new grad/new job

Double-Helix, BSN, RN · May 22, 2013

I don't have any oncology resources that I can refer you to, but I'll offer some general tips.

Know your normal and critical lab values, particularly the CBC and differentials.

Learn your s/s of infection, s/s of septic shock (huge problem for these immunocompromised kiddos). Learn infection prevention methods- practice them diligently and enforce them with visitors and other staff. Never let a person walk into a neutropenic child's room without washing their hands. You are the advocate for these kids. They need their nurse to be bold enough to keep them safe.

Brush up on the the most common pediatric cancers and blood disorders. Ask around on your unit and find out what diagnoses they see most frequently so you can read up on them in advance.

Review Port-a-caths, PICC's, Broviacs and other long term central access. Know how to safely care for and use the line. (i.e. only 10mL syringes on a PICC line, accessing and de-accessing a port, drawing blood, changing dressings, etc.) Know your facility's CLABSI prevention policy like the back of your hand. Perfect your sterile technique. These kids are at high risk of infection and their long term central access is vital to their plan of care. An infection or a malfunction in these lines is a huge issue.

Practice your therapeutic communication. You'll be dealing with families who just learned their child has a terminal illness. Teenagers who have relapsed and know exactly what that means for their future. Children who have spent more of their life inside the hospital than out. You'll be the shoulder to lean on and the ear to vent weeks or months of frustration and anger. Avoid false reassurance and false hope no matter how badly you want to make the patient or family feel better. Don't tell them that you know how they feel. Don't take their bad mood or anger personally. Remember that it's the situation, not you, that has upset them.

Respect the parent's wishes. Give them, and the patient control and choices when they have them. Realize that having a sick child and not being able to help them is possibly the most helpless, terrifying and agonizing feelings imaginable. The world is out of their control and these patients and families desperately need to feel like they are doing something. Allow them to help whenever possible. Teach them about their child's condition, the tests and procedures, and what the lab results mean, if they are interested. Increasing their knowledge will help increase their feeling of power over the situation. Allow the child to choose the order he takes his medications, which arm he wants his blood pressure taken on, what he is going to wear or what toy to play with. Even small choices will help.

Respect developmental differences. Remember that a 2 year old will not cope with a hospitalization like a 6 year old or a 10 year old or a 15 year old. Babies need to be cuddled. Toddlers need to play. Elementary school children need to feel accomplished, and teenagers need to be with their peers (and sometimes they just want to be left alone). Whenever possible, advocate for their needs, and respect them.

Be prepared. Hemo/onc patients tear your heart out. Probably more than any other pediatric specialty, your patients will have the worse prognoses, the longest lengths of stay, and the highest percentage of mortality. You'll get attached to the patients and their family. You'll laugh with them, celebrate with them, worry with them and cry with them. As soon as you can, develop your own coping mechanisms and ways to de-stress. You'll have patients who love you and who will tell you that you've made a world of difference in their life. And you'll have patients who will make a lasting impact in yours.

brithoover · May 22, 2013

I recently just started in peds heme/onc as well. My hospital gave a wonderful 3 month orientation and taught me everything I needed to know. Don't kill yourself trying to find out everything before you start. It's nice to have a good base knowledge but if its a good hospital they will give you a good orientation.

I have a wonderful peds heme/onc text that I can give you the name of when I get home

bnm9485 · May 28, 2013

Please do! I appreciate your replies!!!! =)

bnm9485 · May 28, 2013

Thank you very much!!!! =)

anonymous 456 · Jul 8, 2013

Wonderful advice for us new grads entering the Peds arena. Thank you very much :)