LaRoseRN

Thanks for your response, jrtaylor4, after talking to a number of different folks I've decided CPHON is the best option at this point in my career. I like that it's peds focused and covers Heme/Onc/BMT together. One of our travel RNs pointed out the same thing you did: that other units are usually combined rather than just BMT. If I ever want to move to another hospital or try travel nursing CPHON would be the most useful. Thanks again for your thoughts, I really appreciate the feedback!

We draw labs on the kiddos w/ CVC or PICC lines. Phlebotomists usually draw on kids w/ IVs. We also have an IV team for difficult pokes.

Hi There! I posted this the Oncology section but also thought I'd post here: I work on a pediatric BMT unit and am looking at testing for one of the specialty certifications: either CPON (Certified Pediatric Oncology Nurse) or BMTCN (Bone Marrow Transplant Certified Nurse) which covers both adults & peds. Any advice which might be better? I had a manager say CPON would be more useful if I ever wanted to work at another hospital and it's more focused on Peds. She also noted it's the professional standard for nurses working in the pediatric oncology specialty. A RN colleague of mine who holds both certifications thinks I should do BMTCN since "you're a BMT nurse...that's what you do." Another RN colleague said it really doesn't matter which certification I site for. Just holding a specialty certification shows professional growth & specialization either way. Thoughts on this? Thanks for you insight!

...also if you run a search, there are a couple threads on here outlining lots of tips about what to study in preparation for BMT work. Check them out, they're full of useful information!

Congratulations! Pediatric BMT is where I started straight out of nursing school & I love it. I was so terrified, but the nurses I work with are an incredible bunch mixing extremely intricate, specialized knowledge with deep compassion and commitment. It's definitely a steep learning curve, but it's also very team oriented. Ask questions, soak up everything you can, and be gentle with yourself. It's hard work but so very rewarding :)

Thank you!! I really enjoy my job, my patients, and my coworkers/managers too -- I'm a second career RN, and often tell my preceptees that going into nursing was one of the best (and hardest) decisions I ever made. I had to move far from home to secure my first job out of nursing school, but it was an amazing opportunity on a fantastic unit. Now my friends and family ask when I'm moving back, and I don't know if I want to give up such a great work environment : ) Again, thanks for putting it out there that nursing can be deeply rewarding despite the challenges.

When I first graduated and landed my job in peds oncology, one of my male nurse friends who worked in the ER told me, "I could never do that. The only reason you can do it is because you don't have kids yet. Once you have kids, you'll understand." Seriously?!? Not having children makes me more desensitized or something?!? What about my coworkers who already have children or are pregnant? People make the weirdest comments sometimes...

Some places ask for this, others don't consider it experience -- there are a few threads on this. I'd suggest a separate page, include the hours of that rotation (this was requested at some major teaching hospitals I applied to) and focus on skills -- discharge planning, eh... What hands on skills did you do? IV starts? Managing complicated lines or high acuity patients with vents, trachs --- what skills do you think you shine at in school ... Psychosocial support? Geriatric populations? Delirious patients --- this is a good place to highlight both experience in the context of skills and strengths in your practice so far. Don't be afraid to point out areas that need improvement during interviews and an interest in learning those skills too... Good luck!

