luvbug9956

It is lonely at the top! I have to say though, although this seems like a weak answer, sometimes it is time to move on. My first career in management was very difficult - I managed a group of unusually dysfunctional nurses and other staff. My director was very difficult to work for, and the organizational structure was also a barrier every time I turned around. I stuck it out for four years because I believed that this was just "being a manager". I was very successful in developing the unit, the program, and implemented some very great things - however, the inter and intrapersonal nonsense was, like you said, keeping me up at night and making me very unhappy. I recently (4 months ago) obtained a management position in another hospital, and I am SO happy. You don't have to put up with disrespectful and dysfunctional staff, weak directors, and unsupportive organizations - there's lots out there and sometimes the grass IS greener. I know it seems like a cop-out, but it's the BEST decision I ever made. Just be sure to really weigh all your options - I was offered 3 other positions prior to taking this one, and none seemed like the right fit. I am now where I am meant to be, with respectful and hard-working staff, a FABULOUS director, and a supportive organization. Trust me, it ain't all sunshine and rainbows, but it is SO different from what I was assuming management should be.

I get up at 5:15 on work days and I tend to wake up around that time on my off days...but try to get back to sleep until at least 7:00. I am one of those who feel like crap if I sleep past 8:00 or so.

I draw back to check for blood return anytime I access a port. When I do that, I just go ahead and waste 3-5 cc's. I want to know that I am flushing into a patent line!

Telemetry units are notoriously difficult. I floated to tele one day from my med/surg unit and was flabbergasted. I had a new-found respect for all you tele nurses I work in oncology, but really wasn't happy on the inpatient side. I moved to outpatient oncology after two years. I am now extremely happy in the profession, but actually MISS inpatient nursing! Ha...ya just can't win! It WILL get better once you gain the experience and the confidence. Trust me. But tele may not be right for you.

I am a recent (5 years ago) grad, and I struggled with the same issue. Do I go and work for awhile, or go straight to grad school? I decided to work, and I am really glad I did! I have already moved into a leadership position with my BSN and am now in a really great spot to start my Master's program. I truly don't think it's about paying your dues. I think that, with a Master's degree, you are showing that you have an advanced level of knowledge and skill. Whether you want to do leadership, clinical specialist, nurse practitioner, or education, you truly need basic experience to do any of those positions. It may be hard for someone who hasn't worked yet in the nursing field to realize what those advanced positions entail. You will never find a staff nurse who will respect you as a manager, leader, clin spec, or NP if you have no basic nursing experience. Unfortunately, that's just the honest truth. Honestly, a BSN does NOT prepare you for the realities of nursing...especially the politics that exist. And a resume that includes a 4-year BSN degree followed by a Master's degree, but NO work experience will NOT get you very far. I am on a recruiting committee that helps to choose leaders and clin specs for our organization. There are MANY applications for each position; someone with no work experience will not obtain a position in our organization. That's not to say you can't go straight for your Master's, but get some even part-time work experience. There are skills you never practiced in nursing school, whether it be a BSN or AA degree. And, if grad schools in your area are like they are here, there are probably 20 spots for every 500 applicants - you will not be selected without proof of progressive work experience. Like the above posters have stated, it's not about paying your dues....it's a reality.

I worked there for about 2 years as a student, and then 2 years as an RN. There are positives and negatives and I think it depends on which unit you work. I worked newborn nursery/postpartum as a student and it was great. GBMC is known for their OB program, and it really shows. However, I moved to the med/surg/oncology unit and had a (mostly) negative experience. Positives: great team on that unit (I miss them all!), mostly relaxed atmosphere, self-scheduling, no rotating shifts, fair holiday requirement, free/convenient parking, good benefits Negativies: poor leadership (my old manager has since left, so that may have changed), very little input asked from the staff when changes are made, fairly low pay rate, mandatory overtime (uh-huh, and we though that didn't exist), bully-type coordinators, and difficulty getting staff on night shift (meaning that day nurses often work over). I don't think I would go back to GBMC at this point, but never say never!

I have to say, my facility received Magnet status about a year ago. And honestly?? The staff nurses hate it. They don't feel that they are receiving any benefits from it. And they are required to do a LOT more work. They must be members of committees, audit performance improvement initiatives, be involved in unit education, etc. My honest opinion (I might get shot for saying this....)....it's another thing that takes the RN away from the bedside.

