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  1. nursie_pants

    Outpt Infusion Clinic and PPE

    Hi All: It has been a bunch of years since I was last on allnurses.com but I have a burning question/survey type thing I was hoping to get all your input on. I have worked in the last 4 years in a private, stand-alone (no hospital affiliation) outpatient oncology clinic. We are part of McKesson/US Oncology network. Anyway, the PPE and hazardous drug protocols seem to be *extremely* lax: no double gloving, reusing gowns x 1 week, no eye masks that I've ever even seen, gloves hit at the wrist (not further up the arm), the repeated reuse of plastic chemo bags that the spiked bags/tubing are stored in between admixing and hanging at chairside). I worked for about 1.5 years prior inpatient med onc and it was very different. I really love my job and my coworkers. I'm part-time and it's gotten me through my 2 pregnancies and a transition into a new city. Some of my coworkers are nearing retirement and have been doing this forever. I don't want to step on toes or stick out like a sore thumb but I would like to try make some safer changes. However, we do have a new nurse manager and she is very open and has been implementing some good changes lately. Your thoughts? I am presenting at a staff meeting next month. Thus far, I'm using ONS's paper (https://www.ons.org/practice-resources/clinical-practice/know-most-current-recommendations-ppe-when-handling-hazardous), NIOSH (CDC - NIOSH Publications and Products - Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings (2004-165)), and other resources. Thanks!
  2. nursie_pants

    OCULAR Cancer/melanoma:mucoepidermoid

    Not sure if it has anything, but OHSU's Casey Eye Institute may have something on it. My husband is being followed by an MD there (after getting LASIK) for a potentially pre-cancerous area on his iris.
  3. nursie_pants

    NPO/clear liquid status during labor - evidenced-based?

    Here are just some random links supporting in a quick Google. Note I have not verified the sites: http://www.instituteofmidwifery.org/MSFinalProj.nsf/a9ee58d7a82396768525684f0056be8d/3f66c7d76a80b37f8525739500756493?OpenDocument http://www.nurse-anesthesia.org/archive/index.php/t-9588.html http://www.theunnecesarean.com/blog/2009/8/25/the-big-push-for-midwives-acog-wants-to-keep-women-hungry-in.html?currentPage=2
  4. nursie_pants

    NPO/clear liquid status during labor - evidenced-based?

    No formal research, just in what I've read as far as midwifery books go (like the crazy but on-her-game Ina May Gaskin)... I'm sure in the NICU you've seen/heard a lot of the pros for a NPO/clr liquid diet given cesarean rates at those facilities. Then again, the cesarean rate in general in this country is fairly out of control.
  5. nursie_pants

    NPO/clear liquid status during labor - evidenced-based?

    Honestly, I don't work on an L&D floor, but I'm quite sure the NPO/clear liquid orders are *not* evidence-based. It's completely ridiculous. Fancy getting enough energy to push out a baby from only h20, jello, or a Popsicle. I 'm preggo but planning on delivering with a midwife at a facility that, I think, does not require pts to be NPO/clr liquids. Otherwise, guess I'll just be "non-compliant". :)
  6. nursie_pants

    perfect ppe gown

    I work outpt (just started there) and they use cotton snap in front gowns and wear them for 4 shifts (only during hanging/taking down chemo, of course) unless soiled. Thankfully, we're switching to the disposable one-time use gowns. You just never know... When I worked in-pt we had them. I'd use the same gown to hang the chemo as I would to take it down since the tubing was primed with NS. After taking it down, I'd bunch up the gown and dispose of it in the chemo bin.
  7. nursie_pants

    Possibly getting my OCN?

    Yay for looking into the OCN certification! Not to be a downer, but you have to have logged 12 months work experience before you can even register to take the exam... I started my first job in January 2009 so the first time I could have even sat for the OCN exam would have been May 2010. So, just keep that in mind. I'm registering for it now and planning to take it in November (2011). The deadline to register is July 20th, so you can see how they make you sign up well in advance. Plus you have to have so many CEUs as well, which you probably have with orientation, etc. Also, re: chemo certification, the hospital where I used to work (I just switched jobs) said they wanted 12 months work experience before getting chemo certified. I just asked if I could do it at 7 months and got the green light. So, depending on your hospital/working situation, you may have some flexibility. Best of luck!
  8. nursie_pants

    payscales are secrets huh?

    I find the lack of transparency annoying. Just makes doing your due diligence/background research that much more difficult. I had the issue of pay brought up in an HR screening interview - the first of 4 interviews - for a job I just landed. They wanted to know my "salary requirements" in order, I suppose, to weed out folks who expected a higher salary. They loved the way I answered the question, though. I remarked that salary wasn't the top deciding factor for deciding to take/not take a position - that the workplace environment, coworkers, etc mattered a great deal more. I had also looked at salaries for similar positions advertised in the area. I gave the HR person a range, and they gave me the upper end of the range in my contract.
  9. nursie_pants

    Zofran: IV push or Piggy Back?

    I'm not sure how many 50cc bags of NS we'd go through on our floor if we diluted > or = 8mg zofran w/each administration. You can safely push it directly - undiluted or not - over a couple minutes. Just remember the side effects: dizziness being a biggie, so keep that in mind w/pt ambulation, etc.
  10. nursie_pants

    Upcoming oncology opportunity for new grad!!!

    As a new grad, they'll probably ask you pretty general questions, which could include things like: (1) Why do you want to work in nursing and more specifically on an oncology floor? (2) What are your long-term career plans? (3) Tell us about yourself. (4) General questions regarding how you work with others, on teams, etc. (5) Give an example of a time you worked in a stressful situation? -or- How do you deal with conflict in the workplace? (6) How do you organize your work/time? Those are some to get you started. You can also google "nursing interview questions" to find lists that folks have compiled. Good luck! I love working in oncology. :)
  11. nursie_pants

    want to be an oncology nurse

    If you're willing to move, I worked in St. Louis straight out of school for my first nursing job in oncology. In fact, the floor I just left is hiring 10 new grads this June and continues to hire newbies (we're cheap). :) I think the key is willingness to relocate, get that magical 1-2 yrs experience, and then go from there. Good luck!
  12. nursie_pants

    Giving Methotrexate in an OB setting-Nurse safety?

    To dovetail on OCNRN63's response, make sure you also do some teaching with the patient/family about chemo in the pt's bodily fluids for about 72 hours following chemo administration. That means no family member's handling of vomit/urine/etc and the use of condoms as a barrier method. Also, close the toilet lid before flushing x 2. If the patient is staying in an in-patient setting, make sure staff also follows those safety protocols as well (chemo gown/gloves and a sign on the door).
  13. nursie_pants

    No blood transfusion r/t high WBC??

    Sorry, I'm responding not with an answer but to also express my curiosity w/this. Depending on just how low the h/h was, I think I've heard of doctors holding transfusions for pts w/leukocytosis... I'm not sure if the pt is at an increased risk for sepsis, or if an elevated WBC count generally presents a less-than-ideal conditions for a pt to receive/benefit from packed cells. Hopefully someone else here has some answers! :)
  14. nursie_pants

    Treatment for uncontrolled N/V post chemo

    At my last job, docs never ordered phenergan for those side effects you list above. Like other people mentioned, alternating zofran and compazine ATC seems to help folks + ativan PRN. Dex and Emend also seem to work.... I just heard from a pt that Emend was costing her $100/pill w/her prescription. Craziness.
  15. nursie_pants

    What's the worse thing you have seen?

    Hardest thing with my job - wounds aside, since I have a weak stomach - has been seeing patients in their 20s dying of cancer. Gets depressing and wears on you sometimes.