Shan

Hello! I've been a nurse for almost three years and am also piecing together a plan for the trajectory of my career. My first bit of advice would be that while it is great to look ahead and have an idea of what's out there, don't trap yourself in a rigid plan this early in the game. You're still at the beginning stages of learning about the iceberg of nursing, and there is so much beyond ER/ICU/med-surg/L&D. Give yourself room to adjust your plans as you learn what's right for you. That being said - the debate about going straight into specialty versus starting on med-surg is a hot topic. I believe the right answer is different from person to person. I started out on an oncology unit that took a lot of med-surg overflow; I wanted to be a CRNA but had been a PCT on that unit and wanted to spend the fledgling bits of my journey with the team that I knew and loved. I quickly learned two things: I hated working inpatient, but I loved oncology. I had to accept that my personal happiness would not allow me to remain in a hospital long enough to garner the work experience necessary to qualify for CRNA school, so I let that path go and decided to go all-in on oncology. I was blessed enough to follow my preceptor when she left the unit to go to an outpatient oncology clinic doing chemotherapy infusion. As I grew more comfortable in my specialty, I became a member of the Oncology Nursing Society (ONS), which is the main organization for the specialty. I am a faithful attendee at our chapter's monthly meetings, wherein we learn about advances in the field, network, and discuss community opportunities. I also went to our national conference in Washington DC last year, which was amazing. I've met so many amazing nurses, physicians, and pharmaceutical reps - and through them, I have discovered so many interesting roles that nurses can have in oncology (clinical trial specialist, pharmaceutical educator, oncology nurse navigator, etc). I am still narrowing down which path appeals to me the most but I love that I've been exposed to so many wonderful options. So take this time to explore and experience small tastes of different specialties. In the interim between passing the NCLEX and going to grad school, join the national organization that represents whatever specialty you choose. I'd suggest pursuing certification when you feel confident in your expertise - you usually have to work in your specialty for a few years before you qualify for certification, anyways. Best of luck!

I was with one preceptor for the first half of my orientation and a second preceptor for the latter half - but several other preceptors were interspersed quite often when my primary was on PTO or our schedules didn't quite line up. Fortunately, none of my preceptors ever put me in a position like you're describing. I definitely understand how this can be frustrating, especially when everyone is insisting that their way is the "right" way. And obviously, there often is a right way to do something, especially when your institution's policies say so (in which case I would hope that you're not receiving too many conflicting instructions since everyone should be following policy - but that's a perfect world and those don't exist outside of the NCLEX). However, there are often multiple ways to accomplish the same task and I found it very valuable to learn several different methods for doing so. Nursing is an art and a practice, and every preceptor taught me something that sticks with me to this day (even if that "something" was what not to do, haha). Also, preceptors have different strengths; one may be good at foleys and another may be better at NG tubes, so capitalize on those differing facets of expertise. When in doubt, just prioritize patient safety above all else. There are no dumb questions - if you have a concern, voice it professionally and privately (I.e. not in front of the patient). Best of luck!

Wow, so good to know! Here in Fort Worth, we don't really do CAR-T or ASCT - all the patients go to Dallas for those things. However we have quite a thriving medical district here in FW so I think a lot of the pharmaceutical companies are really wanting to get more hospitals onboard with offering those treatments. So even Grade 2 CRS is managed outpatient? We do have toci at my clinic because we are delving into the BiTEs but we've yet to have any instances of short-onset CRS (knock on wood) and patients go to the hospital for obs, anyways. Do you manage low-grade neurotoxicity outpatient? Thanks so much for the reply!

That's really interesting - I'd love to read your evidence review. I understand that most NPs work in primary care but the OP was specifying a specialty, and I have a hard time believing that RN experience in that specialty doesn't make someone more prepared than going straight to NP school. I work in outpatient oncology, quite closely with several NPs and PAs, and the new hires always come to shadow in the infusion room as part of their orientation. The ones without oncology experience are always very intimidated by their lack of that experience, and they tend to stay on orientation longer. But the NPs with previous RN experience in oncology - they're a veritable treasure trove of information and wisdom about their practice and my practice. It was the same when I worked in acute care, as you alluded to. However, I understand that I was perhaps too general in my original reply - thanks for your perspective. I can absolutely see how RN experience could be a detriment to some people, who perhaps find it more difficult to change their lens from that of RN to provider, or alter some preexisting habits in thinking.

