SCARED of being a nurse - hazardous drugs

OCNRN63, RN · Feb 12, 2012

I'm not going to give you a list. What I am going to do is tell you that if you are so pre-occupied with your own well-being that you can't get past it to focus on your patients, you probably shouldn't be in nursing at all. What about all of the diseases out there you could be exposed to as a nurse? It doesn't just stop with drugs.

I think your fears are out of control, and not realistic. Take that for what it's worth from someone who hangs chemo all day.

Rick68fl · Feb 12, 2012

I'm not going to give you a list. What I am going to do is tell you that if you are so pre-occupied with your own well-being that you can't get past it to focus on your patients, you probably shouldn't be in nursing at all. What about all of the diseases out there you could be exposed to as a nurse? It doesn't just stop with drugs.
I think your fears are out of control, and not realistic. Take that for what it's worth from someone who hangs chemo all day.

Plus 100!

Time to get out of nursing school before you waste any more time & money. :uhoh21:

rn/writer, RN · Feb 12, 2012

You can make yourself crazy with worry if you focus exclusively on this one aspect of nursing and obsess about it to the exclusion of everything else.

Obsessive thinking is very often displaced anxiety about something else. Agitation and fear from some other area find a way to come out without exposing the real issue. You could be experiencing fears that have to do with self-image, past issues, death, intimacy, etc., that have attached themselves to something that sounds reasonable on the surface but becomes suspect because the reaction is out of proportion to the actual risk.

You have to decide if you want to be a nurse or not. You will always find some level of danger no matter what kind of unit you decided to work on. Certainly, some pose more risk than others, but nothing is completely safe. Driving to work is a hazard all its own.

If you choose nursing, I would strongly encourage you to seek counseling to find out, a) if the cancer/chemo drugs are really the basis of your anxiety or if something else is hiding behind those thoughts, and, b) how to manage your symptoms and learn to replace the fearful thoughts with truth, knowledge, and a sense of balance.

Even if you don't stay with nursing, this is no way to live.

I wish you the best.

montecarlo64, ASN, BSN, LPN · Feb 12, 2012

As a nurse, you most likely will NOT be mixing the chemo meds..Just administering them. You can wear gloves & some medications actually say 'do not touch'...I DO wear gloves when administering certain IV medications, applying medications such as nitro patch, fenatnyl patch, exelon patch and many po meds such as methatrexate, proscar, megace, etc...As you become more comfortable with medications in general, your phobia should get better. If you are young enough and are academically strong, maybe you should consider being a pediatric nurse practitioner. Good Luck!!

Wrench Party · Feb 12, 2012

We also have nurses in the US that work in health and wellness. They do wellness visits in doctor's offices, work for public health depts. giving vaccines and basic primary care, and work in holistic/integrative medicine centers promoting alternative and complementary therapies alongside more standard Western practices. I'm sure there are more things they do, but that's all I can think of before my Sunday brunch coffee has kicked in.

And, I do not think OSHA is going to intentionally expose any of us, students or practicing nurses, to hazardous or toxic drugs. If you follow standard precautions and use PPE, and use your common sense with handling toxic substances according to their MSDS sheets, you should have minimal exposure to everything. Same goes for microoorganisms, parasites and other creepy crawlies.

nurseprnRN, BSN, RN · Feb 12, 2012

if you ride public transportation, catch a whiff of a cigarette on the street, drink or eat anything that comes in a plastic-lined can, wear clothes with sizing on the material, chew the end of your bic, use tampons, chew gum, drink water out of plastic bottles, or breathe the dang air, you are exposed to carcinogens all day long. and you know what? so is everybody else. well, the guys don't worry about the tampons.

now, why do you think everybody else isn't hunkered down inside in the cellar in a hazmat suit from cabela's or running around in circles decompensating over this? umm, could it be because they aren't completely delusional about the relative risks involved?

yeah, it really is pretty funny. you are allowed to crack a smile now.

i agree with the others. you are worried about something else entirely and this completely out-of-control notion about chemo exposures at work seems to have hitch-hiked onto it. you owe it to yourself to figure this one out with the help of a professional. so... we're done here?

KelRN215, BSN, RN · Feb 12, 2012

I was going to reply to this thread but everyone else seems to have said everything I would have said. OP, you need to address your anxiety.

