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the healer's art 6,350 Views

Joined: May 8, '12; Posts: 212 (22% Liked) ; Likes: 61

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  • Mar 8 '15

    I am in a similar situation as you - in fact, I'm the poster that imenid37 refers to in her comment. I was accepted into Hopkins for their 2015 ABSN cohort, and was trying to determine whether it was worth it for me to spend ~$70K for the degree from Hopkins vs. a much cheaper (albeit longer) state school. In the end, I chose to go to Hopkins. It all came down to several factors. First, what do you ultimately want to do with your degree? If you want to stay just a bedside nurse, or perhaps make it to head nurse, than by all means don't go the Duke route. However, if you want to make it into a top notch grad program later on (like Duke's or Hopkin's), or get a management position at prestigious hospitals, or if you live in an area that is saturated with BSN's, than going to Duke for your ABSN will make all the difference. It will give you that edge that your competitors may not have. Personally, I live near Baltimore and competition in this area for new-grad positions at major hospitals is FIERCE. I need all the edge I can get to beat out other BSNs, and I know that Hopkins will give me that. Also, I know that I don't want to be a bedside nurse. I want my DNP, although I'm not sure yet as to which speciality. I am sure that if I do well at Hopkins, and excel at my job afterwards in a world-reknowned hospital like Hopkins, the world will be my oyster. I believe the same would apply for you. As one poster on my thread stated, $60K to get a degree from Duke is a bargain. Your opportunity to train in a high acuity area and the professional relationships you could make are priceless. And contrary to what many posters on this site say, there IS a difference in the education you get from different schools. At a school like Duke, you have faculty who are the national and international leaders in their field; you have a wide range of opportunities to work with top clinicians in the clinical placements, you just have a much richer and more stimulating academic environment with significantly higher standards, and that is something that, apart from anyone recognizing the name of the school, will serve you well throughout your career. Where there's a will, there's always a way. Sometimes you have to let go of the pragmatist to fly high with your dreams. Good luck with whichever path your nursing dreams take you!

  • Sep 20 '14

    Hey there! Huge Congrats!

    I did my senior practicum in BMT too & LOVED it. It's not for everyone, but it was definitely for me. I remember it being a steep learning curve because, as you mentioned, we really hadn't learned much about BMT during nursing school.

    Now I work as a Pediatric BMT RN. We usually have no more than two patients, sometimes we share 1.5:1, 1:1 (and in really serious cases 2:1!) but on adult units it can be 3:1, and on mixed BMT/Heme/Onc it might be closer to 4:1 or 5:1 (but I think 5 is too much if blended with a BMT patient!)

    Here's a taste:

    Folks get super sick on BMT -- we "condition" them with very high-dose chemotherapy (Imagine the equivalent of 1 years worth of chemo given over 6 days) that ablates the bone marrow, then we infuse them with either donor stem cells (allogeneic) or their own cells (autologous, sometimes called a "rescue") -- then we manage the symptoms of the high dose chemos et al while they grow their new marrow/immune system back. Those who receive cells from a donor source take a lot longer, and require immunosuppressive drugs for life so they don't reject the transplant.

    It's an incredible process, and very hard on the patients. During my senior practicum, my preceptor told me "we basically bring them to the edge of death and back again..."

    With no WBC counts, they are prone to infection, their bone marrow is essentially non-existent so they need multiple platelet and blood transfusion (or FFP, Albumin...) until their counts are back up. Antibiotics/Antivirals/Antifungals are the norm. The chemo can be cardiotoxic, hepatotoxic, and can fry the kidneys, so knowing those systems are important. Knowing all the systems is important...and signs those symptoms are shutting down. Managing, pain, fevers, nausea (look up antiemetics), fatigue, mucositis, GI issues/weight loss, emotional support, the process of being in isolation for weeks to months..."those walls can close in fast"

    Review general heme/onc w/ a focus on blood diseases (leukemias, sickle cell). We also transplant SCIDS babies (born without immune systems to start) and some others...what you'll see really depends on the hospital.

    Review the process for transfusing blood products (probably won't be able to touch blood or chemos while your precepting, but you'll see plenty) also managing transfusion reactions. Know your antibiotics, antivirals, antifungals. Research working with severely neutropenic populations & practicing impeccable hygiene/precautions. Learn about mucositis, pain interventions, all pain narcotics. You'll learn a of critical care. We are categorized as an ICU but we don't do vents. Review signs of sepsis, infection, signs of bleeding problems (read up on hemophilia), topical skin lotions (some of the chemos burn/irritate the skin and it can peel right off), incredible wound care, working with CVCs & Ports.

    I remember being intimidated by the amount of lines to manage. We frequently have kids on PN + Lipids + Heparin + Dilaudid or Morphine PCA, sometimes lasix or insulin drips...then add on their antibiotics, or blood products, and various IV meds -- and you have to double and triple check what's IV compatible with what...that can be quite a juggle! But you do get used to it.

    While you are there, you will have great opportunity to practice your head-to-toe assessment and monitoring vitals signs. I'm sure you've heard throughout nursing school how important these two skills are. On BMT these two skills are SOOO important. Sometimes the slightest change in your baseline assessment can indicate a serious change in condition and these patients can crunk out fast. We've had kids who were up talking & playing and within 30 minutes were going septic! There's an art to getting reliable temps and BPs on our patients. Even changes in weights or abdominal girth can indicate big issues. Look up Veno-oclusive disease & hemorrhagic cystitis.

