Transitioning from inpatient oncology to outpatient oncology infusion

Posted
by Jamoro (New) New Nurse

Hi everyone! Just a disclaimer that this is a post is a mixture of me talking and also asking for advice, all fueled by anxiety. Sorry if anything doesn’t make sense!

I just wanted to get opinions about transitioning from inpatient to outpatient. I currently work on an inpatient BMT/Oncology unit and was recently offered a position at my hospital’s outpatient oncology infusion center. I currently work night shift in my current position, 3 12s. I’ve been there for a little over 3 years now and unfortunately, night shift is starting to take a toll on my health. Our patients typically require a lot of blood products and IV medications and get quite sick. I’ve functioned as the charge RN but at the same time I’m feeling a little lacking in general onc knowledge because I see the same few BMT conditioning regiments (rituxan, antithymocyte globulin, IVIG, thiotepa, fludarabine, BEAM, etc) over and over. I know those extremely well, but rarely see other chemos such as vincristine or really any IV push chemo. Additionally, all patients have a central line for their transplant so I’m very familiar with those, but have probably inserted 3 IVs during my 3 years as a nurse (one for each year, haha).

I’ve been told our infusion center is quite busy, sees about 150-200 patients a day, and requires a lot of IV starts (which worries me). Being an onc infusion center, they also see a wider variety of treatments which is great because I want to expand my onc knowledge. The shifts are 4 10s with rotating Saturdays and no holidays. I have my OCN and am chemo certified, but BMT is so specific that I’m not very knowledgable on drugs other than what I’m constantly dealing with (aka I haven’t used the knowledge so I’ve mostly lost it). So basically, I feel like I appeared qualified to them but it’s all a farce!

Starting a new role is always a stressful and worrisome time and I know I won’t be perfect from the beginning. Im just worried that it’s going to be too fast paced, as everyone says that my hospital’s infusion center is extremely busy (they call it a zoo). I’m also worried that I might be jumping into something that I’m going to hate and am better off remaining in my current role until a day position opens up on our unit.

I just wanted to hear from those of you who have transitioned from inpatient to outpatient: What is the difference in workflow/what is a typical day like, was it a huge adjustment, do you feel like your work-life balance is better or worse, and just any other tips/advice you may have for someone possibly making the transition. Im excited at the opportunity to learn new things (and finally be on a day schedule/not have to work holidays) but also extremely nervous that I’ll struggle due to my lack of IV skills and very specific chemo/biotherapy knowledge. I’m also worried that I’ll be miserable if it’s as horrendously busy as everyone says it is and would be better off waiting on night shift until something “better” comes along.

If anyone actually got this far, thanks for reading!

DavidFR, BSN, MSN, RN

Specializes in Oncology, ID, Hepatology, Occy Health. Has 36 years experience. 465 Posts

I came to oncology very late in my career having never given chemo. You learn with experience. When you don't know you ask. You will be in a better position than somebody coming to the unit with no oncology experience because you've experienced some chemo, and you know the basic principles even if you haven't seen the whole range of products yet.

Isn't it a good idea to get proficient at posing peripheral IV lines wherever you work? You'll soon get the hang of it  and once you're confident it's like riding a bike - you'll  never forget.

Changing work area is always stressful but ultimately good for your career development and all round polyvalence. Wherever we go we face new challenges. You will overcome them.

The key issue for me is that you say nights is affecting your health, in which case I would say get onto day shift as soon as you can.

You can swat up on the chemos you don't know before you start. Can you  express your concern and request a period of preceptorship, which hopefully would be anticipated anyway for a new starter? Even volunteer to go in for a day or two unpaid and shadow a nurse before you start?  

There are ways around your concerns. Good luck!!

Edited by DavidFR

Danielle Reinis, BSN, RN

Specializes in Oncology/ hematology. Has 12 years experience. 1 Post

Hey There!

Your career sounds just like mine! I started with nights on the BMT unit. Then, I transferred to outpatient BMT and then outpatient oncology ( all diagnoses). As much as I loved my night shift family the night shifts were taking their toll on my health. So I switched, just as nervous and freaked out as you might be. But FEAR NOT! Firstly, you are more knowledgeable than you think. The first thing I learned is that if you have worked inpatient with the BMT's a.k.a. the sickest patient population (outside of ICU) on the block, than you are miles ahead of others who have not! TRUST ME. Then there's the new regiments (EEEEKKK). Calm yourself and remember , you will never give a drug without being taught first, remember your patho- phys care plans, look up the regiments. I highly recommend chemocare.com, its run by the Cleveland Clinic and its terrific for easy to understand knowledge of each drug and side effect. You can do this! It's so much nicer not to have to wipe butts all night too, the patients just get up and LEAVE ! Yes it can be busy but usually you will have your schedule at the beginning of the day with 5 - 9 patients depending on what they are receiving. Sometimes, its just labs or hydration or blood transfusion and THAT'S IT! Its a nice change of pace and you get your life back. I wish you luck luck luck. Please reach out if you have any other questions. I have worked 10 years in oncology, right now I am a nurse navigator for hem/ onc outpatient clinic. 5/8's no weekends no holidays. It's nice. 

