Starting on the bone marrow transplant unit - help!

brithoover · Oct 30, 2013

It's a great place to start out but be prepared to learn and fast! It will be a lot of info at the beginning. I'm hoping your hospital will give you a really good orientation. I work peds heme/onc but we work very closely with bmt and float there often. You will be doing lots of transfusions, working with central lines, and lots of emotional support. It's a great place to work! Good luck I'm sure you will be great

DoeRN · Oct 30, 2013

I'm sure you will have an extensive preceptorship. You will learn a LOT that you didn't learn in school. Know your lab values and be well versed on oncological emergencies. But I'm sure it will be quite a while before you are actually hanging chemo and doing a transplant.

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Manal Al Humaid · Nov 1, 2013

Firstly, welcome back

Secondly, don't think about making mistakes because for sure they wont throw you alone with patients, they will prepare very well since it's a sensitive specialized area. My advice, ask, ask , ask never be a shame of asking. It's better to ask than making mistakes.

all the best :)

schmez · Nov 7, 2013

Hello Elisheval!

I know exactly how you feel because I too started out on a BMT unit right out of nursing school. I was panicking in the beginning thinking I was in way over my head but after a couple of weeks, things really start to come together.

My advice would be to really study up on some diseases you might encounter frequently (multiple myeloma, ALL, AML, CML, non Hodgkin's and Hodgkin's, etc). Once you grasp these it's easier to understand what's going on with your pts.

Next I would study up on bone marrow transplants, allos, autos, and cords. be aware that allo and auto transplants can present with different side effects. Allos because there may be a mismatched donor and a hemolytic or autoimmune reaction can occur. Autos usually have reactions to the DMSO which is the preservative mixed with their stem cells. This can cause reactions like SOB, fever, itching, anaphylaxis..

Get familiar with the chemo regimens your hospital administers for each transplant. (Don't stress too much about chemo though because your hospital should train you extensively before you're allowed to handle it). Just know the lingo, like we give pts BEAM+R or Flu/bu/tac/rappa. The first time I ever got report I was sure the nurse was speaking in some secret code.

Know the side effects you may be dealing with- mucositis, Graft vs. host, DAH, diarrhea, infection.

Your patients will likely need frequent electrolyte replacements and blood and platelet replacements- so know your lab values and read up on hospital protocol on how to administer these.

Ok, now that probably seems like a lot, but it all comes together very quickly. Give yourself some slack and remember not only are you learning a very difficult specialty but you're learning how to be a brand new nurse!!!! First and FOREMOST focus how to time manage, deal with lots of line traffic, central line dressings, and pass meds. THEN worry about being a BMT expert.

Good luck and I hope everything goes well! Let me know if you ever have any questions!!!

Certifiable, BSN, RN · Nov 7, 2013

Thank you, this was reassuring.

annacat · Dec 1, 2013

I am finding the above advice reassuring too! I am going to start on a BMT unit as a travel RN. I have 3 years experience giving chemo and blood products (and dealing with side effects) in a very busy outpatient infusion center. I haven't worked oncology in patient but do have experience working in a step down unit in the Neuroscience department.

I had a anxiety dream last night that I went to my first day and didn't know how to use the computer system and got so far behind passing meds that I was reduced to tears.

I am hoping reality is nothing like that dream!

I have found that the Leukemia and lymphoma society is a really good source of information.

Any more suggestions for where to get my info to study up on?

decembergrad2011, BSN, RN · Dec 3, 2013

I work on the overflow unit for BMT and we're basically BMT Jr. We don't get the active transplants but we do have patients on the service. I also float and pick up over there quite a bit.

Learn your BMP and Hemogram with diff very well. You'll be giving lots of blood products and electrolytes. You'll be given lots of support, too. Oncology nurses are a breed of our own, and as long as you're willing to learn and care, supportive coworkers will bring you into the fold and have your back.

LaRoseRN · Dec 4, 2013

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 :)

LaRoseRN · Dec 4, 2013

...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!

Rjschultz801 · Jan 3, 2014

I started on a pediatric oncology unit out of nursing school. It was overwhelming at first and everyday on my way in I was nervous I was going to make a crucial mistake and harm someone but thankfully that never happened and I now LOVE it and actually enjoy going to work. I agree with Manal Al Humaid ask questions whenever you are in unsure or have any doubt. I would ask questions of the people on my pod and when I felt like I had asked them to many questions I would go ask nurses on other pods (I still ask questions every day). On our unit we start out taking pts that are not getting chemo such as count recovery (AML treatment at our HS is about 10 days of really intense chemo and then the pt stays till the get an ANC. These kids can be very stable but turn BMT class.

I now see that your post is from October, how is it going? For me it really did take almost a year for me to feel comfortable and not be scared to go to work.

Certifiable, BSN, RN · May 3, 2014

Thank you all for the great advice.

A little update:

i'm 6 months into working on the BMT unit, and my heart still pounds whenever the charge nurse writes the patient assignments on the whiteboard -gulp!

the problem is, during my month-long orientation, i was so focused on learning all these new nursing skills that all the important info that was bmt focused flew straight over my head, so i'm still playing "catch up"....

I do fine with patients post bmt, managing symptoms and juggling AB regimens, but pre-transplant i really dread- back to back chemo - I never get comfortable with that.

Another problem is the day shift. My hospital works in 8hours shifts so the 7-15 shift is when most of the chemo and bloodwork is done- I HATE that shift! There is a ton of insanely pressurized work, worst pay--- in all i feel like i've been run over by a truck by the end of the shift.

For some weird reason our unit is really low on transplant patients at the moment so our pt:rn ratio is waaaay off. So every so often our nurses are being floated elsewhere (mostly hem/onco)- tonight i was sent to hematology as a float nurse- I was super stressed all night! I almost missed the last bus home!

And did i mention the kids? Our unit usually has 2 kids (5yrs and up) receiving a transplant- i really hate working with kids for a number of reasons, but the main thing is just the medicine safety issue- the doasages are different, less fluids going in- and when they crash- they do it in spectacular fashion.

Oh, and not to mention that the language most spoken is arabic or russian- which i am not fluent in? (Arabic is easier to pick up than Russian though)

I still don't know if this is the specialty i want to work in, at the moment what really keeps me going is the great staff that i work with- 100% willing to help even when they're super busy.