New CNA in Oncology Unit

SoldierNurse22, BSN, RN · May 23, 2012

Special considerations for this population are going to be different from those for an older population. As an onc RN, I expect a few things from my techs:

1. Immediately report abnormal vitals signs, particularly elevations in temperature, even if it's just a little bit. Many oncology patients are neutropenic, meaning their immune systems are severely compromised or even absent, and a low-grade fever can be the first sign of an infection. My techs know that I like to be informed if the patient's temperature breaks 99.5 or deviates significantly from normal (for instance, a pt's temp is normally around 97.0, but on this reading, it's 98.8).

2. If the patient tells you they have pain, let me know immediately! Pain in oncology patients is a issue all its own. Not only is it often difficult to treat, but like other populations, pain, especially acute, severe pain, can indicate trouble (such as infections!).

3. I'm that nurse that likes to help give patients their baths if they request help. Some nurses don't, but I know of no other way to more thoroughly assess the status of their skin. If you're giving a bath and you notice a portion of skin, usually on a patient's lower back or bony prominences (heels, shoulders, etc) that is reddened, will not blanche (turn white when pressed with a finger) or is showing signs of skin breakdown, let your nurse know. Much like in an older population of patients, skin breakdown is a serious concern, and the great risk for infection in oncology patients makes it all the more urgent.

4. Oncology patients are some of the most emotionally heavy patients I've ever cared for. Make sure you're taking care of yourself and speak honestly with them if they decide to confide their fears in you. If you're not taking care of yourself, you won't be able to care for them. If you're not plain with them, they'll know. It's OK not to have all the answers when they're telling you what they're experiencing. More often than not, they're not looking for answers. They're looking for someone to listen.

5. Nausea. Let your nurse know quickly if a patient even hints that they're nauseated. Nausea is a chronic problem with many oncology patients. Much like pain, if you get behind on treating nausea, you'll be fighting an upleasant uphill battle.

6. Ask your nurses the same thing you've asked on this discussion board! Most RNs are happy to educate their CNAs and appreciate CNAs who want to do the best for their patients, as you are clearly demonstrating now. If you go into your new job with this attitude and ask your nurses to give you guidance so that you can better assist them, you shouldn't have any problems.

Those are the big hitters that come to mind immediately from my experience on my own ward. Let me know if you have particular questions and I'll re-post if I think of anything else. Good luck and congrats on your new position!

tigerlogic · Jun 11, 2012

I'm a night CNA float and find oncology has a much tighter VS schedule, especially for IL2 patients, so time management is crucial. Also family care and making the space comforting seems more of a focus than other wings as the oncology patients are sometimes there a long time. There are lots of really specific isolation procedures for chemo, IL2, I131, stem cell etc so when in doubt ASK. If you might have a cold or are sick check with the nurses about where you need to wear a mask to protect immuno compremised people. Surgical oncology seems to also be emptying a lot of drains (jp, foley etc) so work with your nurse to make sure you don't miss any. Sometimes they're emptied qshift and some time q8 or more. Anyways.... Be chipper and enjoy. You're working on the cutting edge of science and making a big difference to your patients.

chemochickrn · Jun 12, 2012

Soldiernurse made a lot of good points. Temperature is a big thing. But don't panic in front of the patient if they spike a high fever. I've had patients freak out when an aide does their vitals and there is a big abnormality. Just tell them what you got for vitals and mention that you are going to bring up the abnormal reading to a nurse. A smile and reassuring nod goes a long way for a patient with a cancer diagnosis.

Nurses' aides typically have closer contact with the patients than the RN (unfortunately). You become the extra eyes and ears for us. Watch for things that seem "not quite right". If let's say you had a patient the day before that was chatty and seemed completely with it, and then you come in today and that same patient seems not "all the way there" - they say unusual things or do something impulsive, report your feelings to the nurse. Subtle things like this could indicate a drug reaction or "chemo" brain. I always listened to what we called our "spidey senses". I appreciated when aides came to me and said "Mrs. So-and-So" is not acting herself today." I may not have been there the previous day and you help me learn more about that patient. I once was able to avoid a code blue because one of my aides came to me during first set of vitals and told me a patient seemed "panicky" today. That patient was very close to coding but we caught it and were able to treat appropriately.

And I agree with tigerlogic, always check for drains, wounds, bruises, bleeding, etc. Many cancer patients are at risk for bruising and bleeding.

hospitalcna · Apr 22, 2013

Hello

I am a CNA on a surgical oncology floor....I was hired without experience for a full time day position at a hospital. I just had my 90 day evaluation and was told that they were extending my evaluation 30 days....I am afraid this means I will be fired.

brithoover · Apr 25, 2013

Protect yourself..we use precautions on any bodily fluids for 48 hrs post chemo