New grad - Renal/Diabetes vs. Oncology?

[biltz]

I need some advice. I have the choice to choose between two new grad opportunities at the same hospital. One is in oncology and the other is in the renal/diabetic unit.

I have always imagined myself as working in renal with the goal of eventually working with a transplant center. I have close personal ties with transplant and dialysis patients in my family and have had a passion for transplant nursing since starting nursing school. I even precepted in a rental unit and enjoyed it. Oncology has always been the farthest from my mind

Through a strange set of circumstances I ended up with an interview in the Oncology department and decided "what the heck it's another opportunity to practice interviewing skills". As I discussed the role of an oncology nurse with the manager I realized there were a lot of similarities between what appeals to me about working with renal/transplantpatients and what working with oncology patients entails. Both are more wholistic types of nursing - i.e.seeing repeat patients, following them through the long arc of their illnesses, lots of patient teaching, dealing with families, complex care, multi-systemcomorbidities, etc. By the end of theinterview I not only sold the interviewer on me, I started to sell myself on Oncology

Since then I've been talking to my BFF who was an onc nurse and loved it. The more I look in to oncology the more interested I am in to it but it is still all very new to me. I know a lot more about renal than I do about onc. She tells me that renal patients are much sicker and stay sicker (they are usually the most non-compliant patients when they come in and stay that way when they go out - and that's why they are frequent fliers) - vs. - onc patients who have been healthy and have a new diagnosis but fight to stay alive and do whatever they can to comply with the regime. She hates working with renal patients but loves working with onc patients. I'm wondering if it's just a bias or a perspective I've never encountered before

What are any of your thoughts/input? Have any of you worked both units? What do you think gives one a better new grad experience/basis of learning the profession? If one didn't stay in either renal or onc their whole nursing career, does one offer more opportunities to branch out and/or limit you in the future? Any input would be of great value! Thanks!

[SoldierNurse22, BSN, RN]

I worked onc for several years. As to why your friend would think that renal patients were sicker and stay sicker, I really don't know. That assumption blows my mind, quite honestly.

We have patients who literally don't have a white cell to their name. Just because they're onc patients doesn't mean they're all compliant (not by a long shot!) or that they'll fight to stay alive (some people have been sick for so long, your job is simply to help them die in some semblence of peace). Not all of them are newly diagnosed, either, though just because someone is newly diagnosed doesn't mean they aren't symptomatic and very sick with cancer.

Oncology was intense. I often had patients who were a sneeze away from the ICU. It doesn't get much more acute than inpatient onc.

I can't speak for renal as I have never worked as a renal nurse, but I can't imagine anyone sicker than I've seen some oncology patients--who else do you know who is trying to fight off bacterial infections, viruses and cancer without an immune system in sight?

[mycallingKia]

Speaking as a mother of a pediatric oncology patient, there is never a dull moment in this unit. You also can still experience a stem cell transplant with oncology (my son had one). My son had his ups and downs but faired his much better than most but he had great doctors and nurses, God watching from above, and two parents who worked hard to keep him healthy as possible. Once I finish nursing school it is one of the units I'm considering applying to.

[CDEWannaBe]

I have no practical experience with either, but come at your question with a different perspective. If you go the renal/diabetes route then it's important for you to become a diabetes expert. And know that you are dealing with the effects of a badly managed system of diabetes treatment at hospitals and by healthcare providers, especially with type 2 diabetics.

Lifestyle definitely affects outcomes in diabetes management. But the reality is you can find diabetes treatment to maintain good blood sugars for almost any patient. The only exception I've found to that are diabetics who have gastroparesis (delayed stomach emptying) because it can be almost impossible to time insulin doses to food metabolism.

In my experience, diabetes patients are often given little or outdated treatment information from their healthcare providers and then blamed for their "noncompliance" when they have poor results. Patients are again blamed when their uncontrolled diabetes leads to complications like renal failure. By the time the patient gets to your unit, they're are pretty frustrated and hopeless. Some are stubbornly ignorant, but most would have avoided a lot of trouble if they had decent treatment and diabetes education a decade earlier.

So if you go into the renal/diabetes route, understand your patients and all of the factors that contributed to their complication.