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The 4 required discussions are based on your experience. If you have less or no experience, you may say so but will have to share your observation of your own department. The answer to 4 topic questions can also be found in the book. But your answer has to be subjective and it's to test if your organization is following the standard of practice. I agree with littleguccipiggy, stick to the book for the final test questions. The slides are helpful reading materials with links to video and some studies and evidence-based practice, but for the final test, all you need is your book. Make sure you download a copy of the ebook in pdf format. You can search the keyword and help you get to the pages easily. You can take the final test while waiting for the final grade of your 4 discussion questions. Good luck!

Thank you dream'n í ½í¸€

Hello- I've heard some clinics have RNs mixing Chemo. Is this within the Nursing Scope? Is there a website I could go to to support this idea that it's legal for nursing to mix chemo in stand alone clinic in California? Thank you in advance. RNview

Thanks for the confirmation :-)

Does any one here using EMR for Oncology? As an Oncology Nurse, we need a cosignature from a 2nd RN. Now that we have Electronic Records, we kind of use the term esignature. As far as I know, esignature requires a user name and a password. If you just type in the 2nd RNs name, and she doesn't type in her password, then it's not the same as cosigning. Does it make sense? Any input is appreciated. Thank you.

I work in Med/Onc. We have medical patients mostly but not limited to Pneumonia, MI, CHF patients. Then we have oncology patients. Our manager sends new nurses to a chemo certification class after 6 months of hire date. I love where I work. I also started as a new grad in that unit, and I'm still there and very well at home Goodluck!

I work in the inpatient and we also have our own pharmacist. In our OUTPATIENT they check everything at once for EACH patient. One time, when an OUTPATIENT RN floated to our unit, she double checked all the 3 chemo for the same patient all at once with another chemo certified RN. Our CNS questioned them. Our inpatient and outpatient infusion center have the same manager, same CNS and same protocol and it has been like that for years. I think double checking the pump setting is such a great idea for safety. Because one time, we had a case when a chemo was hung and double checked per protocol. It was supposed to run for 24 hours but in 2 hours it was all done... The patient survived, the nurse almost pass out. She was so sure she checked everything but there's no witness. From then on every time we hang chemo, we also lock the pump. And now we are double checking the pump setting too. And I think we are in the process of changing the rules and policy for checking the chemo. The outpatient nurses need to check chemo one at a time now. I don't know how are they going to do it in a very busy and fast paced outpatient clinic. Thank you for sharing.

Thank you guys. I work in the inpatient and usually we check one chemo at a time. When I first started working there, there was no policy whether we check the pump rate too. One time, a nurse from the infusion center worked in our unit and asked another nurse to double check chemo with her. 3 different chemo for one patient were checked per protocol. Then the CNS questioned these 2 RN for doing it and for not checking the rate of the pump. NOTE: the nurse who floated to our unit is from our outpatient cancer center. We have the same manager, the same protocols. It's good to know that some institution checks the pump settings too. I think it is safer that way. Thank you for your responses.

I would love to have 2:1 ratio for First induction of Rituxan. In our unit, we have 5:1 no matter what. This is crazy at times, especially when there's no charge nurse around to help out. It makes me want to cry sometimes. No matter how good I am with time management, things happen and you know the result of that. :redlight:

In our hospital, we check a lot of things before we hang the chemo. It has to be double checked by the 2nd RN who is also chemo certified. original order VS MAR VS Chemo Tag Patients Full Name Patients Medical record/ Account Number MD's Calculations VS Nurse CalculationsQuestions: 1) Do you ever check the pump too? Like how the primary nurse sets up the pump? 2) In the outpatient infusion center and/or hospital setting, do you check all the chemo all at once (for one patient)? Or do you check it one at a time prior to each infusion? I'd appreciate your feedback. I'm just wondering how other institutions do their safety checks on chemo. I've heard some issues at work related to my questions above. Thank you.

I hope you feel better. I know it's not easy to get an ASAP appointment with the PCP. If you don't feel any better, just go in the ER. For the meantime, take care of yourself and get better :icon_hug:

I totally agree with you with every thing you said! I was one of those lucky ones who had only one preceptor and it made a huge difference. One of my friends who started at the same time had 4 different preceptors and she was totally lost. She missed a lot. It was very stressful for her and she left after 8 months.

