ENT/Allergy Nursing - what is it like?

T-Bird78 · Jul 30, 2013

I've been lucky enough to work both ENT and allergy/asthma/immunology. The ENT was fun because there was some more variety. The nurse would be in the room with the doc/PA for everything from routine exams to surgical procedures--got to see an uvulectomy!--and would hand instruments and set up for procedures. The ENT had an allergy component so we did the skin testing and allergy shots and I even mixed allergy extract. Allergy extract is not a medication, it's the specific allergens that a person was tested for. In fact, I attended the AAOA (American Academy of Otolaryngologic Allergy) conference and they had a segment on mixing extract. Also remember, ENTs are surgeons so they'll start considering surgery instead of a 5th round of antibiotics for a sinus infection.

Allergy/asthma/immunology is the same focus but much higher volume. They're usually more aggressive with allergy shot buildup than ENT allergy. They're not surgeons or rhinologists so there's no surgery or nasal endoscopy. My clinic has a nurse devoted to allergy shots and phones, one for skin testing, and one to room pts and assist the doc (usually kenalog shots or pt education materials and proper inhaler technique). We rotate each day so we all can do the same jobs in the office. We also do not hire MAs. We have staggered hours, some early days, some late days, to accommodate pt's work/school schedules.

I've loved both offices and they go hand-in-hand, even though there's a little competition between the specialties!

Oedgar · Aug 1, 2013

I worked in an Allergy Office for 6 years, ending in 2000 with the birth of my son. I also did a little PRN there in 2001, 2002, and 2008. Anyways, in a nutshell, allergy office nursing is a welcome relief if you are overwhelmed by hospital work. I worked in a small practice with one other fulltime nurse, a secretary, and, when we were lucky, a fill in nurse as needed. My doc was a very quiet, cautious man who cared about and developed long-term relationships with is patients, which I loved.

The other LVN and I took turns. One would mix antigens and handle injections in the mornings while the other did testing. For testing, we did the scratch testing but the doctor interpreted. We would prepare the interdermal trays, and help the doctor, but he actually administered the interdermals. In the afternoon we would switch. We also did PFTs and nebulizer treatments. When I returned to PRN in 2008, I had to learn how to mix and give Xolair injections. We also did patient education regarding inhalers and self-administering antigen injections. I also occasionally handled the front desk and insurance, as well as phone triage and calling in prescriptions.

I loved this job, my coworkers, and my boss. However, there were a few drawbacks. In mixing antigens, and giving injections, there are many chances for error. Attention to detail is a must of course. A few times in my years there, we would have some pretty severe asthma attacks there that I was nervous about handling in the office. I never saw a severe reaction to a shot, though my coworker, who had been there for 20+ years before me, had. (a couple).

Also, there was the handful of difficult patients... and if they were on antigen injections we got to see them week... after week... after week.

But the plus side was the majority of nice people that I got to know pretty well.

andreasmom02 · Aug 2, 2013

I've been interested in allergy nursing for a while now too! Thanks for the info everyone!

cherrydollface · Dec 4, 2013

I currently work in an asthma and allergy office as a medical assistant. I work with a registered nurse, and we work as a team under our Doctor. We both bring patients back, take vitals, chief complaint, HPI, medical history, and ROS. We perform testing for environmental allergies, antibiotics, local anesthetics, and venoms. All of these tests included the percutaneous scratches and intradermal injections. For asthma we do spirometry, FeNO measurements, bronchospasm evaluations, nebulization treatments, and methacholine challenges. We educate patients about their medications (MDI's, nasal sprays, antihistamines, epipen) We also set patients up with peak flow meters, if needed. We have an immunotherapy department where patients can get their allergy shots Monday through Friday. However, if a patient needs to build up on their antigen quickly, we set up an appointment for them to receive rush immunotherapy. It's a very long appointment, in which the patient receives an allergy shot every half an hour. Obviously there's always a risk of anaphylaxis in an allergy office, so all nurses and medical assistants are trained to handle anaphylaxis with Benadryl, epinephrine, albuterol, supplemental oxygen, and oral or intramuscular steroids. IV steroids are handled by licensed nurses. We perform influenza desensitization for patients who have had anaphylactic reactions to the flu shot, or who are allergic to eggs. We do patch testing to test for chemical allergies. We also mix and administer Xolair injections. We also do rapid influenza and rapid strep tests. On the clerical side we answer patient phone calls, prescription refills, lab orders/results, and initiate prior authorizations. We have an X-ray tech who does sinus and chest x-rays. There's so much to do in an allergy and asthma office! The RN that I work with does IV IG infusions for our hypogammaglobulinemia patients. Obviously the RNs and LPNs in the office are limited to this treatment, because they're IV certified. She also does IV infusions for hereditary angioedema patients. Although we also have HAE patients who receive subcutaneous injections. I have been at this office for almost a year and I'm loving it! The hours are great. Seeing the same patients on a regular basis is pretty awesome. As you can see, we do a variety of different tests and procedures so it's rarely a monotonous week. I'm extremely happy working at this office, and hopefully I'll be here until I get into nursing school. I hope this is helpful and provides a good glance into what goes on in an allergy office. :)

Ella26, BSN, RN · Dec 13, 2013

Cherrydollface,

Very good description of the duties in your office. Very similar to mine except we don't do methacholine challenges or IV stuff.

ksuSN12 · Dec 28, 2013

Im a 2012 BSN grad and Ive been working part time for an ENT and Allergy practice for 2 months now. Its really awesome!

