him 20+ years and she was a great teacher. We are all still friends, and it was a pleasure getting to work with her again for a few months.

Do you dislike giving Xolair? I watched the others mix/give it many times before I did. I also read through the detailed mixing instructions on their website.

jennrrn · Oct 23, 2008

I hadn't even heard of Xolair till I saw it in your email. We do not give it in our office. I mentioned it to my coworker today and she said they did give it in her old office in Missouri. She hadn't been trained yet to do it though when she worked there. She worked in a large Asthma/allergy clinic. I kind of wish I worked in something like that now so I could get more training. I do alot of internet searches to get info. We don't do a lot of patient teaching right now, I do the PFT and then the Doc talks to the patient. We don't do peak flows before shots at all either, which is something I find odd.

Ooooh another question here, did you do vitals on patients before shots? We do not. If we have problems we will do them, but not normally. Gave one shot last week to a patient just to check for a positive reaction to Histamine. She hadn't stopped taking her claritin before the test dte. With about a 3 second warning she passed out cold. That was the first time I'd had that happend since I have worked there.

Okay, another question here, did your allergy shot patients make appts. or did they just walk in. I'm trying to get our schedule organized better since we do a lot of testing at the same time. We end up getting some shot patients just walking in when we are both really busy. It seems like it is either dead quiet or extremely crazy busy.

Thanks for all the info...........Jenn

Oedgar · Oct 24, 2008

Hi,

We did not do routinely do vitals on shot patients. If there was something questionable we did though.

Our shot patients did not make appointments. We had shot hours that allowed for the 30 minute post-shot wait. Back in the busiest days there, we had two nurses every day. Often one was tied up doing testing. We usually divided that by one does morning testing and the other in the afternoon. Whoever was not testing handled the shots. It used to still get crazy, especially Friday afternoons. I remember some days were we did 89 shots in one day, plus the testing. On days when one of us had to be out... it was very hard on the other nurse.

I worked there right until the moment I went into preterm labor with my son. I left on a Friday afternnon as usual... I was about to hit 32 weeks. Sunday night I was in the hospital. I remember sitting there for the first couple of days on that nasty Mag Sulfate drip, worrying about how things were going for my coworker. But as things got more diffiult for me in the hospital, I got over that.

When I went back earlier this year, things were not quite that busy. He had one nurse fulltime, and then a part-timer. But every day I worked I was alone. It was plenty busy, but not quite as much as before.

jennrrn · Oct 25, 2008

Hi there,

Our office seems to run the same way. I tend to do all the testing when I am at work and the other nurse does the shots. She really doesn't like to do the testing, which I don't mind. But they have started to have both of us testing at the same time, which gets a little hairy. Our shot patients are supposed to make appointments but a lot of them walk in when they are around the area to see if we can give them a shot. I have a feeling we will be on our own soon though when they need a nurse at their new office one day a week. I just dread that we will have to do the testing and shots on the same days again on our own.

I did the same thing though, worrying about work all the time even at home. The full time nurse left for a month but then returned and they gave her her job back. But all of June I was on my own. I worked three days a week to help out but it was crazy to test and do shots all day long. Not too mention try to make the vials somewhere in the mist of all that. We got really backed up. I was whipped when I got home. I finally said to myself "Slow down, you don't make anymore money for the amount of work you do, the doc does :)" I was just afraid I'd make a mistake because I was so rushed. I had the girls up front doing all my arms checks for me, because I didn't know which end was up. All I did was run. The doc was very helpful though and when I got backed up he would do some shots in his exam rooms for me.

Oedgar · Nov 2, 2008

Yes, fitting in time to make vials can be hard. I found that after being gone a solid five years I did everything more slowly. On days I was alone I rarely had time to make vials.

I was afraid of rushing and making a mistake, and it seemed my doc was just happy to have me there so he did not have to give the shots! :)

jennrrn · Nov 4, 2008

It is definitely very easy to make a mistake on a vial while making it. I am almost tempted to bring in my ipod so I can play music and block out all the other people in the office. We do sublingual immunotherapy also and we have to make those vials. Those are a little trickier than regular vials. I usually make vials in the time slot where an allergy tester has cancelled. It's hard to do it inbetween all the shots/checks. When you worked in the doc. office were you responsible for getting your CPR card renewed on your own time. Mine expired last month and I let the office manager know. SHe has been saying for months they are going to bring someone in to train the whole office. I'm so not used to having to do these things on my own time. In the hosp. they usually have scheduled time slots available right there.

iwanna · Apr 2, 2009

I know this thread is a bit older, but thought I would post anyways. I did not realize an allergy drs. office would be so busy. I have an interview on Mon. for a PT position. The ad said two to three days a week. The pay is only $10 an hr., but I figured it would low stress and not too physical. On the down side, I was thinking about the peds being a challenge. I am sure many kids are not very cooperative.