Hello! I'll do my best to give some advice, though I would have a few clarifying questions: do each of those classes come with separate lab portions? Are they 16 weeks long or more of a fast-track length? Are you already accepted into a nursing program or are your grades in these classes going to be part of the admissions criteria when you submit your applications? I took A&P 1, then micro, then A&P 2 - and I took each class without taking concurrent classes, so I was focusing solely on that material the entire time. Each class came with a lab portion that had its own assignments and exams, so they were more like two-in-one courses. The material in those courses, especially A&P, doesn't just go away when you start nursing school. You need to remember it because it will be built upon down the line. Therefore, to set yourself up for further success, I'd take them one at a time instead of doubling up; I feel this would allow you to really soak in and retain the information instead of just doing enough to get by. I know it would be nice to have the Summer off, but it would also be nice to still be in "school-mode" when starting nursing school. Nursing school will demand so much more of your preexisting study habits, and I felt that not taking a break served me well, personally. Of course, everyone is different - but I agree with your advisors on this one. Best of luck to you!

I'm afraid I have to agree with FullGlass. I'm always wary of people who want to skip actual nursing and get right to the "provider" part. I'm not an NP, but I would assume that NP school builds on the foundation of existing nursing experience, and fast-track programs have always felt dangerously superficial to me. As a patient, I would not seek care from a nurse practitioner who had never actually practiced as a nurse. As a healthcare worker, I would not feel comfortable performing the duties of a provider without a wealth of knowledge and experience. I know this isn't what you want to hear but proceed with caution. What I can tell you with certainty is that there is no way to safely complete that sort of education cheaply and to do it online would be robbing yourself further of invaluable hands-on experience, which you would already lack.

Hi all! I was at a vendor fair a few weeks ago for my local ONS chapter, and I was speaking with a drug rep for Carvykti. She said that 40% of patients receiving the therapy are now getting it outpatient. I was shocked - I had no idea that outpatient CAR-T administration was a thing. My practice has started administering bi-specific T-cell engagers (Blincyto, Tecvayli, Epkinly, etc), but we strictly adhere to the inpatient observation recommendations; however, I was under the impression that anything CAR-T was totally inpatient due to the higher likelihood of CRS and neuro tox. I was wondering if anyone on here has any experience with giving CAR-T outpatient - how do you monitor for complications? Do patients manage low-grade CRS at home?

Never get lax on your A&P knowledge. The more you can retain from that class, the better off you'll be once you start nursing school. Maybe get a dosage calculation practice book and start working on that, or brush up on algebra and dimensional analysis calculations. Best of luck!

I listened to a fascinating podcast that featured a nurse who worked in an "awake and walking ICU." She talked about how prolonged sedation can have significantly negative psychological effects. Incredibly interesting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188455/

I work in chemotherapy infusion, and my clinic only requires 6 months of experience before they'll consider someone's application. I was like you - I had been a PCT on an oncology floor all throughout nursing school and knew quite certainly that I did NOT want to be a floor nurse any longer than I had to. However, like me, you will likely have to start out there. Most non-floor nursing jobs require at least 1-2 years of experience - rightfully so, because the floor is the absolute best place to learn about holistic patient care. I disliked many things about being a floor nurse, but I'm so very grateful for the skills and knowledge that I gained in my short time on the floor. I searched high and low for jobs once the three 12s became unbearable, and I was incredibly lucky not only to find my dream job, but that they would take me without 2 years of experience. I love how science-oriented chemo infusion is, and I get to exclusively practice my favorite skills: IV starts, accessing ports, managing complex treatment regimens, etc. And one added point of interest - they started me at pay that I wouldn't have gotten as a floor nurse for about 6-8 years. If you discover that you like IVs and complicated medication administration, look into infusion. My advice would be this - don't write off the floor entirely. Use it as a place to start, to build your foundation as a nurse and explore what you like. A lot of people are under the false impression that your training as a nurse is complete when you finish school, and the opposite is true. The floor is where you learn the most - it is your most valuable professor. There's no problem at all with knowing early on that you don't want to be a floor nurse. That's like saying someone shouldn't become a pilot if they want to fly cargo instead of airliners. But just know that your options may be severely limited until you get some experience under your belt - which is not necessarily a bad thing. Best of luck to you!

