SCARED of being a nurse - hazardous drugs

Saija · Feb 13, 2012

Are you serious? If a nurse is concerned about her own safety when dealing with drugs listed as hazardous by NIOSH then she is self-absorbed and shouldn't be in nursing at all? I'm sorry, but you don't know enough about me to judge me like that in a split second based on a single post I made as a nursing student who was asking for guidance and reassurance. If I didn't care about the patients I never would have pursued nursing at all. It's really disheartening to hear how many people took my concerns and jumped to the conclusion that I'm going to be a terrible nurse. Maybe this is part of the reason that there is a lack of safety concern for nurses - if it is assumed that the only way to care about patients is to sacrifice taking care of yourself. Most safety protocols involving hazardous drugs are set in place for the safety of the patient, and only recently have people started realizing that those drugs are a hazard to all hospital staff - physicians, nurses, and even housekeeping. I care just as much about the wellbeing and safety of my patients as my own, even more to an extent, but I see no reason to ignore safety protocols and put myself and other staff at risk when I don't have to. I can't understand why safety protocol isn't followed when it's so easy to do.

I am just as particular when it comes to patient safety and making sure that I don't transfer anything from patient to patient or me to patient or object to patient. I speak up when I see that safety protocol put in place for the patient's safety is not being followed too, and I see it a lot. Even when other nurses think I'm being overly careful (like a nurse who was my mentor for a day who put in a urinary catheter with dirty gloves instead of sterile gloves and told me that is unnecessary when I tried to offer her a pair of sterile gloves), I insist on following safety protocol myself. In fact it's a lot easier to speak up for the safety of patients than for my own. Why that is allowed when patient safety is involved but not staff safety, I'm not sure. But I'm a little offended about implications that I'm self-absorbed and unfit to be a nurse just because I am worried about something that has to do with my own health. Your job is supposed to be a source of satisfaction and joy, not something that kills you or causes a decrease in your health. A nurse who ignores safety standards is a bad nurse.

I came asking for advice and support from nurses more experienced and wiser than me, and I appreciate those who gave me advice without feeling the need to jump to conclusions so that they could imply that I'm not worthy or altruistic enough to become a nurse. That's a big judgement to make about my character over one post - why don't you scroll down to my post on this page and read about why I want to be a nurse before you write me off as selfish and unfit: https://allnurses.com/picu-nursing-pediatric/md-vs-np-610821-page2.html#post5802445. Is this the nurses eating their young thing I keep hearing about? A student has a single doubt, a fear, a concern, and instead of getting support and advice, they get smashed down like if you're not perfect 100% of the time while you are still learning, if you ever experience doubt or fear, then you're unworthy? I could understand someone saying, "Hey, if the drugs really freak you out that much and you can't get over your fear, hospital nursing might not be for you." But to say that because I'm nervous about handling these drugs and their by-products, it means I'm too self absorbed to care for my patients? Give me a break here, I'm still learning and I want to be a good nurse and also be safe so I don't take myself away from my family earlier than I have to or bring any nasty bugs or diseases home. I may have blown the risk out of proportion, but it is real and it is irresponsible to ignore safety precautions if they have been proven to lessen exposure.

I have not and will not treat patients any differently because of this. And mostly I've been stressing about this at home, not while I'm at the hospital, where I'm pre-occupied with taking care of patients and it usually keeps me in a good mood.

This is one article I read: http://www.medsurgnursing.net/archives/11apr/79.pdf

Also, although I have probably been more afraid then I should be, I don't understand this resistance to using proper extra PPE as recommended by NIOSH in the replies I've received?? This whole time I keep saying I just want to follow safety recommendations, not that I don't want to be around the drugs at all. I really don't understand why all the negativity just because I brought up the fact that they are not following the recommended safety protocol, not wearing proper PPE for the situation, etc.? Isn't that a no-brainer? Why is it so bad that I want to wear the PPE that NIOSH says I should? The same way I wear a seatbelt in the car and drive a car with airbags and antilock brakes to minimize my risk and wear PPE when taking care of MRSA or Clostridium patients.

OCNRN63, RN · Feb 13, 2012

There's a difference in being concerned for one's safety and being so terrified of the medications possibly harming you that you are driven to distraction. You come across as more the latter rather than the former.

Just because the nurses aren't following the guidelines doesn't mean you can't. Step up and don the appropriate PPE yourself. You are responsible for your practice, even as a student.

I didn't see any negativity here. You asked if you were being overly sensitive to this issue and a few people responded that you were. Some suggested if you were so anxious about handling potentially toxic meds/bio-hazards, then nursing might not be for you. Maybe you are unaware how you come across, but the way you sound, you would seriously add to my anxiety if I were a patient and you were my nurse.