I will be starting my grad program in August, and I am currently enrolled in the NP/CS/Oncology program at UMB. I am going to start with one online core course this fall to ease myself in. I work 40+ hours per week (5 8-hour shifts) as a clinical leader. When I attended the orientation, they said that it is nearly "impossible" to work full-time through the program. So, has anyone been through this program (or a similar one) and been able to maintain full-time hours?? I REALLY want to go through the program, but am the major breadwinner in my family (hubby is a contractor and winter work is always slow). I cannot go back to being a staff nurse at this point b/c I rely on the leadership income. I am also quite shocked that all of the grad courses are middle of the day on like a Friday! No way will my employer allow me off EVERY Friday to attend a class from 11am-1pm! And even if they did, it really wouldn't be fair to my coworkers that I have every Friday off. I really expected some evening options, and there really are none. I am thrilled to have been accepted, as I know UMB has a great NP program. I just don't want to set myself up to fail. At this point, I am considering moving into the Leadership and Management program (completely online) and taking oncology courses as my electives, but my ideal position is to be a clinical specialist in oncology. Can anyone give me their experience in this (or a similar) program??? Were you able to work full-time? Were there ANY evening courses offered?

Nurses in pediatric oncology tend to be quite loyal...less turnaround time. It would probably be very difficult for a new grad to obtain a position in that field. I would suggest starting in adult. This way, you could start on an inpatient oncology floor that also sees medical/surgical overflow and get a good variety of experience. This will help you to manage your oncology patients ' comorbities if you choose to specialize further into oncology. Just a thought!

I agree with the above posters. We did not institute CBI unless our patients showed initial signs of hemorrhagic cystitis (first sign of blood in the urine). I would think that infection rates would increase drastically with prophylactic CBI...

Taxanes are always given before carboplatin, or severe pancytopenia can occur. We actually give the Avastin FIRST in our clinic. We do this for convenience, as we do not wait for the patient's lab results and can start the drug immediately, then giving the rest of the chemo after the labs come back.

There is a big difference between chemotherapy and biotherapy in regard to both toxicities and method of action. I am 26 and have worked oncology for 3 years. There is no definitive data on whether nurses working with chemotherapy have a higher risk of fertility issues. However, in my facility, once you become pregnant, you have the option to not hang chemo. Many of the nurses that I have worked with over the years have had normal, healthy pregnancies; some have gone through IVF to get pregnant. Whether or not this has anything to do with hanging chemo is unknown. To protect myself, I always wear my PPE...gown and double gloves. There are also different levels of risk...at my facility, we do not mix the agents, we just hang so there is much less risk of exposure.

We usually give chemo with ANC of 1.5 or above. Often times we will treat with a lower ANC with filgrastim or pegfilgrastim support. It also depends on the patient's regimen. If you are a member of ONS, there is a great online lecture through their web site that discusses ANC, GSF support, and discusses high-risk vs. lower risk patients.

I work in an outpatient oncology clinic infusing chemotherapy. In the years that I have worked in oncology, Phenergen is rarely given. With the new alternatives out there that have FAR fewer side effects and increased efficacy, it's just kinda fallen off the map in cancer care. If it is given, it must be through a patent IV with a positive blood return and must be given over at least 15 minutes as a piggyback diluted in 50cc...never pushed as it is VERY caustic to the veins and can cause increased side effects (dystonic reactions) at higher infusion rates. The only times that I have given Phenergen are when other alternatives have been ineffective and this one doc prescribed it all the time (but he was still prescribing IM Demerol/Vistaril for pain, so...). Our facility has changed the policy to reflect this new data...if yours has not, that would be a great performance improvement opportunity to stir up! http://http://www.ismp.org/Survey/Survey200608R0.asp?ps1=Hospital&ps=Q4_2='Hospital'

In one of the hospitals that I had been previously employeed, an LPN program was piloted, as they had previously not employed any LPN's at all. The program was piloted on one of the medical-surgical units and I think that it has since dissolved. The LPN's of course could administer meds, but no IV push meds, and could not do assessments. This actually was found to burden the RN's, as the RN staff had been cut, with the assumption that with the LPN's, less RN's would be needed. The remaining RN's thus had to still assess patients, with a much increased patient load (up to 10 pts compared to their previous 5) and still were required to give the IVP medications, including pain meds. Then whenever a patient would "go bad" the RN was still responsible for the emergency treatment and plan, all with a much increased nurse-patient ratio. There are absolutely places where LPNs are used and highly appreciated! Most LPNs I know have a fantastic work ethic and desire to learn! I think that this is why LPNs are used so often in long-term care; the patient conditions tend to remain a bit more stable and IVP meds are more rare. This provides great opportunity for LPNs...it just doesn't seem to work well in the hospital setting.