Outpatient infusion/chemptherapy staffing

[herring_RN, ASN, BSN]

I've never worked in an outpatient setting. A neighbor gets outpatient chemo. She had to wait several hours because they had to few nurses. Her daughter had to work so I drove her that day. I went home to get us books.

I'm wondering what is considered an appropriate number of clients for one nurse to administer chemo to at one time.

How many a day? The center is open 10 hours.

[mappers]

We don't really have a pt-nurse ratio like in a hospital. We have 11 beds and 15 chairs. So potentially, we could have 26 pts on the floor at one time. We usually have anywhere from 8-11 nurses on the floor. I rarely have more that 4 pts at one time, but that can vary based on the types of treatments. I can have anywhere from 8 -12 pts in one day. Some are complicated with several different chemos. Some are single agent with little chance for reacton. Some are single agent with a high chance for reaction. Some are vesicants that require being pushed. Sometimes we are waiting on labs, trying to get the doctor to review something, etc that requires more time and attention. New pt's always require more attention d/t their nerves, questions, etc.

We also watch each other's pts. If your pt's IV pump is beeping, I might check on it. We have orders at the bedside, so I can hang the next drug. I know our protocols, etc. If I have a question, I'll ask my colleague about it. If a patient is finished, I might DC the IV, deaccess the port etc on someone who isn't my patient. That helps keep the flow going.

So, if I have 3 pts and they are all under control, (that means their orders are approved, IV is started or port is accessed, labs are all good, and medication is started), I might pick up another pt. Starting patients takes time and if I don't think I can give them that time, I'll wait. For example, I might know that I have a pt where I need to push a vesicant in 15 minutes. I'm not going to start someone (which might take 30 minutes) until my first pt's vesicant is done.

Also, scheduling (at least for our office) is extremely complicated. Many of our patients go to our lab first, then see the doctor, then come back to see us. We try not to schedule anyone to start between 11:00 and 1:00 so that we can take lunches. We get 30 minute lunches and 1/2 the nurses leave the floor. It really isn't safe to start a new pt with only half the staff. So we have to schedule lab, MD, and Chemo in one visit. Everyone who comes into our office goes to lab. About 1/2 -2/3 see the MD and 1/2 - 2/3 come to see us. The schedulers have a tough job fitting all those schedules together.

So yes, sometimes our patients have to wait. On perfect days when we are not overbooked, no one is scheduled to start during lunch and everyone is there, and we don't have any reactions or add-ons, then it runs well. Those days aren't as frequent as we'd like.

Does this long response answer your question?

[herring_RN, ASN, BSN]

Thank you!

My friend really likes and respects the nurses at the infusion center.

Thank you for doing this.

I mean it, nurses need appreciation.