Hi! I worked inpatient oncology for nearly two years (part as a PCT and part as an RN) and have recently switched to outpatient chemo/immunotherapy infusion. If you're looking for quality nurse-patient relationships, oncology is a great specialty for that. You see the same patients repeatedly and for long periods of time, so you really get to know them and their families. It can be emotionally taxing--especially inpatient, wherein you will likely deal with a lot of end-of-life patients transitioning to hospice. That was very common on my unit. Chemotherapy administration is a fascinating topic, and I've really enjoyed cultivating that skill as an infusion nurse. As for the multiple vacancies, I would wonder if maybe the leadership or work environment is to blame, more so than oncology as a specialty. Most of the nurses I've worked with have been in oncology for many years and have no plans to leave. It's not for everyone, to be sure, but a lot of people discover a passion for these patients that they weren't expecting to find. Best of luck to you!

Study up on how exactly dimensional analysis works. I went into nursing school with a background in engineering/physics, and dosages were a walk in the park because I knew how to set up dimensional analysis equations with ease. If you can get that down, you can solve any dosage problem. Always go into the problem by writing down the unit that your answer should be in. Then, cancel out the units until you're left with ONLY what you need. Go back over everything carefully to make sure you're not missing anything, or that you didn't accidentally incorporate something unnecessary (dosage problems love to give you info that you don't need). Then, re-write the equation with just the numbers and multiply/divide. Run everything through the calculator at least twice, because all it takes is one wrong button to get a really wrong answer. Memorize your key conversions (ml to L, mg to g, lbs to kg, etc.). Do A LOT of practice questions--there's tons online. Start with easy ones and work your way up in complexity as you gain confidence. Look up tutorials on YouTube. Take time to really understand the solutions to problems that you get wrong. There's also some great workbooks out there that focus solely on nursing dosage calculations. Best of luck! ?

I got a part-time job as a PCT during my last year of nursing school. I worked on an inpatient oncology unit at a large hospital in my city, and then went on to do my residency on that same unit after graduation. The experience I gained as a PCT was incredibly valuable and made the transition to nurse SO much easier. I was already comfortable interacting with patients, taking vitals, giving baths, etc. The nurses on my unit were always very willing to teach me; even though I couldn't try many of the skills due to scope of practice limitations, seeing them repeatedly and learning different ways of doing them helped me catch on quick when the day came for me to try them myself. I would 100% recommend getting a job as a PCT/CNA if at all possible.

That's a great idea!! I think my hospital would very likely have something like that, I'm going to look into it! Thanks so much ?

This may be sort of an extreme tip, depending on your circumstances, but have you thought about getting a part-time job as a PCT/CNA while you're in school? That was a HUGE thing that made me comfortable interacting with patients (real or fake) before I ever had to do so in a nursing capacity. Whenever we had simulation, I just operated like I would at work and I felt a lot more comfortable than a lot of my peers who found the whole situation to be totally unfamiliar. In simulation, you feel like you're under a microscope and like you have to perform well in an alien environment; anything you can do to make that setting feel more familiar may help you out. If you can't work as a PCT, I'd suggest practicing simulation at home. Pick a stuffed animal and practice assessment, patient education, etc. Try to develop good habits (like hand hygiene) before you have to perform them in front of judging eyes. Regardless, you are not alone in feeling this way; simulation is terrifying for a lot of people and can make 90% of what you know fly out of your head. Best of luck to you!