Hey there! Huge Congrats! I did my senior practicum in BMT too & LOVED it. It's not for everyone, but it was definitely for me. I remember it being a steep learning curve because, as you mentioned, we really hadn't learned much about BMT during nursing school. Now I work as a Pediatric BMT RN. We usually have no more than two patients, sometimes we share 1.5:1, 1:1 (and in really serious cases 2:1!) but on adult units it can be 3:1, and on mixed BMT/Heme/Onc it might be closer to 4:1 or 5:1 (but I think 5 is too much if blended with a BMT patient!) Here's a taste: Folks get super sick on BMT -- we "condition" them with very high-dose chemotherapy (Imagine the equivalent of 1 years worth of chemo given over 6 days) that ablates the bone marrow, then we infuse them with either donor stem cells (allogeneic) or their own cells (autologous, sometimes called a "rescue") -- then we manage the symptoms of the high dose chemos et al while they grow their new marrow/immune system back. Those who receive cells from a donor source take a lot longer, and require immunosuppressive drugs for life so they don't reject the transplant. It's an incredible process, and very hard on the patients. During my senior practicum, my preceptor told me "we basically bring them to the edge of death and back again..." With no WBC counts, they are prone to infection, their bone marrow is essentially non-existent so they need multiple platelet and blood transfusion (or FFP, Albumin...) until their counts are back up. Antibiotics/Antivirals/Antifungals are the norm. The chemo can be cardiotoxic, hepatotoxic, and can fry the kidneys, so knowing those systems are important. Knowing all the systems is important...and signs those symptoms are shutting down. Managing, pain, fevers, nausea (look up antiemetics), fatigue, mucositis, GI issues/weight loss, emotional support, the process of being in isolation for weeks to months..."those walls can close in fast" Review general heme/onc w/ a focus on blood diseases (leukemias, sickle cell). We also transplant SCIDS babies (born without immune systems to start) and some others...what you'll see really depends on the hospital. Review the process for transfusing blood products (probably won't be able to touch blood or chemos while your precepting, but you'll see plenty) also managing transfusion reactions. Know your antibiotics, antivirals, antifungals. Research working with severely neutropenic populations & practicing impeccable hygiene/precautions. Learn about mucositis, pain interventions, all pain narcotics. You'll learn a of critical care. We are categorized as an ICU but we don't do vents. Review signs of sepsis, infection, signs of bleeding problems (read up on hemophilia), topical skin lotions (some of the chemos burn/irritate the skin and it can peel right off), incredible wound care, working with CVCs & Ports. I remember being intimidated by the amount of lines to manage. We frequently have kids on PN + Lipids + Heparin + Dilaudid or Morphine PCA, sometimes lasix or insulin drips...then add on their antibiotics, or blood products, and various IV meds -- and you have to double and triple check what's IV compatible with what...that can be quite a juggle! But you do get used to it. While you are there, you will have great opportunity to practice your head-to-toe assessment and monitoring vitals signs. I'm sure you've heard throughout nursing school how important these two skills are. On BMT these two skills are SOOO important. Sometimes the slightest change in your baseline assessment can indicate a serious change in condition and these patients can crunk out fast. We've had kids who were up talking & playing and within 30 minutes were going septic! There's an art to getting reliable temps and BPs on our patients. Even changes in weights or abdominal girth can indicate big issues. Look up Veno-oclusive disease & hemorrhagic cystitis. Some of what I love about BMT is there is a big emphasis on "team nursing" -- so much of what we do has to be double checked by other RNs at the bedside (Chemos/Blood Products/Drip Changes/Narcotic PCAs) so everyone works together a lot. You also work with patients for such an extended period of time that you really get to know them well. I love the psycho-social support aspect, personally, and with the kiddos we do so much to keep things fun and interesting and developmentally appropriate. I love the critical care aspect also (nerd alert!) and really do a lot of review and education regularly. I also like that most of our patients can still talk and interact (no vents!) and most of them have central lines so we aren't doing a lot of poking (alas, I have zero IV skills working on BMT). I also like that there is so much teaching involved. You really have to enjoy developing relationships with people and being creative in educating them about their "new normal" post-transplant What I don't like about it is sometimes all the interventions in the world don't seem to ease the suffering and I go home some nights feeling like I didn't provide any relief despite throwing my entire orificenal of interventions at them. Sometimes patients really break down psychologically, and if they react to medications they can hallucinate, or they don't make it through treatment...dealing with grief, and the dying process is also important to review -- and therapeutic listening/communication. Losing patients is so, so challenging and you have to learn really good coping and self-care methods to avoid burnout. Remember to take care of yourself. Set healthy emotional boundaries. I find working with this patient population makes me recognize how magical every day is, and to not to take anything in life for granted. I really give thanks on a regular basis, and take full advantage of my days off! That's probably more than enough... At the end of the day, just try to soak up as much as you can! Ask questions, keep a notebook handy, and look up everything. I hope you have an enjoyable experience. It can be incredibly difficult work, but also deeply rewarding. And I forgot the mention: BMT nurses are a super unique kind of wonderful -- often a bit type A, but extremely compassionate and fantastic colleagues. You're going to learn so much! Enjoy the process & good luck!!!

