nursie_pants

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!

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

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.

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". :)

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!

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.

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.

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!

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).

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! :)

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.

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.

Oh, we get those gems on our floor as well. :) I had a patient tell me a couple nights ago that I enjoyed waking patients up in the middle of the night. I wanted to roll my eyes. Yup, that's why I became a nurse: to sadistically wake you up as soon as you fall asleep. When we have these kinds of patients - who forgot they were in a hospital, not a health spa - I gently remind them that we are first and foremost concerned with their treatment and keeping them safe. I then also remind them that they have the right to refuse (and I always use the word "refuse") any treatment while they are here. I think it restores a sense of power that is commonly lost w/patients, especially those who have been in the hospital for some time. Usually they'll have a come-to-Jesus moment and either refuse their 0200 vital signs (which I'll thoroughly document) or agree to follow their treatment plan.

Also, not to sound negative or anything but just based on experience I wanted to throw this out there: I know the excitement of wanting to start a family.... and yet getting/maintaining a pregnancy can sometimes unfortunately be harder than it seems. It's such a personal decision and it's so unfortunate that discrimination against women because of pregnancy takes place all the time. Only you can decide the right time to try and start your family... a job is a job. It doesn't define us 100%. :) (thank God, huh?!)

Glad that helps. ? Yes - you'd change the tubing per policy. Our hospital is every 72 hours or whenever you start a new peripheral IV or change caps/reaccess a central line.