Saija · Feb 13, 2012

Thanks everyone for your replies. I feel like what bothers me is that no one handles these drugs any differently than any other drug - no one even told me that they were hazardous drugs and no one used the extra PPE that I thought NIOSH recommended for hazardous drugs (double gloving, a plastic apron/coat, in some cases eye protection, etc. while handling the drugs and/or patient's bodily fluids). At least that was how I understood what I read on their website, that because there are so many new drugs coming out all the time, they don't have specific recommendations for specific drugs, rather they recommend that standard extra PPE for every HD. Feel free to correct me if I'm wrong. I just feel like I want to know if my patient is getting a hazardous drug (and obviously it's not realistic that I could memorize every HD and all the different brand names, so I feel like my work place is responsible for telling us, especially because if I work there in the summer I'll be more of a helper and I won't see the packaging of the drugs the patients are getting to read for myself), and then I want to follow the NIOSH recommendations for handling it and know that my coworkers are too to minimize the risk. I guess I just feel like - if we know it's a hazardous drug, why wouldn't we wear extra protection? But then no one seems to pay attention or know, which is why it makes me feel nervous - how can I follow precautions set by NIOSH if I don't even realize the patient is taking a hazardous drug that excretes into feces, urine, vomit, etc.? Would it really be so unreasonable to talk to my employer about making these things known so that proper PPE can be worn?

As far as anxiety goes, well.. this is kind of personal, but I guess I'm surrounded by nurses, so.. I actually just came off birth control pills the other day for this exact reason, mainly because of my fears about the chemotherapy drugs, or rather that's what pushed me over the edge and made me decide that I need to choose my mental health first over the bc pills. Because as much as I feel like this is a real concern, I also can tell how it's a little irrational to freak out over such a small amount of time in the oncology ward, and once I left there, now I've found other drugs to focus my fears on. Very often on the pills I have felt like my thoughts fluctuate with my emotions instead of the other way around, and that's not normal. This isn't the first time that I've felt bad about something silly on the pills, it's just the first time I've ever felt so bad about something so scary and irreversible, and it's made me decide that I don't want any extra, synthetic hormones in my body anymore because I'm tired of feeling bad all the time and wondering when my feelings are my own or the pills. Hoping that once my own, natural hormones get time to regulate themselves again that I'll feel better about this, too. I'll never know until I try. At the moment I feel like I keep going back and forth from feeling like this hazardous drug thing is no big deal to feeling like, oh my gosh, what have I done to myself?! X)

And I really hope that no one assumes that just because I'm concerned about following safe work practices to keep myself and my coworkers safe, that that somehow means automatically that I don't care about the safety and wellbeing of my patients. I have been so excited to become a nurse up until now, and even while I was at the cancer ward stressing every day about possible exposure, I was actually considering asking for a summer job there because I liked it so much otherwise and I enjoyed talking to the patients and answering their questions, etc. Caring about myself and my own health does not take away from my ability to care about the patients. Obviously if this fear is not something I can get over, that would make me a bad nurse, but the fact that I want to be safe while at work does not make me unfit to be a nurse. In fact, I think being particular about safety and doing my own research should make me better at keeping my patients safe, too, as long as I don't overdo it. And yes, I know I want to be a nurse because I can't imagine myself doing anything else, though I might consider preventative care over hospital care if it would make me feel safer. The truth is, though, I applied to nursing school because I wanted to be a NICU or pediatric nurse, and I always thought that I want to work with the sickest kids, because that would be the most rewarding.

NCRNMDM, ASN, RN · Feb 13, 2012

I do not want to deny your fears, or say that you are being irrational, but you really need to step back and look at what you are afraid of. You were in that oncology ward for two weeks (I would guess one twelve hour shift a week, but I don't want to make any assumptions), and you were in the pharmacy for 45 minutes. You did not directly administer any chemotherapeutic drugs, and you simply shadowed nurses in the unit. There are nurses who work oncology for their entire career, and they never have any problems. As far as I'm concerned, the risk is so small that it isn't even a concern.

I am interested in being a full time surgical/trauma ICU or burn ICU nurse, but I want to do oncology nursing part time. I would be thrilled to get a six week rotation through a dedicated oncology unit, and I feel that you don't appreciate the opportunity as you should. You had an amazing opportunity to learn new drugs, new procedures, and new ways to communicate with patients. You had the chance to encounter people at some of their worst moments, and you got to learn from experienced nurses. I feel like your fear is holding you back from realizing how lucky you are, and that is really sad. I'm not even sure that you learned all that much because you were so afraid for the entire rotation. I don't understand why you didn't just ask one of the oncology nurses what the risk of the drugs and unit was. I'm sure that one of them could have allayed your fears in a short period of time.

I also feel that your fear, like someone else mentioned, will hold you back from providing the level of patient care that you should, and that simply isn't acceptable.

As a related aside, there are hazards no matter what unit you work in. You have to deal with HIV/AIDS, MRSA, VRE, TB, influenza, pneumonia, Hepatitis, hazards from toxic medications, possible injuries to your back and body, RSV, etc, etc. The list is exhaustive, and it really goes on and on. You can't let your fear consume you, and it sounds like it's doing a pretty good job of that right now.

I think you need some professional evaluation to try and sort out what the deeper cause of this issue is. This may be the catalyst, but it sounds like there is an underlying problem buried somewhere inside. Until you get these issues sorted out, I'm not sure that you're fit to continue pursuing nursing, and I know that you aren't fit to provide direct patient care. Good luck!