It is not worth a penny. Precepting is not for everybody. I've been doing it longer than anybody else in our unit. I like doing it, but it wears me out too. Honestly, this past few months, I asked my manager to give me a break until next year. Some of my co-workers think that it's easy until one day I called in sick :chuckle and one of them was assigned to precept the new nurse then they start rolling their eyes . Every time we get new nurses, some of them literally hides in one of the rooms so they won't be assigned to orient the new nurse.

I precept and get paid. There were classes offered before (when I was on vacation). I never took the class, but I'm still precepting and getting paid. For a long time, I was the only one precepting then I get tired and asked my manager to assign somebody else because I'm getting close to blow my fuse. It finally occurred to her that she needs to have a back up preceptor. Now, classes are offered for those who ask for it. Classes or not, we still get paid.

Not a lot of people where I work compliments anybody when I started working there. From the management down to the housekeeping. It was so sad 'coz everybody works hard, and not even a little word of appreciation was said. I decided to show them that it's ok to compliment each other for the job well done. The first person who noticed? Our chaplain. So she and I worked together to recognize everyone who did an excellent job. We write them a letter of appreciation, a copy goes to the manager, then the manager pass it to the admin. then the person's name shows up in the newsletter under the lists of the MVP. The next thing I know, it becomes a norm in our unit. I'm glad it broke the ice. It helps build a good relationship with colleagues and build a good team work! With all the stress we are experiencing at work, it's always helps to hear words of encouragement and appreciation. It doesn't only help for Patient satisfaction, it's certainly good for Nurse Satisfaction too.

Where I work, we always tell them the risk of having it and the advantages of having it. Risk of infection is our main concern and we teach them how to care for it at home. He may shower but he has to cover the PICC line with a plastic bag so it wont get wet. We give them an elastic bandage (I forgot the name of it) to cover the PICC line so it's not hanging like crazy. The dressing needs to be changed once a week in the outpatient clinic and be flushed per protocol. He needs to watch out for any signs of infection (redness, swelling, itching on the site, skin warm to touch) and report this to his MD right away. If they are going to be seen by the Home Health RN at home, we provide them their number. Ask the nurse you are working with about their policy. Every facility has their own policy and protocols to follow. Good luck!

1) Medical Oncology = we take care of Cancer patients as well as Medical patients. All registered nurses on the unit are required to participate in a chemotherapy administration certification course and must maintain ongoing education specifically related to oncology practices. The clinical mentor and the clinical education department develop education opportunities throughout the year. They work closely with the physicians and pharmacy to provide the most recent clinical information possible. 2) Medical Surgical = Mostly post-op and also some medical patients. Although most people associate med/surg nursing with caring for patients in a hospital after illness, injury or surgery, the field actually encompasses nurses who care for adults with acute health conditions, whether in outpatient facilities, hospitals or long-term care facilities. Elements of care may include patient education, pain management, case management, discharge planning and other interventions to restore or maintain patients' physical and psychosocial health. 3) Telemetry (Critical Unit) = Cardiac patients. Care is more high tech and includes treatments that require more intense care and monitoring than those on med/surg units. ''What makes the difference in our telemetry patients is their need for high-frequency monitoring for cardiac changes and interventions often the result of medications not administered on medical/surgical floors''. 4) Trauma (Critical Unit) = Trauma nursing involves responding quickly to a wide variety of single- and multisystem trauma involving different patient needs, ages, cultures, and severity of presenting symptoms. The trauma nurse must respond with decisiveness and clarity to unexpected events by assessing, intervening, and stabilizing patients about whom there is minimal information. 5) Medical Neurology = While we care of all Med-Surg patients, we have a special focus on caring for Stroke Patients.