I handle cytotoxic drugs every day in my job. I know what I'm talking about when it comes to appropriate level of concern.

loriangel14, RN · Feb 13, 2012

Being a nurse you have to put your patient first.You don't seem to able to focus on anyone but yourself.

MusicEMT · Feb 13, 2012

you have the realize in the end your dealing with medications which are meant to heal (in a pradoxial way).. if they were deadly toxic than that would kill (no pun intended) the point, wouldn't it? While Chemo-therapy drugs are way more harsher than other drugs, they are still meant to heal.

As long as you don't drink/eat or rub the chemo medication all over your body you should be fine..

Your not dealing with Arms Grade Uranium or any other stronger HASMAT..

you have to realize that as healthcare providers we are going to be constantly exposed to carcinogens and pathogens and other things, as long as you use common sense you should be fine. but that does not mean, freak out because you think you breathed in a few molecules of chemo medication/C-diff/MRSA from across the room..

also you have to realize that being overly cautious and freaking out about everything can be a huge damper on efficiency and make things come to a crawl.. and in the world of nursing everything has to be done NOW! and efficient as possible.. essentially if you risk efficiency you will risk your job..

while i applaud your cautious approach to things, you will get chewed and spit out in a rapid paced environment if you fret about every little detail.. Sure protocols/rules are supposed to be followed, but if there is a better way then do it (without causing harm to anyone)! sometimes rules/regulations are based on archaic/outdated information

and one more thing, you shouldn't fret that other nurses arnt wearing their gloves or PPE.. if they feel comfortable doing their thing with out gloves or whatnot then let them.. just like if a rock climber is confident enough to climb a rock without any safety harnesses, let them!

Saija · Feb 13, 2012

OCNRN63, yours was not a comment that offended me, nor were most of the others. I agree that if it's a fear I cannot overcome then hospital nursing is clearly not for me, that is what I said in my post afterall. Though the assumption that I need to get out of nursing now because obviously I can never get past this fear that I've had for only a couple of weeks in 2 years of nursing school is a bit less than encouraging. MusicEMT, thanks for the advice.

The real problem here is not so much that others are not using the PPE, it's that I was not made aware by anyone that this patient was taking a hazardous drug, so I didn't realize I should have worn PPE. I had read the patient's papers, but obviously I don't recognize all of the drugs on the list yet, and apparently the paper that said he was a kidney transplant patient was really far back in the records, or maybe I just didn't look closely enough at the history, although at that time I didn't even know that many immunosuppressives are even hazardous, so I didn't know to look at that. I'm a student, and I expected that my mentor would tell me if extra PPE is required. And I guess I sort of assumed that if hazardous drugs are being used, that they would mark it on the patient's papers somewhere obvious or even put red tape on their bed or something to let everyone know (the same way they put a sign on the door when it's an isolation room for MRSA or something). And if I do go to work there in the summer, I'll be more like a "nurse's aid" and won't be handling drugs at all, and I'm not sure if I'll be given the time I need reading about the patients every day to check for these things. That is what worries me - how can I wear the proper PPE if I don't even know the patient is getting a hazardous drug?

Loriangel14 - What if I told you that we had patients with MRSA or Clostridium Difficle and no one told me and no one used any extra PPE or washed their hands after leaving the room and moving on to the next patient? This is no different except for the fact that the risk is probably smaller.

I get it, I was freaking out about a very small risk. But the risk is real (however small) and every nurse and worker has a right to protect themselves. I DO put the patient first when I am at work. I AM willing to take risks in order to be a nurse, but I don't see a reason to take extra risks for no reason and no benefit to the patient. I can put the patient first while wearing extra PPE as recommended by NIOSH. You wouldn't go into a room with Clostridium without extra PPE, would you (with the exception of a real emergency, of course, in which case I would go in without it if I needed to)? How in the world can you call it selfish to protect yourself while you are at work? I really don't understand that attitude at all.

I just feel bad now that my concerns over safety are met with that kind of comment. OCNRN63, I understand that I was being overly sensitive and actually that is what I wanted to hear, because it made me feel better and helped me put the risks into perspective. It was some other comments that have made me feel unwelcome and discouraged. I was looking for reassurance that I needn't worry, for tips on keeping myself safer so that I don't have to worry, etc. I wasn't looking for people to tell me I'm doomed and to give up. X) Am I really the only nurse/student who has ever been scared of something in nursing?