    Some of what I love about BMT is there is a big emphasis on "team nursing" -- so much of what we do has to be double checked by other RNs at the bedside (Chemos/Blood Products/Drip Changes/Narcotic PCAs) so everyone works together a lot. You also work with patients for such an extended period of time that you really get to know them well. I love the psycho-social support aspect, personally, and with the kiddos we do so much to keep things fun and interesting and developmentally appropriate. I love the critical care aspect also (nerd alert!) and really do a lot of review and education regularly.

    I also like that most of our patients can still talk and interact (no vents!) and most of them have central lines so we aren't doing a lot of poking (alas, I have zero IV skills working on BMT). I also like that there is so much teaching involved. You really have to enjoy developing relationships with people and being creative in educating them about their "new normal" post-transplant

    What I don't like about it is sometimes all the interventions in the world don't seem to ease the suffering and I go home some nights feeling like I didn't provide any relief despite throwing my entire arsenal of interventions at them. Sometimes patients really break down psychologically, and if they react to medications they can hallucinate, or they don't make it through treatment...dealing with grief, and the dying process is also important to review -- and therapeutic listening/communication. Losing patients is so, so challenging and you have to learn really good coping and self-care methods to avoid burnout.

    Remember to take care of yourself. Set healthy emotional boundaries. I find working with this patient population makes me recognize how magical every day is, and to not to take anything in life for granted. I really give thanks on a regular basis, and take full advantage of my days off!

    That's probably more than enough...

    At the end of the day, just try to soak up as much as you can! Ask questions, keep a notebook handy, and look up everything. I hope you have an enjoyable experience. It can be incredibly difficult work, but also deeply rewarding.

    And I forgot the mention: BMT nurses are a super unique kind of wonderful -- often a bit type A, but extremely compassionate and fantastic colleagues.

    You're going to learn so much! Enjoy the process & good luck!!!

  • Jul 21 '13
  • Jul 21 '13

    Quote from LM NY
    For those of you that got your credit checked, is your status still "under review" or does it say "finalist"?
    My status still says under review and my credit was checked on the 16th.

  • Mar 20 '13

    Had to check back in on your big decision day! Congratulations to all! You're going to be awesome, and you're going to love it!!!

  • Mar 19 '13

    If anyone is torn between johns hopkins and Duke, let me know. This is such a tough decision and I'd love to hear others take on it.

  • Mar 18 '13

    does anyone know anything about when we will hear about financial aid?

  • Mar 18 '13

    That explains why my application was missing, lol. Yikes... another day filled with anxiety and jumping out of my skin at every email and alert on my phone!

  • Mar 18 '13

    Hopefulnurse24 - mine says the same thing, so hopefully it's nothing to worry about. I have a feeling we'll get another late email...

  • Mar 17 '13

    I applied to UVA (CNL) and thats it! I got in and start May 20!! I can't wait. If I had more flexibility I would of applied JHU and DUKE. I love Baltimore.

  • Mar 13 '13

    Hey Lattae! I received the same email about accepted student's day. I called in... and apparently they had the wrong phone number on file and was suppose to call me yesterday about my acceptance. I would definitely call in and confirm your application status!

    For any midwifery lurkers, they are still making decisions on a rolling basis. I am a fall entry student!

  • Mar 13 '13

    I only applied to Ohio State for CNL and got in. There wasn't an interview, however I did attend the open house that had break out sessions with each focus where I was able to talk with the head of the CNL program. From what I've been able to figure out, there seems to be about 85 grad entry students spread throughout the specialties and my advisor mentioned that there's 6-8 CNL students so the small group is a plus (compared to about 35 or so in FNP). I'll have a better idea of the breakdown in May when we have our orientation.

  • Mar 13 '13

    I just wanted to post and say that I also attended Columbia’s visiting day and I really enjoyed it! I thought that the faculty seemed very supportive, and I really liked getting to know more about each specialty (especially since Columbia will let you change if you decide on a different area of interest after the ETP year). I applied for the FNP specialty so I was also disappointed the director of that program could not make the event, but I was able to speak to FNP students and other faculty which was helpful. I had a great student ambassador who was extremely enthusiastic about the program and enjoyed answering all of our questions.

    Good luck making your decisions!

  • Mar 12 '13

    Hey guys! So since I started this thread, I wanted to come follow up and see how everyone was doing and what their decisions were! Here's what I want to know: where you applied, where you interviewed, where you got in, and what school you ultimately decided on, and why. If you aren't sure, you can hold off on posting, or you can post again later on (this is what I'm going to do), but I'm really interested to see! It's been so fun following your journeys and seeing where we've all ended up since the very beginning of this thread! I'm so excited to call you all my colleagues and it's cool to see where everyone is headed.

    Where I applied: Johns Hopkins, Marquette, Penn, Duke, NYU

    Where I interviewed: Johns Hopkins, Penn, Duke

    Where I got in: So far... Johns Hopkins, Marquette, and wait listed at Penn. Waiting to hear from Duke and NYU!

    What school I ultimately decided on: Still waiting to hear back from 2 places, but I'm thinking it'll come between Hopkins and Duke I loved Duke and the program seems to be a perfect fit for me, and I love the loan repayment option at Duke Hospital. There's a lot of growth in the Durham area as well, especially with Duke building their new hospital dedicated to surgery only. Hopkins is an awesome program, offers a BSN, and also has a ton of opportunities with their amazing hospitals in the area, and I think it would be a good fit for me as well.

    I'll post again later when I have finalized my decision

  • Mar 11 '13

    Thank you, Pianoman! Can't tell you how nice/useful it is to hear more ground-level info from a current student.