I try to avoid them & wish they were labeled clearly like in Europe so I could make better, informed decisions as a consumer. At least let me choose -- GMO plants are NOT the same as hybrid plants, and trying to sell them as such is a big ol' lie. If other people want to eat them, go right ahead.

Susan Cain is also the author of a wonderful book on introverts aptly titled "Quiet"

I love child life! They offer so many wonderful, creative services!! So glad we have them as part of our team at work.

Hi there! I am compiling a list of gift ideas/toys that are particularly good for sick kids - both in the hospital and at home. Aside from the normal things like puzzles, and art supplies, what clever or popular items have you seen at the bedside that help kids get through their treatment? One of my parents recently brought in a bunch of those removable plastic wall decals and completely decorated his daughter's room. It looked amazing! I've also had a lot of moms rave about these little ice-bears that you keep in the freezer. Not sure who makes them. Queesy-pops & queesy-drops have been great for our chemo-kids during treatment. What else??

I wasn't planning on working Peds either! Of course, life had a different idea. I had a background in education working with children before nursing school and the idea of working with sick children just felt scary and too emotionally challenging for me...but my first/only job offer after school was in peds onc (I had been targeting oncology from the start) and now I am so happy I am working in this specialty. I realized all my fears were really because I love kids so much and didn't want to be around them suffering, but I've come around significantly and have learned so many ways to help them. Very, very fulfilling. I am even interested in working peds palliative care/hospice someday. What a switch! The girl in my class who was certain she wanted to be in peds now works on an adult tele unit. You never know...

I second that. I do think my class was very unique, we were small, and the competition to get accepted to the program was SUPER fierce (state school tuition pulls a lot of apps!) so our group had a lot of fascinating life experiences/background coming in. I only got called for ONE interview and that was all I needed. Once I had that face-to-face opportunity I took it for all it was worth and landed the job. I believe many of my classmates were in similar situations: they lept at whatever chances presented and excelled from there. The exceptions were the few who had been working as CNA's already. They had jobs lined up at their hospitals before graduation. So probably a large part of our hiring stats were due to the type of student population my program recruited and that we were able to maneuver competitively in this rough job market for a variety of reasons. No one really makes a big deal of my having a MSN as a bedside RN and neither do I. At my hospital everything is so seniority based that it really seems to all come down to how many years you've worked on the unit..not what letters come after your name...but you do get little pay differentials for said letters. Right now I am learning all I can and trying my best to grow professionally as a competent RN. I do hope to put my MSN to good use later in my career and felt it was the best path for my situation (low cost, quicker completion, no 2-year wait list like w/ the ADN program, able to qualify for federal aid for grad school) So, yes, your best bet is probably: ~lowest cost ~BSN ~work in the field as a CNA ~network like crazy But there may be other life circumstances for you to consider that will skew those around. Good luck!!

PS: I definitely agree that working as a CNA is probably one of the best ways to get an edge as a new grad!

I completed a generalist (not NP, or specialty based) direct-entry MSN at a cal state school. No previous healthcare experience other than volunteering. Myself and my classmates all had jobs within a year of graduating. None of us had to relocate out of CA, although some did move South and North of the Bay Area. Fields of entry included peds/onc, public health, er, cardiac step-down, tele, women's health, good ol' med/surg...one classmate went on to get her FNP while working her first year in ER and now works in primary care family practice. We graduated in 2011. Can't say a direct-entry MSN guarantees a job or gives much of an edge, but it certainly didn't seem to be a hindrance to our careers by any means.

Sounds like you know your answer. I wish you the best on CTICU!!!

I'd find out if "part-time with full time hours" means no benefits & factor that in. I have some classmates who were hired "part-time" only to work full time hours w/out medical insurance or a 401k. I personally favor full-time benefited positions over part-time ones. What are the job prospects long-term with the unit? Maybe see if you can speak with recently hired new grad RNs about their experience at the hospital? I don't really know about this mandatory med/surg for a year myth that gets thrown around all the time. Fair compensation, high quality training, and future job security are all critical factors. If this is offered to you and happens to be in a specialty you're interested in, go for it. I started as a new grad on a specialty unit earlier this year - peds bone marrow transplant. I wanted oncology, I had a previous career in child education which looked good on my application and was offered a 5 month paid precepted training + two year full-time benefited contract at a great, supportive hospital. It was my first and only job offer, paying less than other hospitals, & I probably would've taken anything (since I was applying to every type of job under the sun). Just so happened I landed something I was looking for on the first go and I am very pleased with it so far. -- on a side note, night shifts are pretty aweful & I NEVER had any intention of working in peds but now I love it -- New Grads can flourish in any environment with the right support and training. Following what makes you feel inspired and excited in life is always a good idea. If ICU/Critical Care is where your heart is -- especially since you live rent free and can afford a little lower pay -- then I would say go for that one. I also see a lot of positives in the benefits, extra income to pay down loans +a broader nursing practice foundation, from the med/surg offer. It's really nice that you have options! You must be a very competitive candidate. Let us know how it goes! : )

