Transplant nursing

Trauma Columnist · Jun 24, 2012

What kind of transplant nursing; being the coordinator?, caring for transplant pts afterwards on the floor, doing f/u care? Which organs? Adult/kids?

emilynorth · Jun 25, 2012

Those are good questions. Ha I don't really know the answer. That's probably my main problem. I don't really know what the coordinator does? I'd like to help get the organs deal with patients before the surgery. Maybe help with surgery If possible.

RN58186 · Jul 2, 2012

I am a Transplant Coordinator; I have a case load of approx 200 post transplant pts that I do case management for. I follow them from the time they get their kidney or kidney/pancreas until they either die or return to dialysis. We also have Coordinators who manage the pts who are going through the work up process and are waiting on the list, as well as one who works exclusively with living donors. I work in an outpatient clinic, so M-F days, no nights or weekends. Here we have an entirely different program that looks after the deceased donors prior to going to the OR - since our program is focused primarily on the recipient side of things, it is considered a conflict of interest for us to have anything to do with the donors. Also the reason we have a specific Coordinator for living donors. I work with renal transplant pts, in my clinic there are Coordinators who look after liver, heart and lung transplants as well.

I worked for 12 years on the inpatient dialysis and transplant unit prior to going to the clinic. It was great to see pts get their organs and do well. Especially the type 1 diabetics who have had diabetes since childhood leave hospital not even needing to check blood sugars anymore after their pancreas transplant.

As for the actual surgery, the OR nurses do that as part of their usual job. Most of us have gone into the OR and watched a transplant, but none of us actually assist with the surgery.

Not sure if that helps or not. Happy to answer any questions.... I think I have the best job in the world. I love what I do.

emilynorth · Jul 2, 2012

No that was really helpful! What would you suggest the best way to get into that field? I am a nursing student right now, first semester and just want to have an idea what to be looking for or doing so I could get into that field.

RN58186 · Jul 3, 2012

Most of us in our clinic came from either the inpatient renal unit or dialysis. The liver and lung nurses all came from ICU, heart nurses came from inpatient cardiology and CCU. If any of the hospitals you work in have an inpatient renal unit or a dedicated transplant unit, try to get a clinical placement there. But for a job like mine, you won't probably walk into it right out of nursing school. All of us worked on inpatient units of some description first. There are transplant teaching websites out there as well, I can send you links if you want. There are courses you can take to become certified in transplant nursing after graduation. YOu can try websites for ITNS (International Transplant Nurses Society) or NATCO (North American Transplant Coordinators Organization). NATCA still does, I believe, an introductory course for transplant coordinators. I went to Arizona for one in the fall of 2002, it was really good.

Feel free to ask any questions. Good luck!!

ThanksForAllTheFish! · Jul 24, 2012

. I have some questions!

I am currently a second career nurse that has been working in the ICU for almost 4 years. My ICU has a varied patient population, but we do take care of kidney and liver transplant patients with the occasional panc (and of course before they got their transplants too). I have been looking to leave the bedside for some time now (I really really need a job with a regular schedule and normal hours, you know like a real person lol). I also wanted to leave direct patient care and have been looking at getting into informatics. However, there aren't many informatics jobs in my area. I had briefly considered pursuing transplant coordination awhile ago. My concern is that most of my transplant experience involves post op care and I really don't know much about recipients life outside the ICU. Generally, yes, but I would need to be taught a lot that I know our transplant floor nurses already know and therefore would have a considerable advantage over me.

What is "a day in the life" for you? pros/cons? Also, do you know anything about the work schedule/structure of inpatient transplant coordinators?

Any info would be greatly appreciated! Thanks :)

RN58186 · Aug 9, 2012

We don't have inpatient coordinators here, just outpatient. When they are in hospital their care is totally managed by the inpatient staff.

