Chemo without pumps???? A little long

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Specializes in CCU MICU Rapid Response.

Hi all, I am a fairly new nurse with ICU experience and now work in an outpatient Chemo/Hematology/Internist office. I left ICU because of several reasons and relieved to be on days with no weekend or holidays.

I was born into a world where I look at my pt's charts and really know whats going on, from H&P's to CT results. Here there isnt time for that. Its more like get em in, get em started, get em out, cause there are more waiting...

I have a few concerns including the absense of pumps, and am afraid that I dont even know just exactly how much I dont know. (if that made sense) No crash cart/AED. No pulse ox. Nothing of that nature and that worries me ALOT.

There is one RN- myself for the office. The nurse checks labs, does the medport accessing, draws and flushes. The nurse mixes the chemo, starts and discontinues infusions.

I will be on my own starting the 1st of December and the gal I am replacing will be done as of Wednesday. I will have had 2 full weeks of training by her. (if you can call it that)

Typical day consists of 8-16 chemos in am, 2-3 infed Iv's, 5-10 procrits/B12's and then afternoon appointments that are non chemo.

I have no chemo experience, its been an on the job thing.

No pumps for chemo... I find it difficult to mix, switch over bags, start lines and disconnect these folks all by myself.

I guess that I am afraid that things are a little lax here and I worry about everyones safety, including mine. I LOVE the patients, they are the nicest. The doc is wonderful and keeps reassuring me that I am doing great. :rolleyes:

I come from ICU and this is a whole different world. Is it just me?? I'm not sure that I am loving it, or if I will. Tell me what you guys think.

Thanks, Ivanna

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I know nothing about onc other than what I've studied, but that situation would scare the poop out of me. But again, I don't know what's normal.

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Specializes in CCU MICU Rapid Response.

I dont either and thats my problem... I have briefly thought about suckin it up and going back to my unit. :( Ivanna

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First of all, let me say that, that is a lot of chemo pts that you see in a day for one nurse (particularly if you mix chemo). Sounds like a lot of responsibility. I also work in an outpatient chemo clinic & mix chemo. We maybe have 6 chemos per day on average and a number of hydrations, zometas, port flushes, ect. We have 2 nurses. Will you continue to be the only nurse? Who covers you when your off?

Oncology is both a difficult and enjoyable area. I also love the patients (they are like no other)- and frankly make my job worthwhile. I feel a lot of intensity just having 4 chemos to be responsible for. It takes a lot of attention to detail and good time management skills to be a chemo nurse. I believe that you must be pretty awesome or have a lot of nursing experience if you're not running away after caring for 8-16 pateints! Seems a little like a safety risk- but I don't know exactly how the clinic you work at runs- perhaps you have techs, ect?

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Specializes in Oncology.

Holy crap, if I'm reading this correctly, you're working in a place that runs chemo sans pumps (by gravity? OMG), doesn't have proper vital sign equipment (I can't imagine starting chemo or sending a patient home without a full set of vitals). You don't have a crash cart? Dear god.

And you're actually MIXING chemo? That should be done by a pharmacist, under a hood.

And if you're the only RN, who are you double checking the chemo orders with?

This is a disaster waiting to happen. I'd run away, fast.

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I worked for almost a year in a similar situation, with nurses leaving every couple of months. I was six months out of nursing school and became the lead nurse - mixing, triaging, administering chemo. The doctor in charge of the clinic just didn't want to spend the money on the clinic infrastructure, and thought that we were just inefficient at what we did. There was seldom a day where I didnt put in 12 hours and get paid for 8. I finally left after 11 months because I felt it was too unsafe. I am now working in another oncology clinic with 8 doctors that has multiple sites across the country. One of my prerequisites was that there be a more structured environment, and I feel totally safe now. We staff the clinic according to need, and there is never less than two chemo nurses and one triage nurse.

If you can't your physician/nurse manager/or office manager to get you some qualified help, I say run as fast as you can. They should be advertising for ONC nurses, too.

Good luck to you ---

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Specializes in CCU MICU Rapid Response.

Holy crap, if I'm reading this correctly, you're working in a place that runs chemo sans pumps (by gravity? OMG)

You don't have a crash cart? Dear god.

And you're actually MIXING chemo? That should be done by a pharmacist, under a hood.

Yup. Pretty sure that you read it correctly. I guess I just didnt know if it was just me... :(

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Specializes in CCU MICU Rapid Response.

To BottomsUp, I guess asking for a second nurse would be a fab idea, but I have a pretty good feeling that it wouldnt happen. Maybe I should go back to ICU. :zzzzz ~Ivanna

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Specializes in Oncology.
To BottomsUp, I guess asking for a second nurse would be a fab idea, but I have a pretty good feeling that it wouldnt happen. Maybe I should go back to ICU. :zzzzz ~Ivanna

Go back anywhere. The situation you're describing is in violation of JCAHO regulations. You're practically begging the state to take your license away working there.

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That is a totally unsafe situation for you and the patients. We work 1 RN to 1-3 patients and when I have 3 it feels unsafe at times. I actually think this should be reported. We are required to have the 2 day Chemo Certification class to even hang chemo. Have you had that class? I thought it was required. You might want to check with your state nursing board. There is the ONS (Oncology Nursing Society) to check with. Just google ONS. They have replied to questions I have had.

We have a similar clinic and have 6 nurses working every day. And we dont mix.

Do you have a hood to mix under?

I cant even comprehend how you can possibly do what you say you do every day. It would be unsafe with 3 nurses. No pumps is unheard of. If this MD is doing this he is making and incredible amount of money and can afford pumps.

I agree---- RUN-- don't walk away from this situation. It would take lots to remedy this situation. But for the sake of the patients tell someone in power. I could go on and on about this situation but I will stop.

JMHO after 35 years nursing, 4 years working chemo and 18 months as a OCN.

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Specializes in CCU MICU Rapid Response.

Beth, I sent you a pm.

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Specializes in CCU MICU Rapid Response.

Thanks for all of your replies and advice. I just wanted you all to know that I am going back to ICU..on night shift...where it is safe..and where I belong. :snowman: Ivanna

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