"Always laugh when you can. It is cheap medicine." - Lord Byron

I found my job off Facebook -- there was a group page that had started for new grad RNs looking for jobs in my state. Everyone would post updates about new grad positions they had found, or when a particular residency program application was going to open. They'd also post useful interview and resume tips. I never would've found the application for my residency program on my own & it was only open for three days! But I saw a post on FB and that's how I knew they were hiring new grads. That FB page was truly useful. It was also really great to hear updates from a community of people all in the same place as me -- newly graduated and struggling to even get a call back for an interview. So, while you might not need it, there are some useful elements to social networks. I've never used FB for networking purposes outright -- I make a point of not having a lot of coworkers and bosses as "friends," nor do I ever contact people I haven't met in person first.

I am in my early 30's and my first year of practice. Definitely doable!! Only thing I grapple with a little is postponing starting a family while I am building my foundational nursing skills and expertise at the bedside. But I guess I'd need a husband first for that anyways ; ) There were many second career students my age and older. Go for it if that's what you want. Good luck!!

Thanks! I actually really love my job and feel very blessed to work where I do...it just amazes me that even during those crazy shifts, when you think you're doing nothing right, there is still room for appreciation -- when you least expect it. It does make such a difference!!!

...one of those running around all night, kid's spiking, need STAT cultures, and blood products to pump up BP's that are bottoming out but there's no type & screen yet and parents are annoyed that there's a BP cuff going off Q15mins, and there are pumps beeping...everywhere...always...and you can't tell where it's coming from but it doesn't matter 'cause you're still just running around trying to take care of everything... ...the MD is irate that you didn't call sooner...because you forgot your darn polycom phone at the station...and this kid is on total isolation so you're not leaving the room to go get it...and respiratory therapy just called because "did you notice there's no order for blow by oxygen?" ...nothing like finding out the day shift RN taking your sickest patient has called in sick at the last minute (and no one bothered to tell you until change of shift) and they don't have coverage until 9am... ...and you're giving report late, getting out late, driving home with tears in your eyes feeling like a terrible RN and hoping you did enough and cared enough and trying to remember what you forgot to chart... And the next night, when you come back, your manager says: "You know, that family REALLY, really liked you!"

Hey Fireball! Looking forward to seeing how you progress towards your dreams!! I developed an interest in palliative care/hospice during school -- shadowed a hospice RN during CNA training, then in nursing school did a rotation in a free-standing pediatric palliative care/hospice facility that was incredibly moving. I did go to work at the bedside as advised, and have been working pediatric oncology/BMT for about 9 months. It's a really amazing unit and I am learning a ton! I am also learning a lot about the discomfort around hospice/palliative care in the medical setting especially when working with critically ill kiddos. I hope I can do some work to improve our culture of comfort and openness to these difficult transitions. We have an INCREDIBLE palliative care team in house, but they can only be ordered to consult by the patient's physician & they are very underutilized on my unit. At my one year review, I am hoping to present to my managers an interest in ELNEC training to bring back to the unit...we'll see! In the meantime I discovered a cool non-profit organization near my work that trains volunteers (licensed massage therapists & healthcare professionals) to offer compassionate touch services to hospice patients in my area. I see this as an opportunity to see the workings of various hospice organizations, network, and get a better feel for the patient populations/work. Like you, I am really drawn to this field. I also believe your time at the bedside will be invaluable to you -- it can really only improve your foundation for wherever you end up. Not to mention, there are lots of opportunities to bring the spirit of palliative care/hospice to the bedside as well. Best wishes to you on your journey :)