OncologyCat, BSN, RN

Specializes in Medical Hematology/Oncology/Stem Cell Transplant. Has 5 years experience. 122 Posts

I’ve only been a nurse for 3 years but moving to outpatient nursing is the best decision I’ve ever made career-wise! No nights/holidays (our clinic still opens on the weekends but we take turn doing them so we only need to work 1-2 weekend shifts a quarter; I’m doing 2 consecutive weekend shifts every 4 weeks for the incentive pay program), so my circadian rhythm/work-life balance is much better.

Like you I started in an inpatient BMT unit, so my IV skills were subpar. IV insertions are still not my thing now, but I always at least try once before I ask my peers for help. As with anything, IV insertion is a skill, so the more you do it the better you’ll become, aka it will come with time.

The flow is definitely so much different, and you’ll sometimes feel like you’re on a time crunch since every patient wants to get their treatment once they’re there so they can get home early. With that said, time management is very important. You’ll find yourself communicate with different members of the interdisciplinary care team as well (especially the attending physician) to organize patient schedule and treatment. In my clinic there’s no resident, so I work primarily with attending MD, NP, and PA.

With chemo regimen, again, the more you do it the better you’ll become. There’re a couple of chemo/immunotherapy that are widely used for many disease groups (e.g. Pembrolizumab, Doxorubicin, Bendamustine, Cyclophosphamide). Look the chemo up before you give them so you are familiar with what they are. Also take time looking at the chemo plan to understand how often the drug is given, any premeds or prehydration, an neulasta needed, etc.

I think you should go for it! Wherever you go you’ll have to learn and readjust, but I think this change will be worth it! I’ve only done outpatient oncology for 7 months now but I absolutely love it and have no plans to go back to inpatient oncology any time soon!

INN_777, BSN, RN

Specializes in Oncology, Medicine. Has 7 years experience. 429 Posts

You have what it takes!

With IVs, scary as it might be and frustrating, the more you do the better you get. I started my nursing and oncology career inpatient and barely had a chance to start IVs, most of our patients had central lines. I had huge anxiety about IVs when I transitioned to outpatient, but after a year or two became a "go to" to tough IVs. You are not born with it, it's all practice.:)

Do not worry about knowing all about chemotherapy. You will have orientation and likely some classroom training. But mostly, you will learn about various chemo regimens in infusion by giving them. You learn practical details, related to safety, administration and typical regimens for various types of cancer, not necessarily mechanisms of action, rationale for a regimen. In a very busy infusion clinic you just don't have time to dig.

Having now worked in both inpatient and outpatient, I recently took a role as a Nurse Navigator and NOW I am learning more of the big picture - how folks get diagnosed, how regimens are chosen, what patient's journey is like through treatment.

Each type of oncology nursing contributes a piece of the "puzzle" of your growing body of knowledge and understanding. Enjoy the transition!

 

Edited by INN_777

DiscGolfNurse, BSN

Specializes in Pediatric/Adult Oncology. Has 7 years experience. 148 Posts

I’m actually the opposite of you and wanted to offer my experience. I’ve been in med/onc or peds heme/onc for the last 4 years and this last year once we moved home to CA for my husbands job, got into an outpatient infusion clinic after only working 3 12’s on days and nights. 
 

I thought it was going to be the change I needed and spending more time with my family and a better more “normal” feel to life but I am actually going back inpatient on nights on a BMT unit. For me, 3 12s on nights provides me the most time with my family. Yes I work nights but my son and my husband are sleeping so I don’t miss much and I usually do 2 on 1 off in my schedule so that I’m not exhausted after 3 in a row. I felt like in the outpatient setting I wasn’t getting enough “me time” on my off days and 2 days off a week was not worth the normal hours when I could have 4 days off or even a week if I wanted too without using PTO. I felt like I could also do more for my family with my days off rather than being exhausted from a busy week at the clinic (which turned out to be every week). I feel like in the inpatient setting it’s easier for me to separate from my work life and come home to be a mom and a wife. But again, that’s my experience. 
 

I learned a lot outpatient about chemo but I don’t believe you are less of a nurse or less qualified because you don’t give different chemos or only give certain kinds. 
 

Ultimately, it’s the choice that best fits your life and what you feel is a good work life balance. For me, nights is a fair trade to get alone time and rest and I also feel I can balance time with my family as well as pursuing my masters. I hope this helps but ultimately no matter what, even if this isn’t the right choice, you can always go back to inpatient because your knowledge and experience is always highly sought after! Good luck!