ChristinP · Feb 13, 2012

intrusive thoughts combined with an ocd? obessive scary thinking?

we, the human race are exposed to numerous carcinogens on a daily basis.

there is no safe nursing unless you sit behind a desk all day and never see a patient.

honey, please get yourself some help.

badmamajama · Feb 13, 2012

I hate to hear that this has caused you so much anxiety. I think you have good reason to be concerned and I applaud your efforts to look into policies and safety guidelines. I don't have to beat a dead horse by saying you may be overly concerned, of which you have said you are aware. I honestly don't blame you or think you are going to be a bad nurse. I agree with the Guide who said this may a manifestation of some underlying issue. You are still a student, so you have a million reasons right there to be a nervous wreck. We've all been there, we should all understand. I remember every having it drilled into my head that any mistake can kill a patient, or cost you your license, or at the very least get you fired. Every day I had to remind myself that if others can do it, so could I. But I digress... Think long and hard about all the things that may be causing you anxiety. I don't just mean school stuff, the other parts of life, too. Who can you talk to that you can trust not to be judgemental? Talk to them about exactly what you shared with us, and get some positive affirmation from them. By the way, AN should be a safe place for us to confide our fears. I'm sorry you feel you were attacked and told you are self-absorbed. I didn't find you to be self-absorbed, just overwhelmed by a fear. Channel that concern you have for safety into positive outlets. Maybe you have a good future in an Infection Control department! :nurse:

Since you brought up hormones and the pill, maybe that wasn't such a bad idea. Hormones can do crazy things to your brain, especially when you are stressed out and vulnerable. Talk to your doctor about this. Talk to someone who doesn't want to just hand you a script for Cymbalta to make it all go away!

Good luck to you! I think you will make a great nurse! Btw how much longer do you have?

:hug:

KelRN215, BSN, RN · Feb 13, 2012

What if I told you that we had patients with MRSA or Clostridium Difficle and no one told me and no one used any extra PPE or washed their hands after leaving the room and moving on to the next patient? This is no different except for the fact that the risk is probably smaller.

It is actually a lot different. The purpose of contact precautions is to prevent the spread highly contagious pathogens MRSA, VRE, C-Diff etc. to other patients. The purpose of using PPE with chemotherapy doesn't have anything to do with other patients. In fact, chemo patients very frequently share rooms with other non-chemo patients and they vomit and urinate and defecate and since they're often on strict I&O, their bodily fluids even remain in the shared bathroom for several minutes. We do use nitrile gloves when giving chemo and when dealing with bodily fluids as well as have special bin to dispose of anything chemo-related and use these [stupid] things that are meant to prevent chemo spillage at the end of IV tubing. I have never had an issue with chemo exposure nor is it something I really worry about.

NCRNMDM, ASN, RN · 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.

I understand that you are upset that no one informed you that you should have used PPE in the oncology unit, but it's over and done with now. My main question is this: after you found out all this information about the drugs, needing extra PPE to handle body fluids, etc, why didn't you just don that PPE to enter rooms regardless of what the nurses did?

I don't think that the minimal exposure you received during your time on this unit will amount to anything, and, frankly, there are tons of things that increase your risk of cancer. Have you ever been sunburned? If so, your cancer risk has gone up. Have you ever used a tanning bed, or laid out in the sun to tan? If so, your cancer risk has gone up. Have you ever smoked, or been around those who do? If so, your cancer risk has gone up. Do you have a history of cancer in your family? If so, your cancer risk has gone up. What I'm trying to say is that there are things we encounter everyday that increase our risk more than what you did for two weeks on that unit.

I think you need to get your fears under control, but I am not saying that you should totally leave nursing right this minute. As a nurse, and a student, you can choose to wear extra PPE and go the extra mile. You may be laughed at, or viewed as odd, but if it helps you sleep at night, then do it. The worst thing you can do in donning inappropriate or unnecessary PPE is waste a few minutes out of your day.

montecarlo64, ASN, BSN, LPN · Feb 14, 2012

I agree with mattrnstudent...I have been a nurse for a very long time & I use whatever PPE I feel that I need regardless of what anybody else says...I double glove @ times..I wear goggles @ times..I really could care less what anybody else thinks..It is your body and you should protect yourself, as well as your patients, as much as you feel is necessary..And yes, we are all at risk for cancer and come in contact with carcinogens every day..We just need to live as healthy as possible. Cancer is not the only thing that nurses come in contact with that can be dangerous. We handle sharp objects, violent patients (and families), infectious diseases; however, it is my strong opinion that if we do our part in protecting ourselves and others, the good Lord above does give us a little extra protection:) Good Luck:)

Pepper The Cat, BSN, RN · Feb 14, 2012

I'm a little bit confused.

Chemotherapy drugs are given to treat Cancer - why would you think you would get Cancer from being exposed to them?

Isn't that a little like saying you'll get an infection from antibiotics?

nurseprnRN, BSN, RN · Feb 14, 2012

ummm, no, not exactly. many chemotherapeutic agents can themselves have bad side effects including mutagenesis.