New Grad in Onco/Heme/BMT Unit.

[kmichellex]

I may get a job offer on an Oncology/Hematology/Bone Marrow Transplant Unit (Onco/Heme/BMT). The unit will be split up when they're done with their new building into Medical Oncology and Hematology/Bone Marrow Transplant. The nurse manager (NM) told me that all of the new hires (mainly new graduates) will be working on the Heme/BMT unit and not the medical onco. I will get one-month training on the Onco/Heme/BMT before we're split up.

Onco/Heme/BMT: 21 beds, 6 beds for BMT, 1:4/5 patients per nurse

NEW Heme/BMT unit: 16 beds, 1:3/4 patients per nurse

This is a HUGE teaching hospital in NYC and it's also magnet if that makes any difference.

I'll be working nights 8p-8a, and I will be apart of a 10-week orientation residency program. 5 weeks mixed with classroom and time on the unit & 5 weeks only on the unit. Orientation can be extended by 2 weeks if needed and that will make it go from 2.5 months of orientation to 3 months.

We will be located on one floor with a Transplant unit on the other side from us, they have 18 beds. We're all on one floor and it's all one unit however we're two separate specialties. She told me there MAY be cross-training but more than likely it won't happen for the new grads since transplant is a lot. This transplant unit will contain all transplants except lungs and cardiac I believe.

I wanted to ask you all if this is a good unit for a new graduate nurse? From what it seems like .. it seems like this unit will be an acute/step-down unit? (I'm not sure). I know BMT pt's can be pretty acute but I'm not sure about heme patients. I've always wanted to go to the CVICU or a Cardiac Stepdown and then go to a CVICU but because of the limited openings, I couldn't do that. This unit sounds amazing though, and I'm eager to find out whether or not I got the job. From what I was told a unit that has BMT is great for people who want to go onto ICU's later on because of the assessment skills that you need to have and critical thinking.

Overal, what are your thoughts? ****

1. Is this good for a new grad?

2. Does this unit sound acute to you?

3. Will this make a good transition later on if I go into a Cardiac ICU?

4. Do you have any books or suggestions on how I can prepare for this unit (if I get the job)?

[Buckeye.nurse]

I work on a hematology-oncology floor--also at a large, teaching, magnet hospital. On my unit we treat leukemia, lymphoma, and multiple myloma patients. We also re-admit BMT patients who return with illness 6+ months after transplant. The BMT floor is considered critical care. They do hire new grads in the residency program.

Hematology patients in general are very ill/acute. You'll give a *lot* of chemo and hang a TON of blood products.

As for your question about transitioning to cardiac ICU, I can't comment on that. Oncology and cardiology are too distinct specialties. While oncology patients can have cardiac complications from chemo, most have limited cardiac history (I see a-fib most often on my floor). Patients receive a cardiac work-up including an echo prior to starting therapy to establish a baseline, and ensure they are healthy enough to undergo chemo/transplant.

Finally, in regards to your question about preparing, most information will make more sense once you are actually in the residency program and have a patients to put a "face" and context onto everything you are studying. I highly suggest that you keep a small note-pad to jot questions down in. Once you have down time look up the chemo regimens, malignancy sub-type, therapies, etc. that you had questions about on a respected website. I like Latest Medical News, Clinical Trials, Guidelines – Today on Medscape (it's free) and Evidence-Based Clinical Decision Support at the Point of Care | UpToDate (free if your hospital subscribes to it like mine does). Do learn the basics of neutropenic precautions, thrombocytopenic precautions, and lab values you can expect to see in your first 1-2 weeks of orientation. After that focus on the most common hematology emergencies (neutropenic fever, tumor lysis syndrome, bleeding emergencies, and superior vena cava syndrome).

You may also find the following websites helpful as places to start: ONS | Oncology Nursing Society They have a wealth of knowledge for oncology nurses. There are monthly meetings in almost every major city as well where you can network and learn. They also offer online classes, but can be a bit costly

I also recommend looking over Leukemia & Lymphoma Society | Donate Today! and Chemotherapy | American Cancer Society

Best of luck. Hematology/oncology is truly a cutting edge field where we are discovering new treatments and saving lives. I'm passionate about our patients!

[pebblebeach, BSN, RN]

I'm about to start a BMT residency and this post was super, super helpful, especially the patient education resources. Thank you!

edit: oops, that was supposed to be a reply to buckeye nurse RN

[Buckeye.nurse]

I'm glad you found it helpful. Welcome to the world of Hematology, and congrats on your residency position! :)

[kmichellex]

Thank you so much!

I started on a cardiology unit instead but I'm so glad this post helped others. :)