I spent 3 years as a nursing assistant on med-telemetry floors, then worked as an RN after graduation on med-tele and L&D. Both were short-lived and didnt feel "right". Even as a nursing assistant, I just didnt care for med-surg.

Anyway, after being unemployed for a while and desperate, I signed up with a local temp agency. Thats when I got the call for ENT and Allergy. I actually didnt realize the field existed before (not that I didnt know allergy/immunology existed, just that nurses actually worked in clinics for it, I guess). I knew NOTHING about it beforehand.

Day in the life at ENT and Allergy:

-Come in 10-20 min early. Set up supplies in shot room: Syringes, bandaids, tape, little ice packs (in freezer, they get taped to the patients arms after injections if they want them), allergy vial trays refrigerated when the office is closed, and shot log for the day. Sometimes, Ill check the doctor's schedule and see if I have any patients coming in for a special asthma injection called Xolair for the day. sometimes, now that Im trained, I can also help with allergy testing in between my shot patients. That has supplies too.

-I plant my butt on a chair and look out the window usually until one of my lovely receptionist friends brings me a patient's sign in sheet. I use the sheet to find their record in my shot book. Then, according to their when their last visit was, any previous reactions, and the doctor's order for moving them up/maintaining, I prepare the injection(s). Every doctor has a different way of doing this.

-I call patient back. Patient (usually- I do have some wheelchair bound/impaired patients too) walks into the shot room. I chit chat with them, as I know most of them already. I see these people as often as twice a week, or about once a month, depending. I love that. I ask how their last shots went (how did they do when they went home, local reactions, any signs of a systemic reaction, etc.) and then I clean the area with alcohol, pinch, poke (and actually aspirate, despite them being subq, because allergy shots can be deadly) then place a nice little circular bandaid on the sites. Sometimes, patients like the ice packs too. Some will take a little 20-minute timer off my shot table so they can keep track of wait time.

-That patient goes and sits in the waiting area for 20-30 min (again, this may depend on doctor and policy). I call back any other shot patients in the meantime, and repeat the process.

-In 20-30 min, patient walks back, we usually chat more, I check their arms for any s/sx of reaction. In case of no reaction/small local, some benadryl spray works just fine, and they just on their merry way til next time. Sometimes, I help the girls at the desk scan papers. Sometimes, I look out the window. But as mentioned, I get to do a lot of sitting, which is great because I have a bad back.

-We get an hour lunch. I go to chipotle or somewhere and enjoy some great food with my friends at work. Some daily other tasks include sending out mixing requests for the vials (another nurse prepares them), filing shot records, checking exp dates on meds/vials/etc, calling in scripts for patients, etc. normal doctor office duties.

-Ive had one patient with a severe anaphylactic reaction so far. She was there for a medication challenge. She was given small amounts of the medicine and experienced anaphylactic shock. We give 50mg benadryl deep IM in the thigh right away and draw up 0.3mg of epinephrine to also give IM. In her case, the first interventions worked for a while. She actually went back into shock and at that point, we took more aggressive measures. We put on an o2 mask, threw two 18 gauges in right away each with a 1000mL bag of NS wide open, laid her all the way flat (Important in allergy- if anyone reads all of this, please note this: Patients can actually die during anaphylaxis if you sit them up. They need to lay. In the process of recovery, they must not get up quickly. There is a lot of evidence and research to this, look it up if interested), pushed more epi and actually ended up calling 911 even though we had started stabilizing her on our own. You can never have too much help in an emergency.

-Other less serious systemic reactions were remedied by us in the office with the deep IM benadryl and epinephrine. we lie them down flat. blood pressures q5 min or so depending on patient. doctor is on hand right away in these situations. we end up allowing them to sit up slowly, by placing more pillows under their head until they are fully sat. we give them water to drink. we encourage bathroom use and someone accompanies outside the door (Urinary symptoms are part of the systemic reaction process, all kinds of cool things to learn in this field). they end up leaving when they are well enough and we follow up with calls, then doctor adjusts their next shots accordingly.

Crap that was long but I really love allergy. The nurse that trained me actually gives IVIG infusions too, which is VERY interesting. Thats a whole nother long story though.

Ive done skin testing too, and its not bad. usually just draw lines on the person, then put the test drops on them, then prick the skin. Sometimes intradermal. Sometimes medication challenges and food challenges. Honestly, its all really cool. Its a mostly laid back environment (Ive had crabby patients, BUSY shot days- it is walk in-, etc but overall its very relaxing paced). Theres a fair level of independence/autonomy and you get to see all kinds of people. Young, old, boy, girl, funny, serious, tall, short, disabled, lawyers, schoolchildren, cashiers, I mean....literally anyone and everyone that can come into the office and is well enough to receive the injection. I only do it part time and am doing hospice now as well, and I can tell you that I know allergy is my true love :)