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One the topic of PPE, I work in an out patient infusion area and we wear chemo gloves for mixing, handling and administration and our Program Director is really starting to push the idea of wearing gown, gloves mask and glassesfor everything. They wear it all at the hospital on the oncology unit but we have not done it up to this point. I know that it is coming down the pike and it will become a standard but we also wear street clothes. We have tried to create an atmosphere of comfort and ease and I think it would take away from that to come out in full PPE. PPE is just thatPersonal Protective Equiment. So, what do other areas do out there?

We are scheduling them in our main computer too. Our Docs have all at one point agreed to start early, but quickly go back to the "banker's hours" which adds to our bottle neck. Our PA comes in at 0900 and will start seeing chemo patients right away. Our office only works M-F 0800-1700 and the Docs hate to stay late. We have noted that if the Docs start seeing early our flow is better but we still seem to bottle neck 1200-1400 when all the docs(up to 4 plus the PA) are quickly seeing pts and they are landing in the infusion area about every 15-30 minutes. We only do chemo, gammas, biotherapies and hydration. No blood products. One of the problems maybe our out-take people not understanding the complexity of the patient poopulation, but after 3-5 years one would think they are getting it a little. We have looked at staffing ratios adn patient intensity triage and are still struggling. We (the infusion room RNs) have a min experience here of 5 years and have watched this increase over the past 18 months and are just plain getting worn out from the heavy demanding load.

We have been attempting to solve a bottle neck problem in our scheduling. Our MD's are not varing their schedules and we are getting slammed from 1000-1400. We currently have 12 chairs, 8 pumps and 2-3 nurses working from 0800-1700. Our out-take staff has been doing our scheduling and adjusting our schedule to fit the MDs ( we require MD/PA on site for chemo administration). This is NOT working as the chemos are more complex than ever. We are attempting to work out a system to ease the bottle neck. We are looking into some computer scheduling and then looking at other possibilities. We have researched this and read the ONS articles re Patient Intensity in an Ambulatory Oncology Research Center and other articles. Does any one have any more idea, clues, systems... that might help us?? A Computerized Appointment System was mentioned, has anyone used this system? Thanks for your ear! Deb, RN

I've worked in an outpatient/doctors office for the past 6 years(15 yrs in house with 7 on an Oncology Unit total 21 nursing years). I love my job but it has changed over the last few years. Lots more complicated chemos and complex protocols. Learn the protocols, Acronyms (ie ABVD, FOLFOX7...) and ask if you have any questions. Read package inserts if you are mixing chemo, know compatibilities and always check your patient's counts and make sure an MD is available, if not present during infusions. Good luck! Oncology outpatients are the best and you will learn so much from them!!!!!

Did you ever think that the staff also gets overwhelmed and tired of students? When I worked in ICU and the ED, we had LPN, RN, EMT adn EMS students. It got to the point that I hated to go to work and have to deal with another student and I am a firm believer in teaching and knowledge sharing. Another thing, when you become a LPN/LVN you will carry a work load that will not likely be greater than 4 patients and entail bath and linen changes. This is part of your job even as a student. Remember that there is a differnce between being a student and working as a nurse and this is something you too will come to know. Best of luck and congratulations on wanting to become a nurse!

I have to disagree with the statement that all RN's should be required to advance their education to at least the BSN level. It is a personel choice and I don't care who funds it. I have been active at local and state levels of our professional nursing organization and this push to require BSN is something that is always being debated. A BSN does not make you a better or more rounded nurse. THe same goes for ADN's, they are not all better than BSN's. It is the INDIVIDUAL and there ABILITIES to put it all together and use common sense. More clinical experience is a definite plus. Maybe nurses need to evaulate where they start instead of every new grad wanting to hit EDs, ICUs, CCUs... right off the bat. Maybe medical is a better place to start and get experience. Just in case you are wondering I am an ADN but I also have a BS and MS in Speech Path. I also started as an LPN then went on to my ADN and have no desire to go further in my education. I am happy as a clinical RN with 20years experience and the only reason I would go for a BSN is if I had a desire to go onto a management position.

I laugh so hard everytime this topic comes up! Don't worry about what others think, do it for yourself, if you feel the need. Work hard to be the best nurse you can be, care for your patients, co-workers and yourself. Share your knowledge base and inspire others to do the same. Time to get off the soap box now. deb

I work in an outpatient Oncology office and we do not wear gowns, always wear gloves when handling chemo and administering it. We have gowns and goggles available to anyone who would like to use them, but I haven't worn a gown since I left the inpatient setting

We draw all of our clinic patients off of a 24g IV and have success 99% of the time. Occasionally we hemolize, but not that often. We use 24g Intima IV Catheters. Similar to butterflies, flush with hep and cap until it's chemo time. There are times that the patient needs to be warmed up to dialate their veins. This works wonderfully!!

What I believe you are referring to would be strontium chloride Sr89. It is used for bony met pain from prostate or breast cancer. Patient have experienced relief for 4-16 months. It is administered in Radiation Oncology .

I work in a Hem/Onc office with an OP dept. There are 2 chemo certified RNs and 2 triage RNs, also chemo certified (plus 2 LPNs) We have 12 available chemo chairs (and sometimes there are 12 patients in them and the triage nurses work with us when there are that many patients) I have worked in ICU and the ED and my partner did Med/Surg and Peds. We have 18-20 years nursing each. We Start the IVs, draw blood, mix chemo and administer it. We have had drug reactions and cardiac arrests in the clininc and the hospital. I think what makes the difference is the person you are working with and the response of EMS/code team. Read the directions follow the recommendations and use your head. Start new drugs slow and monitor the patient. We do not have a crash cart, wall suction or wall O2. We have ambu bags, cylinder O2 and 911. Reactions and deaths occur, it's part of the process. we just do the best we can to stop and avoid them at all costs.

I started on an Oncology unit 18 years ago and spent 7 years there. It is the best place to learn about the whole patient. Cancer affects every aspect of their lives. Not only psych-soc but every major organ system. The Oncologist need to work with the entire patient, not just a system. The patients are the best. They are so caring, supportive and loving. More than any other area I have worked in. I worked ICU and the ED and curently work in the Onc office as a chemo nurse and I believe I have once again found my nitch. Give it a try and you too might stay for a few or ten years.

I work in an outpatient Hem/Onc office and we give Iron Dextran, Ferrlecit, and Venofer and (thank goodness) have had no problems. ALWAYS ALWAYS do the test dose. Our Docs require 30 min wait after test dose and then the infusion (depending on the med) over 3-6 hours. Premedicate with Benadryl and tylenol.