Oncology rotation - help!

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Hi everyone,

So I'm in my second year of nursing school and we have our med/surg rotation starting in just a few days (monday). For my first rotation I chose the oncology floor and it lasts 6 weeks. Unfortunately, we studied oncology after choosing these spots, and now I've just found out how dangerous chemotherapy drugs can be, as well as the urine and other bodily fluids of the patients receiving them. It's probably too late to change (though I guess I could try, but I have a feeling I'm overreacting and I don't want to switch over an overreaction). I'll admit I might be a bit of a slight hypochondriac when it comes to things like this, especially since in this case I don't feel my studies provided me with enough info to fully understand my risk and how to minimize it. The reason I chose oncology is because I want to work in pediatrics eventually and I've toyed with the idea of working in a pediatric oncology ward. The ward I'm going to is an adult ward, but I wanted to see what type of work it is and how well I can emotionally handle the sadness of it.

Anyway, I know that the danger to nurses should be minimal if all proper safety precautions are followed. The problem is that I've seen nurses not following proper safety precautions in other wards due to lack of time, or maybe just not realizing what they are doing (absently touching their own mouth, a patients arm, then another patient without disinfecting their hands, etc.). Obviously not all nurses do this, but enough to make me nervous. I'm less nervous about administering the drugs as I am about taking care of patients who might possibly have the remnents of cancer-causing drugs in their urine, excriment, sweat, breath, etc.? My book didn't exactly outline how to handle this in very good specifics, so I feel like I'm sort of at the mercy of the nurses I work with in the ward, because if they do something wrong I won't know it's wrong. Can anyone give me some practical information about how every day care of patients should be handled? When I'm doing things like empyting urine into a toilet, flushing it, etc.? Changing sweaty bed sheets? Just being around the patients? And what about drugs that are in tablet form? My book read to "avoid breathing in dust from the tablets." Great, so I just don't breath and I'll be safe? xD

I know I'm probably overreacting, but like I said this kind of came as a surprise because we were scheduled to learn about it just before starting our rotations, and by then we had already chosen our places. Realistically, do I need to be worried about spending just 6 weeks working there? And how often do accidents happen (though in truth I'm more concerned about "accidents" that no one notices because they are in a hurry)? If it's actually a serious risk, I might consider contacting my teacher, but I think it's too late for that and I have a feeling she will think I'm being ridiculous, as many of you probably think reading this.. x) But I have to ask. I just want to go knowing the proper procedures so that I can speak up if I see it done wrong and avoid doing it wrong myself.

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Specializes in Oncology, Hospice, Med-Surg.

I understand your concerns but you won't be giving any chemo. Chemo precautions are usually only for 48 hours post chemo administration. You have to be chemo certified to give chemo. Also a lot of patients on an oncology floor haven't had chemo within that 48 hour window. They may just be suffering side effects from the chemo or cancer itself. I'd be a lot more concerned at a chemo infusion center which I did go to in nursing school, but they didn't let me touch anything. Every hospital policy is different regarding chemo precautions. At my facility we double gloved, double flushed the toilet and double bagged trash. Also several chemo drugs are given on floors other than oncology for autoimmune conditions or other conditions so it's something you'll have to learn anyway.

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I'm not an oncology nurse, so I can't specifically address your concerns re: chemo precautions. However, I am the wife of a former cancer patient, and I can tell you that these patients (and their families) need support. Please do follow precautions as necessary when you are around hazardous materials, but please don't act like you are going to catch leprosy from being in an oncology setting.

You mentioned handling the sadness of it: if it helps you at all, when my hubby was going through treatment, I enjoyed talking to nurses and even students about it. Ya know why? Because everyone else was scared to talk to us about cancer/prognosis/side effects. They were afraid we were going to get offended or something. So my advice would be to take the time to talk to these folks and their loved ones. Ask how they are feeling; what they need; what you can do to help. There were days we were laughing and joking as he was getting chemo (wearing a t-shirt that said "Chemosabe", no less ;)), and there were days that sucked royally because he felt awful and we just needed someone to acknowledge that. So I just wanted to ask you not to go in with the fear of "contamination": people can pick up on that and feel "less than." Whether people are dying, or sick, or getting chemo, they're people...and you can relate to them as such. Hope you have a great experience! :)

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I agree with Always_Learning. I AM a former cancer patient. Who has gone through 3 VERY difficult sessions of 3 types of chemotherapy drugs for the course of my treatment. Which is never an easy thing to go through, let me tell you. Although, I am cured now, its been 19 years since I was diagnosed, I would be offended and my family would be offended if for any second I'd thought you were treating me any different or less than any other patient or yours. That's just not right. I'm not trying to be mean, so don't misunderstand me, I am just being honest. :) Know what you are getting into before you decide on a career path in nursing. Standard precautions are set in place for a reason and following the hospital's policies and procedures, is a no-brainer. These rules are set for the patient's safety as well as your safety. I can't really offer you any nursing advice on what you're asking for, because I am a student myself. But, I felt it was important to mention how I felt about this. And, I know I'm not alone in that.

Good luck to you.

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Thanks for the responses everyone! It's actually really nice to hear from those with experiences as patients/family of patients. Though I hope I didn't come across wrong, as I certainly didn't mean to imply that I would treat the patients poorly. It's not their fault, afterall, that the drugs are so dangerous! I want to be a nurse specifically because I believe nurses have a unique opportunity to help patients both mentally and physically, because nurses are there 24 hours a day. I would never treat a patient like they are not a person.

