Heme/Onc compared to medsurg and ICU's????

[Storm-warning]

I am a second career BSN who is 18 months into my nursing career, never worked in health care before. I graduated with honors. I am still at my first and only nursing job which is on the Heme/Onc unit at a major research hospital. 18 months in I find I am still struggling to master everything- from policies, to the way the hospital works, to skills, charting, and especially critical thinking. Every couple months I seem to make a mistake-some very minor, some quite substantial, fortunately for my pts and self nothing that has caused actual harm. But enough that I feel like I am always on the radar, and don't have a clean slate.

When I have voiced my concerns to my educator and fellow nurses I am told in a nutshell, that Heme/Onc is the easiest place for newer nurses because you get a little bit of med surg and the rest is mostly chemo, blood, and nuetropenia complications. When things get too hairy, we send em to the ICU.

I am struggling much more so than the traditional aged graduate nurses who were hired at the same time. They seem to have caught on no prob and don't appear to have made any mistakes, as well as excelling on the unit and now precepting students and serving on committees, etc. I seem to be the "old" black sheep who hasn't done enough to get fired but really isn't very good.

Is Heme/Onc really considered "easy" in the hospital setting? I feel if I am struggling where I am at, then surely I will fail should I try to go to a different specialty that interest me-i.e med-surg or tele. As a second career person I do not have the luxury to hop around finding the right fit. I do love the onc population, but will this be all I can do, as everthing else is much harder? Will I even survive Heme/Onc as the months pass and I improve so slowly?

Honest feedback and experiences would be appreciated.

[Ted]

I guess. . . my first thought is after reading your post is. . . How about asking for direct feedback and/or help and support to what you might think to be your weaknesses? If it's a matter of time-managment, how about hooking up with a more experienced nurse for a while and work on that. If it's a matter of "getting to know the computer", then maybe someone would help out with that. Being told that "Heme/Onc is the easiest place for newer nurses" seems like a cop-out answer. At the very least, such a comment doesn't seem helpful and supportive when help and support is sought. My suggestion would be to figure out those areas where you need support and actively seek that support through further preceptorship and/or finding a mentor to help out. If the manager and/or hospital won't provide such support then maybe working at such a place might not be to your best professional interest.

My first seven years as a nurse was spent on a Hematology/Oncology/BMT floor. It was NOT easy. It took me about three years before I began to feel that I thoroughly "owned" my position. It's my understanding that the "three year mark" is not an unreasonable amount of time for a nurse to grow into his/her position.

Bare in mind that I left that heme/onc/bmt floor 13 years ago so a LOT might have changed since I worked there. But back then, that unit took patients from other hospitals's ICUs!! They were sick, and that was BEFORE they received their first round of chemo; the acuity was high on that floor and it was considered a "normal" medical floor. I sought guidance from a couple of wonderful nurse who agreed to help me out with time management skills as well as to help me "put it all together". Eventually, I received ONC Certification and became a preceptor for other new nurses. Seeking mentors and taking formal heme/onc classes (that the hospital provided) and joining a local Oncology Society chapter proved very helpful for me. But I also had a very supportive Nurse Manager, a supportive night staff as well as a hospital with an effective educational department.

I wish you well. . .

[cara1017]

I agree with the previous poster in that heme/onc is NOT easy nursing!! I work on a heme/onc floor, and in general, our pts are sicker than the med/surg units, but we are not staffed as a higher acuity unit. In my hospital, no one likes to float to our unit because of the acuity of the patients and the other staff says "they always end up running around like crazy." Thats what we do around here every day!!

"When I have voiced my concerns to my educator and fellow nurses I am told in a nutshell, that Heme/Onc is the easiest place for newer nurses because you get a little bit of med surg and the rest is mostly chemo, blood, and nuetropenia complications. When things get too hairy, we send em to the ICU."

-I don't understand this comment at all, because adding chemo, blood and neutropenia to med/surg, makes it significantly more difficult than med/surg! Chemo very time sensitive, and not to mention dangerous... it is not something to take lightly!! The process of checking chemo is time-consuming and definitely requires some time management. So does giving blood products and antibiotics to the F/N pts. Pts with neutropenia can go septic fast, so being on top of that is a must for a heme/onc nurse.

I may be bias since I have only worked in heme/onc, but I would definitely say that it is not easy nursing and is one of the most difficult nursing specialties to go into aside from an ICU.

[ctnurse420]

I have to agree with the other responses that heme/onc/BMT is NOT easy.... I was a nurse for 18 months on a surgical oncology floor and this year took a travel job on a heme/onc/BMT floor.... figuring I'd be able to swing it with ports, central lines, blood products, neutropenia, etc. It has been a huge learning curve, not to mention the crazy chemo regimens that heme/onc patients are on....

I have been swinging it but have to remind myself that just because you feel busy, you cannot rush things like chemo- you have to slow down and take the time to do it correctly. Props to you for jumping on this floor as a new grad.... hope things improve for you.

[mzjennx, BSN, RN]

Who said onc is easy. It's hard because anything can happen but it's awesome nursing I think it is most rewarding. So many things can happen and truly tests your skills and abilities as a nurse. I've been a nurse for 3 years in onc and before that i worked as an aide in mother baby care. Im not perfect but im slowly gettig it together. I want my colleagues to tell me how to get better. I don't wanna make a mistake... Just remember to practice safety and if you are ever ever in doubt just ask your colleagues. Im gratefully I work with a bunch of nurses who always help out and teach me. I hope you have great coworkers too!!!