We have some hospitalist who does that. What we do is we page the house supervisor and she works a miracle! This same hospitalist doesn't even want to hear any suggestions from the nurses. We also have an on-call oncologist. He usually works in a different hospital but from time to time he works on-call for our oncologists on the weekends. We have to page him a hundred times before he calls back. But when he calls back, he'll pass the buck to the other MD. He'd tell us to call Dr. So and So to get an order. For goodness sake! I just need an anti-hypertensive drug order for one of my patient. :angryfireIt happened that the patient doesn't have any other MD. So I paged the house supervisor and she chewed him up. Then the following day (Mon) I told the oncologist he was on-call for, that it took him 4 hours to finally order a BP meds for his patient with an SBP >200. That was the last day I saw him in our hospital

Our manager is very strict about it. She throws away every drink she sees at the nurses station even if it is one of the doctors drink. On the weekends, we all have coffee mugs at the station and nobody throws it away. Then comes the week days and we're back to normal. We learned to keep track what day it is so we don't get into trouble. :smilecoffeecup: Let me clarify it, we use coffee cups with covers (disposable and not) not coffee mugs. ooppss!

I was orienting a new nurse in our floor. We were on the bedside and I was showing her how to use our accucheck machine. I said to her "...then it will ask you for a code. Just like this one (6), so you have to press sex". Another embarrassment on my side. In the break room (as always) my co-workers were teasing me all day. I just said "Hmmmm, maybe I need one."

RN1989 it was very well said, thanks a lot! That helps.

Background: Charge Nurse for years. Just got a new position as a clinical coordinator (aka asst. supervisor). She is now a charge nurse and a clinical coordinator. She is also our supervisors "FAVORITE SUPER NURSE" who cannot do anything wrong. Situation: Today, she's the charge nurse. The floor was so crazy busy. Nurse# 1 was so swamped with all the blood transfusions and having to deal with her 2 patients (sitter case) who are suicidal and schizophrenic, and one of her patient has tons of IV atb to give. Where's the charge nurse? At the station not done auditing the charts (which she has been doing every single day). Didn't even offer her a hand. Nurse#2 was getting all these critical labs all at the same time, again giving blood transfusions and getting tons of telephone orders from the MD for all of her critical labs, and where's the charge nurse? Doing her rounds and checking if our (Will be right back) clock is turned on time (FYI: We do hourly rounds and we turn the "will be right back" clock 1 hour ahead each time we go to the room.) The charge nurse found the clock not ON TIME and finds the RN and CNA of that patient to tell them that the clock is not set right. Nurse# 3 Was so busy with patients going on 3 different procedures all at the same time plus a patient on a wound vac who couldn't wait to go to the bathroom, and with a patient next door who follows her around everytime his IV pump beeps. One patient came back from the HBO clinic and was in a gurney. The daughter was on the bedside with her. The patient was an obese total care lady, and needs 3-4 people to transfer her from gurney to bed. Nurse#3 was looking for the CNA but she was on break. She then went to the front desk hoping to find another nurse to help her. She found the charge nurse in front of the computer at the clerk's desk, so she asked her if she could help her. The charge nurse said "Oh Honey, I cannot go, I'm covering for XXX (the clerk). Nobody is going to answer the phone." The nurse was like "What?" "You cannot help me because the clerk is not there and nobody's gonna answer the phone?" Another nurse ended up helping nurse#3. Question: How would you deal with the charge nurse knowing that if you talk to the supervisor about it, it would be just a waste of time and effort and 98% that it might come back at you. I hate to say this, but we have a screwed management.

We don't use colored arm bands for code status. we have a code status form in the main chart which needs to be addressed by the MD upon admission. This form has a yellow copy in the bottom which goes to the bedside chart once signed. At the beginning of the shift, we look at the code status and write in our report sheet. If MD didn't address the code status right away, we look at the old chart and if the patient is A/O, we clarify it with them and write a note to the MD (there's a note section in the code status form). It is a case to case basis. If the patient is not alert and oriented and has a family, we ask them for advance directives (to find out who's the primary agent), then we ask the primary agent for the code status. If the patient is not A/O and doesn't have a family, we look for conservatorship, then we ask the conservator for the code status. If there's no one available at all and the patient is not A/O, the patient is considered a Full Code.

nursing is a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning. modern definitions of nursing define it as a science and an art that focuses on promoting quality of life as defined by persons and families, throughout their life experiences from birth to care at the end of life. after reading your post about your co-worker, i don't think she could be a safe and effective nurse. she may use you as a reference, but you have to tell them the truth "objectively". honestly, she doesn't deserve to have her nursing license. there's nothing to feel guilty about. everything happens for a reason. she should be responsible for everything she does. not you.

we flush the iv line to prevent it from getting clogged.