First Clinical Tomorrow in Oncology... Any Tips?

CharlieTaco · May 28, 2011

Best advice: don't kill anyone.

StephPR · May 28, 2011

Don't kill anyone... check!

jones.rn · May 28, 2011

Be prepared for a lot of loose stool... :)

Ok, now to be helpful. Since you won't be administering Chemo (obviously) be prepared to administer a lot of pain medication, phenergan, zofran, etc. Monitor mental/respiratory status and push meds slowly. The labs are super important to look at- CBC with diff to check their immune status, bun/cr to make sure kidneys are functioning, and potassium because of cell lysis.

Remember cancer is no longer a death sentence, don't "feel sorry" for them, most of mine hate when people do that. Talk about positive things. And last but most important, keep the, safe and show that you care about them as an individual.

Good luck!

annabeap, MSN, APRN, NP · May 28, 2011

Woah, that's a pretty intense first clinical site. You'll be seeing a lot of different medications, and they'll differ pt to pt depending on their diagnosis. You won't be able to help administer chemotherapy, but do your research and perhaps get a broad sense of how most work.

Timing is very important, medications are given exactly as ordered (no 30 min window), and protocol may require checking for blood return every so often for longer administration times. Scheduled labs are very common, and we have specific orders to call MD if labs are out of range. And before you do any pt cares, make sure to fully understand all chemo precautions, for your own safety too.

You definitely will have plenty to think about when you care for these complex pts. And that's not even touching the psychosocial/spiritual side of those families. Enjoy it, ask questions, and learn as much as you can. :)

itsmejuli · May 28, 2011

I'm nervous because this is the FIRST time I will be stepping foot in a hospital as someone other than the patient. Any advice would be VERY much appreciated! :)

Tell the nurse you are following that its your first clinical day, then the nurse will know what to expect from you. Be observant, ask questions, and listen attentively. Take every opportunity to observe and interact with what's going on around you. I can't stress this enough, you'll get out of clinicals what you put into it. Don't hang around doing nothing.

Student Mom to Three · May 28, 2011

I just finished up my oncology clinical rotation a few weeks ago. Loved it! You will need to remember that many of the patients are severely immunocompromised. Wash, wash, wash. Be extra careful when giving anything to IV to scrub with alcohol and then scrub some more! Bleeding is a huge risk, too. Lots of pain meds.

Be prepared for lots of different emotions from the patients- anger, sadness, even joy when they are finished with their chemo.

It was by far my favorite rotation....an incredible experience. Enjoy and be prepared to learn a lot!

BrentRN, PhD · May 28, 2011

Some things to remember about cancer: you cannot learn every kind as every type of cell in the body has its own types.

Cancer diagnosis: You will want to see what was diagnosed and when it was diagnosed. Look for staging information. Your text will explain what the letters and numbers mean. Try to familiarize yourself with them tonight.

Cancer treatment: Most treatment is a combination of surgery, chemicals given to interrupt cell reproduction, and ionizing radiation to interrupt cancer cell replication. You will want to see what the treatment protocol is and where your patient is on that schedule (diagnosis is day 0, each day after has a plan).

The cancer patient: He or she needs to be your focus (don't get caught up trying to read every page of the chart). You will learn from the nurse but be sure to learn from the patient. Ask them about their story from diagnosis, their family and friends reactions, and what they have liked and not liked from the health care people they've met.

No one can become an oncology nurse in a day, so don't think you have to know it all. Be sure to be clear on your instructor's expectations.

Nurse Leigh · May 28, 2011

i have only worked telemetry, but felt compelled to respond because i was lucky enough to do my nursing program required 90 hour preceptorship with an oncology rn on an oncology unit. this was at the very end of my program, so i was expected to act more or less as a nurse under my rn preceptor, where you will most likely have more supervision since this is your first clinical. this is just from my brief encounter on this type of unit; of course others who actually work/worked this environment will have *much* more comprehensive info/advice. still.....

at least at the hospital where i was, only trained/certified (not sure which vernacular to use) rns were allowed to administer chemo meds. so, yeah, if you are to give meds, they will be more for the side effects of cancer and/or treatments.

my experience was truly amazing! we had one particular pt whose prognosis was poor---her bowels did not funciont and everything she took orally came right out of her stomach via a tube....so she was allowed to eat/drink pretty much whatever she wanted since it never really had a chance to digest. she was there the entire length of my preceptorship and i was touched beyond belief by the rapport she and her family had with the staff. there was mutual respect and professionalism, yes, but also something deeper. the pt/family knew what was coming but were able to enjoy one another's company while the nursing staff strived to keep the pt comfortable. every time the family left, they would hug us, tell us how much they appreciated us, and loved us. very cool experience.

of course we also had pts who were understandably upset/irritable and, well, cranky, but it was easy to not take personally (in my few years as a tele nurse, i can assure you there are a lot of pts who are cranky and mean and it it their personality, not due to their diagnosis)

i got to interact with pts in their 70s who were on the floor to receive their treatments and responded well enough that they planned to play golf in a day or two. others were so miserable and weak/nauseous that anything you could do to make them feel at all better felt like a huge success.

i once actually did give an lpn's pt ivp ativan for her (since at that time we could do that sort of thing under our preceptor--oh how times have changed). family was with pt, she was very uncomfortable, and soon after giving the med (maybe an hour or two), she was did pass calmly. i did not realize at the time what was happening, but now i see that making her less anxious, reducing her pain and dyspnea allowed her to relax, and it was as though her spirit felt it could release a tenuous grip. i felt strange that i any have played a part in it, but realize now it had to be easier for her family (who was in the room, knew better than i did what the dynamics were and included at least one daughter who was a nurse) to see her pass in relative comfort rather than moaning in pain and fear. i still think about that experience a lot.

i got to insert my first urinary catheter (coude as the pt had prostate problems). i also performed my first/only digital removal of a fecal impaction (with guidance from my rn)--on the same pt--i know he was miserable and like to think i helped him feel better but was convinced he'd scream if he sa me agian and wonder what on earth i was planning next :uhoh3: .

a pt needed bedside bone marrow aspiration--his pain was relatively well controlled but watching that procedure was almost my undoing and he remarked that he could tell it must be bad from the look in my eyes (i have gotten much better at masking things by now---and very few things have ever bothered me as mush as that procedure---not sure why)

i took advantage of every opportunity to enage in conversations with the pts, families, and staff about what was happening and their thoughts.

seriously, i know it is a difficult unit, but i think the turnover on that particular unit was almost non-existent. the nurses and pt--and pts loved ones--formed bonds the likes of which i rarely see on my floor, even with some of our (very) frequent fliers. my advice--as someone who just got a taste of it--is to be willing to learn from everyone, listen to what the pts think of the treatments, talk about their diagnosis/prgonosis if they open up to you. you can learn so so much from other nurses, ancillary staff, mds, books and experiences, but that sometimes can pale in comparison to what you can learn from the pts themselves!

sorry it this was too wordy....i just really enjoyed my brief time on that unit...glad i have the chance to brag on such an awesome unit/specialty ....bless all the staff who do such amazing things :yeah: , and op, good luck to you on your journey! don't hesitate to ask questions!

:heartbeat:redbeathe:heartbeat:redbeathe:heartbeat:redbeathe:heartbeat

StephPR · May 29, 2011

Thank you all so much! I agree, I thought oncology was a pretty intense place to start, but I'm feeling more confident about it after reading all of your helpful comments!!! :)