My day? Well, like I said, I do case management for approx 200 pts. So, a day for me consists of monitoring bloodwork (our doctors do not look at bloodwork, they can't mange bloodwork on 1000 pts) and flagging anything for the doctors that needs attention. We do clinics just about every day, and when we are working clinic we do prep work before hand - we look at bloodwork, medical history, figure out what tests they are due for, note anything that needs to be discussed with the doctors. Then when clinic actually starts, the clerks bring the pts to a clinic room and weigh them. The RN then goes in, and will review their medication list (to make sure they are taking what we think they are taking), go over their labs (we don't call pts with labs, they all run on the "no news is good news" theory), find out how they are doing - how is BP at home, how is the (whatever) we dealt with last time you were in, etc. We will do vitals, and find out if they have any questions for the doctors. We then meet the doctors outside the room and give them a run down about the pt (our doctors rotate q2weeks so they might never have seen this pt before) and tell them briefly what the concerns are. When the doctor goes in with the pt, I will speak to the pharmacist, dietitian, diabetes nurse, or social work if I identified anything they need to be aware of. After clinic we make sure the visit is charted and orders written. When not doing that, I have phone calls. My pts will call me with any questions (I have had diarrhea for a week, what do I do?) or if they want to know lab results. I call any pts for whom I have identified concerns with their labs (Hi, your creatinine has taken a jump. Are you drinking enough? Can you please hydrate well and repeat your bloodwork in the next couple of days? Your CMV level is rising, how are you feeling? You Hgb is dropping, are you passing blood in your stools? Nosebleeds?). If any of my pts need to be referred to another specialty I write the referral letters. I do reqs for diagnostics and biopsies. I field phone calls from family doctors and community pharmacies about what my pts can take or what to do with the pancreas transplant pt with pancreatitis. Or whatever. We write orders based on the labwork and/or pt's concerns after consulting with the doctors, and then ensure that orders are followed up on. I follow up on testing done as an inpatient for which results might not have been available on discharge. W4ehn pts are discharged following their transplant, I will see them at 0730 M-W-F for about three weeks and do assessments of BP, edema, bowels, mood (high dose steroids) and surgical wound. I will take out staples when they need to be removed. If my pts are admitted anywhere other than our inpt unit, I will call that unit/hospital and introduce myself, give them my phone number and invite them to call with any questions/concerns about the pt's transplant. If a pt is admitted for surgery and is taking sirolimus, I try to get the attending doctor to consul transplant to get them off sirolimus to allow better wound healing. We also do dermatology, endocrinology and gynecology clinics so we have different kinds of prep for each of those.

Pros? I love what I do. Seeing my pts get their organs and do well is awesome. I have a unique kind of relationship with my pts, some of them I have nursed for more than 15 years. I get to know them and many of them I can laugh with and joke with. My pts know me and they trust me. We have pts being treated for cancer or other illnesses who will call us rather than the oncologist or whoever because we know them better. I have a great relationship with the doctors I work with and we are given a lot of autonomy to make decisions. One of the doctors I work with will answer a question with "Why are you even asking me? You know what to do, just do it." (To which I reply that the one time I don't aks will be the time she doesn't agree with my decision.) Our multidisciplinary team is awesome and we work very well together.

Cons? The meds over the long term can do nasty things to pts. PTLD to name one. Breaks my heart to get a biopsy report showing that. Pts who decide they feel good and stop their meds, destroying the organ(s), because they figure they can "just get another one". And while I like how well I know my pts, it makes it that much harder when they die. We do cry over some of our pts. Working M-F means I must take time off for my own medical appts and such as ther are no days off during the week. The pts can become overly dependent on us. Telling a pt that I am referring them back for pre-dialysis care. Or that they need to re-start insulin because their pancreas has failed. I hate those conversations.

Hope that answers some of your questions. Let me know if you have more....

ThanksForAllTheFish! · Aug 12, 2012

Thank you so much for the information! I went ahead and bit the bullet and applied for a pre transplant coordinator position that opened up at my hospital. Fingers crossed. :)

RN58186 · Aug 24, 2012

Did you get an interview for the transplant coordinator position?

ThanksForAllTheFish! · Aug 27, 2012

Sorry for the late reply.Yes, actually I just completed the initial hr phone interview today. He seemed pretty confident that the hiring manager would want to meet with me. If I do well with that, then it's meeting the docs (which many I already work with in the ICU, just don't know of they like me or not :). ). So fingers still crossed. The only bad thing is since the position is at the facility I currently work at, I had to email my manager today to let her know that I had applied. Hopefully that won't cause any problems if I don't get the coordinator position. Cuz you know in the back of their mind they think "she wanted to leave . . . Is she invested here? Hmmm"Wish me luck!

RN58186 · Aug 28, 2012

Oh my that's a lot of people to go through - when I had my interview it was my manager, the assistant manager and the medical director of the transplant program. One interview, 45 minutes with all three. After working a night shift. On my birthday. But they all knew me, the assistant manager just not as well as the other two. So wasn't too stressful. In fact when the medical director came in he looked at me and said "Why now?" (he had known me for about 5 years on the inpatient unit) to which my manager looked at him and said "That's not one of the questions!!" But as soon as we were done he was asking again. At least I had a laugh before I came home to bed. Good luck - keep us posted!