Thank you for your replies, it does make me feel better. Always Learning, thanks for your input, too - sometimes I'm not sure what is a sensitive subject or not with patients and their families, and cancer is entirely new to me. It's actually really really nice to hear from your perspective. :)

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Thanks for the responses everyone! It's actually really nice to hear from those with experiences as patients/family of patients. Though I hope I didn't come across wrong, as I certainly didn't mean to imply that I would treat the patients poorly. It's not their fault, afterall, that the drugs are so dangerous! I want to be a nurse specifically because I believe nurses have a unique opportunity to help patients both mentally and physically, because nurses are there 24 hours a day. I would never treat a patient like they are not a person.

Thank you for your replies, it does make me feel better. Always Learning, thanks for your input, too - sometimes I'm not sure what is a sensitive subject or not with patients and their families, and cancer is entirely new to me. It's actually really really nice to hear from your perspective. :)

Glad I could be of some help! I know you wouldn't treat patients poorly, but what I meant was that if you go in with the "heebie-jeebies" about being around chemo, the patients will probably feel weirded out too (LOL). The drugs do require precautions, but as a student, you won't be giving chemo, and the nurses will guide you if there are chemo precautions to be observed (many patients don't have any special restrictions at all; my husband didn't, and he was getting 3 chemo drugs in high doses). Keep in mind, the oncology nurses work around this stuff every day, and the patients get the stuff pumped into their veins, and they're still around, no? ;) If you have questions, just respectfully ask a nurse and/or have a number to contact your professor if he/she is not immediately available. :)

When you go into anything with an open mind and heart, you're bound to learn a lot. Don't be scared to talk to the patients and families; they don't bite! Hope you have a fabulous experience; let us know how it goes!

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Okay, so my first week is over. I'm disappointed about their safety protocols in that ward. Though of course you were right - students are not allowed to give chemo at all. However my instructors who give it told me straight that they are supposed to wear masks and sleeve protectors in addition to gloves while administering the chemo, but they don't. All they wear are nitrile gloves. Even those they usually take off right away and don't wear any gloves if they have to switch the canule, adjust it, or when stopping chemo and disposing of the bag.

I also did some research on my own and discovered that with patients who have had chemo recently, you're supposed to wear nitrile gloves (x2 pairs?), a plastic apron or coat and possibly other protection for 2-5 days after the chemo when handling laundry, clothing, excrement, or washing. When I brought this up at the ward, they told me my information was wrong, flat out. Then the head nurse brought the ward's own chemo safety guide for me to read to get "real information" and it turned out that in there is read in capital letters that nurses should use at least NITRILE gloves when dealing with urine or stool of patients who have recieved chemo within the past 2-5 days. She had also brought up some books from the pharmacy that gave the same instructions as above (about gloves, an apron, + other protection). When she saw that, she said I can have nitrile gloves in my pocket and wear when needed. It made me feel a little better, but it bothers me that I have no support in this, since I just want to follow the safety regulations put in place by the hospital's own staff. I don't like it that they just expect me to ignore them just because they do. And it was concerning to me that the head nurse didn't even know what the safety regulations were (even though her name was listed in the group of people who made them), nor did it seem that the other nurses were aware of it. I do understand better now that the risk is very small, but why would I take even a small risk when a few easy safety measures can help? And my instructor keeps mentioning how she would be more concerned about things like clostridium difficile, if she were me. She doesn't understand that I would be concerned about that too if they told me, "Oh well we're supposed to wear all this protective clothing when we care for a clostridium difficile infected patient, but we don't really do that here."

However, if I ignore that little fact I REALLY like this ward. The staff is otherwise really nice, trusting me to practice skills I've only practiced before on dolls at school and always inviting me to come along if they are doing something new or interesting that I've never seen or done before. My instructor especially has made it clear that all I need to do is ask and I can go with other nurses even to do things. Also since most of the patients can take care of showering, using the restroom, etc. themselves, there's a lot of time for the nurses to sit down and talk with and educate the patients. It doesn't feel like we're in a hurry all the time. I like the patients, too. I've met some people going through chemo who are just so positive and nice. Although on friday I had some experience with the sadder side, but I think I need to see it so that I can grow and mature and learn how to support patients in difficult situations.

I'm really excited to go back on monday. If they followed the safety regulations it would be perfect. I just don't think that as a student I should have to fight so hard just to be able to keep myself safe, and it's not fair to students or new nurses who come in and probably never realize that safety regulations are not being followed. If I hadn't gotten concerned and done my own research beforehand, I would have just trusted that they were following all regulations. But otherwise I really do love the ward so far and the other nurses.

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I am going to say that I am or was a cancer patient I did receive chemo and went home after. So I was around my family with in the 2-5 day window. They did no have to wear gloves or aprons. My husband even slept on the SAME sheets in the same bed.I am thankful for the educated caring oncology nurses I had. To work in oncology you need to put your self in the patients shoes. They are thankful for every day every moment. The cancer patient need compassionate, caring, understanding nurses.Yes chemo is Poisson, but it didn't kill me it kept me alive. My experience with cancer is what has lead me to nursing school. I am ready to care for others the way that I was cared for.

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Specializes in Oncology; medical specialty website.

Read about the standards for PPE as directed by the Oncology Nurses Society. Oncology Nursing Society

As a cancer patient and a nurse working in a busy oncology unit, I've seen both sides of this issue. I have to say, if my nurse were more preoccupied with her own safety than helping me/supporting me, I would be very upset. The last thing a cancer patient needs is to feel like he/she is repulsive.

If people give you flak for taking extra precautions, tell them you're following ONS guidelines. (Make sure you've actually read them so you can back up what you're doing.)

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