Opinions on oncology

Cascadians · Mar 19, 2002

Adult Oncology -- hard work. The floor we worked on had a lot of surgeries, radiation, chemo, other Admits, isolation rooms, implants, etc.

Many of the pts were emotionally devastated and their families anxious, which is understandable. There were pain issues and many patients on pain meds which reduced their ability to safely navigate Tube City to the B/R, etc -- so a lot of hands-on care with ADLs. Yes, a lot of total care pts also. Multiple crisis per shift times.

Lots of meds, scheduled procedures, JPs, tubes everywhere, suctioning, labs, continually changing Dr orders, paging respiratory therapy, transport, etc.

Intense. The 3BD (blood brain barrier) pts required extensive nursing presence, care, documentation.

The staff:patient ratio you described sounds heavy and busy!

We loved our job and would have stayed had management not kept making insane decisions leading to unsafe dangerous working conditions.

Julie, RN · Mar 19, 2002

8 patients on an onc unit sounds heavy to me. We stay so busy on my adult onc unit they try and give us just 4 pt's per RN. We usually have 2 CNA's for 32 beds. Sometimes thay have to give us 5-6 pt's, but I have never had 8!

eldernurse · Mar 20, 2002

I got out of oncology after this scenario. I had 5-6 patients on daylight. Just as I was starting a chemo that I had to stay with for 30 minutes, my 26 year-old patient (who was the brother of a friend of mine) coded. To cut to the quick, he died, was taken to the morgue and when I returned, they had another patient in the room for me to admit (meanwhile, I still hadn't seen the one with the chemo I shouldn't have left.) I lost it when I opened the closet door and found the 26 year-old's shoes, size 14's.

On the side for oncology, they are some of the nicest patients you will ever meet. They need you more than any other patient you will ever care for. I loved the blood dyscrasia patients the most (leukemics). They were interesting and complicated. After this, I worked on a med-surg/gyne-oncology unit where you had a mix of surgical and oncology patients.

I realized that for me, oncology patients sucked the life out of me. I take my job seriously and I could not separate home and job. I would stay hours longer on my own time if the end was near for a patient, just to hold a hand. I remember each and every one of them as if they were a friend.

grouchy · Mar 20, 2002

I worked second shift oncology for over 5 years. We usually had 6 patients each, with 2 CNAs. The charge nurse took a full assignment. We did not have an admission nurse. So the staffing was a little different so it's hard to compare.

Positive stuff: Very interesting-lots to learn. Oncology is a mixture of high-tech (learning about the chemo drugs, accessing ports) and high-touch (lots of emotional support). I did not feel as upset about dying pts as I was initially worried about. We mostly had older pts, which made it a little easier, plus I liked advocating for good pain control and good end of life care. I really miss the nurses I worked with- some of the best and nicest nurses I ever worked with. We were also too busy to have much time for backbiting,etc.

Negative Stuff: Very tough job, absoloutely insane pace. I have since worked in a stepdown unit, and had easier patients there. Our oncology unit was staffed like a regular medical unit, but should have been staffed like a stepdown unit due to the high acuity. I almost never took dinner, delayed bathroom breaks until it hurt and averaged 2 hours of overtime with every shift. Sometimes had 4 hours of overtime. I almost never had overtime on the stepdown unit, and when I did it was just 15-30 minutes, so I know it's not just me!(Plus everyone else had alot of OT). Pts and families ARE needier. I noticed when I worked cardiac stepdown that alot of the CHF patients have life expectancies similar to oncology pts, but they don't seem aware of it, so they and their families are not as freaked out. Most of our oncology pts were full codes-couldn't deal with the DNR issue- many became unstable, septic, hypotensive and got sent to the unit. Often had to wait hours for an ICU bed, meaning hours of 6 pts with one needing one on one care.Lots of diarrhea- 2' to the antibiotics. Second shift was very busy- we hung alot of blood transfusions, got most of the admissions, did alot of chemo. I'd ask if they have an IV team. Some chemo drugs can cause chemical burns if they extravasate- I want to know a pro has put in that IV. Find out how the staffing compares with that of the regular medical floors. Find out if they have a core of experienced nurses on your shift- you will definitely need them as backup, and to take the sickest pts until you get more experience. Are they all oncology pts? We had some medical overflow, which usually lightened the load a little. Will you be expected to do chemo right away? Until staffing collapsed on my floor we usually waited about a year to do chemo and to take care of the sickest pts, who were usually the leukemics. If the charge nurse checks the chemo orders and helps you might be able to do it sooner.

AmyRN1227 · Mar 21, 2002

Thanks everyone for your responses.

Wow, it sounds like a heavy unit to work in as a new grad.

I thought telemetry was a rough unit...but it sounds like oncology may be a little tougher. Any suggestions for what area would be good for someone with less than six mos of med surg experience?

Thanks!

paigenp · Mar 21, 2002

Amy,

You can pick any area you are interested and go for it! Now because of the shortage, most hospitals will train new nurses to perform in that area of specialty. I worked oncology for 6 1/2 years but also worked adult med-surg, ER and peds. All areas have their positives and negatives. Don't turn down an interview just because you don't think you have enough experience, the more areas you are exposed to the more marketable you are in the future and look at the experiences you can have!

Regarding the oncology floor you interviewed with, that is a pretty heavy load for a new nurse. 4 patients should be the max with total care patients. That maybe why they are looking for new nurses because they burned theirs out due to the heavy loads! But, don't give up on oncology if you are interested in it. It was a wonderful and growing part of my life as a nurse, I have memories of patients I will never forget. I now practice family practice as a nurse practitioner, but my oncology experience has shaped the way I talk to patients and deal with difficult situations and crises. I believe I'm a better nurse because of my experiences.

Hang in there, you will find your niche! But remember, you may find many areas you like, so experience them all!!

Paige

mustangsheba · Mar 21, 2002

Amy: Eight patients is way too many. Don't do that to yourself. If you want to work oncology, find some place where you have no more than four patients. Illinois doesn't seem to be a great place for nurses, does it? You could go to almost any area you like right now, but I would hold off for another year or so on doing ER or Home Health.