immunosuppressed nurse (where to work?)

[MidnyteRaine]

Hi all,

I'm just feeling a little blue tonight and am wondering about my options for the future. I'm 24 years old and I've had Crohns disease for a little over one year, never had to miss a day of work because of it, but I have a feeling things are going to change. I still have inflammation even though I'm on Pentasa, so next month I have a f/u appt where I'll either start 6mp or Remicade, both of which will likely lower my immune system and may even make me neutropenic. I work on a surgical (primarily ortho) floor, but we also get telemetry and regular med surg patients. We also get all the chemo patients and I'm chemo certified. I have a BSN so I know leaving the hospital for something else is a possibility, but I really love my job, my coworkers, etc. And really, anything where you work around people will expose you to lots of infectious diseases. Heck a walmart cashier is exposed to lots of fun stuff.

I'm not sure how to handle this. I'll get blood work done regularly to monitor my wbc levels, but I'm sure many of you have had patients that they've taken care of for days and then 4 days into their hospital stay find out they have cdiff or mrsa and get moved to a private room. By then a person could already be infected. I also don't want to be a carrier if I am susceptible to bacteria and pass things on to my patients, especially my surgical or oncology patients. Is it enough to just be extra careful w/ handwashing and wear a mask around any patient who has a cough or if my immune system goes low to wear a mask and just tell patients I'm getting over a cold and don't want to share it with anyone? Can I switch patients with people so I don't have neutropenic or infectious patients? Who do I need to talk to? Should I mention this to my manager, to the employee health nurse in the hospital? I mean, it's not definite that I'll become severely immunosuppressed, so I don't necessarily want to make a big issue out of something that may never come to be. Any suggestions? Does anyone else have any experience working while on immunosuppressants? I know there must be nurses out there on Prednisone, Remicade, etc for various conditions. I'd like to hear your experiences. Thank you to all!

Ashley

[fultzymom]

How about Oncology where they do the Chemo treatments? When I precepted in that department I did not see a lot of people who were really sick, except from the side effects of the treatments. I would think another good area would be the OB unit. Usually aren't a lot of sick people there (I mean other than the normal germs you get around everyone). I would speak to my direct supervisor and say something like, "I just wanted to let you know what is going on and see what my options would be should I become compromised due to my medications. Is it possible that I could transfer easily to another unit. Or could my assignments be made according to the patient conditions?"

[nyapa, RN]

Have you thought of Burns?

Re: immunosuppression. I had a friend who used to work pool/agency. She refused to go to certain floors because of her similar predicament.

You should be able to approach your management surely, and explain your situation. If they make life difficult for you, because of your health, then isn't that a form of discrimination?

[kukukajoo, LPN]

I have ideas about where to work but I did want to share with you that they have some newer treatments out there available. I will talk to a friend who has gone though this and see if I can get some information to you.

I know I would not want to work on a med surg floor or peds for obvious reasons.

Hope you have more good days than bad.

[RN1989]

I have a feeling that you will come up against great difficulty attempting to switch patients for the long term. Your employer will find that it is too great of a stress on the staff. Just as when people with back problems are on limited duty. It isn't right but most employers find a reason to get rid of employees that require such accomodations unless it is short term. Be prepared. Personally I would not be discussing any of my health with my employer or the employee health nurse unless absolutely necessary.

If you are truly worried about catching diseases then I would be planning to either change work environment or wear a mask all the time. As you have even noted, you are going to come into contact with germs everywhere. Are you really going to disinfect your shopping cart at the store? Are you going to avoid doorknobs? Are you going to stop touching anything that someone else may have touched? Be realistic. You have no idea what kind of germs you will come in contact with anywhere but you should be taking precautions anyway.

You mention cdif and mrsa - these germs are out in the community. MRSA is even killing people who have never even been inside of a hospital. You should be following PPE protocol along with stringent handwashing with EVERY patient. A late diagnosis of cdif or mrsa should not make a difference because you should have already protected yourself. You should already be avoiding touching surfaces in a patients room when they are coughing up sputum or have a draining wound, or when they have diarrhea. Most people have horrible hygiene and are lucky to wash their hands when they have obvious filth on them. How many times do you see people digging in their nose and not even realize what they are doing? By the time a diagnosis is made on anyone, they've already rubbed their germs on the table or coughed them out into the air.

If you have good work hygiene habits (no touching face with hands, no putting on lip gloss without washing hands, etc.) then you probably are safer at work than out in public. At work you will be washing your hands all the time compared to when you will be out and about in public. And you have the ability to get the PPE that you feel is necessary to protect yourself. Are you really going to carry around a mask, gloves, gown, shoe covers, and hand sanitizer when you go to a restuarant? Or when you spend the day shopping at the mall?

You should always consult with your doctor anytime you start a med and discuss the risks and the impact on your life. In the end you will have to decide for yourself what risks are acceptable to you. Think everything through before you get into a depressed or paniced mode. The extra worry is not worth it.

[oncnursemsn]

I'm not sure I agree with a previous post to work in oncology; some of our onc pts get pretty sick with all sorts of nasty infections, including fungal. It depends on how low your counts go, but I would think you might be at increased risk in oncology. I had a similar (not Crohn's) issue with decreased immune system including very low plts. I ended up doing telephone advice for several years- and loved it. Used computer based traige protocols in Northern CA for a few hundred pediatricians. Traded in my stethescope for telephone headsets. Enjoyed my fellow triage nurses, and if we were stumped by a certain call, could bounce stuff off each other. I know it's hard not to, but I pray you're not discouraged. You have chosen nursing as your career, and we have so many options. Hope you find the one that works for you!