Saija · Feb 13, 2012

I was in the oncology ward for 5 8-hour shifts a week for 2 weeks. And yes, I know it's irrational to obsess over getting cancer due to that minimal exposure. It still helps to hear it from others, even if you all think I'm a little crazy now. xD Like I said, it's what made me decide to get off of hormonal bc, because I'm fairly certain that they are either the cause of this or they just made a rational fear seem about a million times worse in my mind. Though I wonder if things work a little differently here, because the oncology ward was just one of many places we could freely choose to go, and there were extra spots left over even after my class had chosen in case anyone else wanted to go there. Not to say I took the opportunity for granted, but the whole reason that I decided to leave was because I felt that my fears were getting in the way of my learning. My teacher was actually really understanding about it and told me I should switch if that's how I feel.

And for the record, my fears in the oncology ward weren't completely crazy, even if I overreacted. The nurses administering the chemo wore special thick nitrile gloves when prepping the bags - they were supposed to wear protective sleeves and masks as per ward policy, but they didn't. My own mentor there told me that, "We're supposed to wear these, too, but no one here really does." That made me really concerned, because if these nurses weren't watching out for their own safety, how could I be sure they would look out for mine, too? They often didn't wear any gloves also when starting the chemo and when stopping it, touching the chemo bags, etc. Don't get me wrong, I loved the staff there in every other way and have a lot of respect for them, but this worried me. Anyway, I did talk to the nurses there about my concerns and they basically just told me that there's nothing to worry about - they had no policy for using extra PPE when handling bodily fluids from patients who had just received chemo. The only thing they did differently was to separate their bed linens, and they told me that nurses in another hospital had laughed at them for doing even that. They told me they had never even heard that you would need to double glove or wear special gloves, an apron, or anything else when dealing with a chemo patient's urine or anything like that.

My mentor asked the head nurse to talk to me about it and when I talked to her, I showed her what I had read in my own school book, as well as multiple other sources, about double gloving or wearing special thick nitrile gloves, etc. and she first told me flat out that my information was wrong and outdated, that there's no risk and no need for any of that because, well, that's the way they've been doing it for the last 20 years so clearly it's working. Then she went and got the ward's own safety manual for chemo and right there in capital letters it said that you need to use thick nitrile gloves when handling bodily fluids of patients who had just gotten chemo. At that point she told me I could wear them if I want. She had also asked the ward's pharmacist to bring up some pharmacy books so that I could get "real" information. When I read the books a bit later, both said that for 2-5 days after chemo, patients' bodily fluids should be handled with nitrile gloves/double gloving, a plastic apron or jacket, possibly a mask or eye protection, and other protection when necessary. I talked to the pharmacist about it and she agreed with the books and even told me she thought the nurses in that ward did not wear enough protection and were putting themselves at risk. I also talked to my teacher about it, and she was so shocked that she mentioned it to another teacher of mine, who happens to be a doctor, who said she couldn't believe the nurses weren't wearing the protection that was in the ward's policy.

I think what freaked me out the most was that not only did the other nurses not seem to even be aware that extra PPE is required when dealing with bodily fluids of recent chemo patients, but that even the head nurse did not know what was written in the ward's own policies, a booklet that had her name down as one of the authors, as well as a couple of specialized doctors. It's probably a big part of why I'm finding it difficult to trust now that other hazardous drugs are being handled properly in other wards. I understand the exposures a nurse would get at work is relatively small, but even a tiny exposure is technically a tiny increase to cancer risk and they is no "safe dose." So I want to do everything I can to make my exposures absolutely minimal. If proper recommended safety protocol was always followed with these drugs (chemo and others), it would go a long way in making me feel better, and not feel like I have to worry about it myself. It should be hospital policy, and instead I feel like it's all on me to do the research and figure out how to protect myself.

So yes, I am aware that my feelings are an overreaction, but I don't feel like they are completely without merit. I guess it made me feel like I can't trust my safety to other people or just trust that things are automatically handled properly. I don't blame the other nurses, either, because it's the employer's responsibility to make them aware of the risks, how to minimize them, and to provide them with proper protection. But it doesn't seem like that is being done everywhere, and I suppose that has left me feeling somewhat paranoid. Even on these forums I've read people saying they work somewhere where nurses mix chemo drugs without wearing even gloves, and without a safety cabinet. It's things like that that have left me wary, even if, again, I'm being overly wary and paranoid.

Or am I really totally off base and shouldn't worry at all?

Actually, I feel a lot better having gotten this off of my chest and discussed it with others who understand the risks and can relate to the situation. I do believe I need to make sure I protect myself, but I also think, as one reply said, that my reaction was out of proportion with the risks. I hope I can keep it in perspective.

JuiceRN · Feb 13, 2012

I think you need to leave nursing, in NICU the last thing you think about it YOURSELF, and you have barely minutes to respond to your patient when tending and nursing these little people. There is ZERO time to self absorb, only time to think about your patient.

I strongly suggest you think about maybe working in a lab.