RE:Connect

The First Day of My Nursing Career

I started my position at Vanderbilt Children's Hospital on Monday, January 26. Due to all the butterflies and my nerves running wild, I had no sleep the night before. I could not believe this day had finally come because I have been working towards this goal to become a Vanderbilt nurse for the last few years!

As I sat there in my orientation, a nurse educator asked each of the 118 chosen for the residency program to look around at each other and see how far we had come. She commented that this was the very first day of our nursing careers, a truly life changing event. She went on to say that we were each chosen for specific reasons. They saw in us a passion to help others, potential to become great nurses and certainty that we would each succeed and pass the boards.

I felt proud sitting there, to be one of the chosen. It was definitely a different feeling from sitting in my first class of nursing school where my teacher said to look around the room because we will probably only graduate with half of our class! I am still getting used to waking up extremely early every day for orientation, but I don't think I will ever forget what that nurse educator said to my fellow nurse residents and I.

So, for the next eight weeks, I will be in classes for two days a week for the didactic portion and have two clinical days rotating through the pediatric ED, NICU, PICU, PACU and Holding, Hematology and Oncology, a Cardiac unit and an infant surgical unit. It is as if I am on an eight week interview because on March 16th, I will be matched to a unit that hopefully I am most fit for.

This is such an exciting time. I take the NCLEX next Tuesday February 3rd, and I can not wait until I can sleep better and breathe a little easier knowing that I have passed! I've taken some of the advice people have commented on my last blogs and have been studying a little each day so I don't get too overwhelmed. I think I am at the point where I either know it or I don't. I am just ready for it to be over! So, hopefully next time I write I will be an official Registered Nurse!

Do you all still remember your first day of your nursing career?

Health History Tool for Paper or EMR

Hi again everyone!

Whether I am working with a paper or electronic medical record, one of the tasks I find most difficult is obtaining and documenting a current, accurate health history from my patients.  When participating in patient education, I speak with both the patient and family members about the importance of keeping an individual and family health history. 

There is a new tool available that can facilitate this process in a very user-friendly way.  For those who are comfortable with the internet, they can complete this tool at their convenience.  For those who may need assistance, a healthcare worker could assist with completion of this tool.

This resource, "My Family Health Portrait" tool, has been released by the Surgeon General and is now available on the internet.

If your facility has paper medical records, the patient can print a copy to bring to their appointment.  If you are involved with your organizational conversion to EMR, the tool is based on common standards so the information is ready for use in EMRs and can even be used to develop clinical decision software.  Organizations can download and customize the tool, even using their own brand.

The tool is convenient and the profile can be completed in only 15-20 minutes.  The information is easily updated or amended and allows individuals to build a family health tree.  Thanks to re-indexing, they can then share the tree with family members who can easily add to the provided information with themselves as the primary focus.  Utilization of this tool should also prevent the patient from having to complete different forms in multiple offices and other healthcare settings. 

For more detailed information, download the HHS News press release attachment.

If you have used the previous version of this tool, please share your insight with the group.  If this information is new to you, please share your thoughts regarding this tool and/or ways in which you might incorporate it into your practice.

Download My Family Health Portrait Tool

"Where were you when Barack Obama was sworn in as the 44th President of the United States of America?"

     There are several moments in American history that prompt the question “Where were you when……..?”  Some of these moments are catastrophic and tragic such as “Where were you on 9/11?” Others are astonishing and extraordinary like "Where were you when you heard Neil Armstrong walked on the moon?” (This moment occurred way before my time by the way :-)  This January 20, 2009 marked another day in US history in which the question “Where were you when Barack Obama was sworn in as the 44th President of the United States of America?” will be asked for years, centuries and generations to come.    

     So I’m sure you guys are all saying “What does this have to do with oncology nursing?”……..right?  Well I’ll tell you what, on that day my institution broadcast the inauguration live at different campus locations so that all employees had the chance to witness history.  Nurses, doctors, pharmacists, accountants and other employees that all work for the institutions mission to cure and care for patients with cancer, sat and listened to Obama’s message as he promised to improve healthcare access and coverage for our patients.  Our employees were also excited because President Obama has chosen our own institutions' president to lead the President’s Council of Advisory on Science and Technology.  Congratulations Dr. Harold Varmus!!!!    

    Also on that day every nurse and patient in the chemotherapy suites were glued to the TV’s to share the moment together.  In one particular unit, no one spoke during the swearing in but applause and cheers could be heard from staff and patients alike immediately after.  I could imagine that many of those patients are as hopeful for change as they are for surviving each day with cancer.

   Lastly, it was sad news to hear that the beloved Senator Ted Kennedy who is battling brain cancer suffered a seizure during the inaugural luncheon.  He was rushed to a nearby hospital where they thankfully report that he recovered well. In retrospect, I’m sure all the other senators wished they had invited a smart, knowledgeable, attentive and caring oncology nurse like yourself to the luncheon :-).

Please comment and let me know

• Where were you when Barack Obama was sworn in as the 44th President of the United States of America?
• Did you watch it live?
• Were you alone, at home with family, at work with patients or maybe you were actually there in D.C.?
• What do you most hope that our new president will do for our patients and our profession?

 

Oncology Nurses Day

In Canada, Oncology Nurses Day is celebrated on the first Tuesday of April every year. This year's theme is "Oncology Nurses: Ignite the Passion." Every year CANO chapters across Canada celebrate in their own unique ways with no real cohesive campaign running across the nation aside from the theme, signage and artwork.

This year we have decided to make some changes. Each chapter has been asked to submit the name of one nurse in their chapter or region who they feel demonstrates the CANO values and who 'ignites the passion' of those around them! Each nurse will have their photo and inspirational story highlighted on the website for every nurse across Canada to see. What an excellent way to recognize and celebrate the work of hardworking, dedicated nurses in diverse roles.

The campaign has been widely accepted and has brought some enthusiasm and spirit to our membership. I look forward to reading about the amazing work of my nursing colleagues. Once again, I encourage every nurse to take the time to acknowledge the work of their colleagues and find a way to say thank you.

What Does Nursing Mean to You?

I recently came across a very inspirational poem from an R.N. named Melodie Chenevert. This poem beautifully portrays what nursing means to me.

Being a NURSE means

You will never be bored. You will always be frustrated. You will be surrounded by challenges, So much to do and so little time.You will carry immense responsibility and very little authority. You will step into people's lives and you will make a difference. Some will bless you, some will curse you. You will see people at their worst and at their best. You will never cease to be amazed at peoples capacity for love, courage and endurance. You will see life begin - and end. You will experience resounding triumphs and devastating failures. You will cry a lot. You will laugh a lot. You will know what it is to be human and to be humane.

I think this poem is very inspirational for all levels of nursing experience. For me, this poem makes me excited to be going into the field of nursing. The poem speaks to the immense responsibility a nurse has for each patient cared for and I think it summarizes the good and bad that all nurses eventually see in their career. I wanted to share this poem with you all because I want to find out if those with many years of experience in nursing still feel the same way about nursing. Have your thoughts about being a nurse changed or do you have any thing you would add to this poem?

Awards

For those who are unfamiliar, the Canadian equivalent of ONS is the Canadian Association of Nurses in Oncology (CANO). I have been an active member for the past 8 years, and since 2005 I have served on our local chapter executive, currently in the role of president.

Last September in a hurried moment I was asked if I would like transition from 'member' of the National Awards and Recognition Committee' to the Chair of the committee. Of course, without thinking I said yes. I firmly believe in both professional development and the development of a profession. The amount of work associated with committees can vary but I have always believed that what is personally gained far outweighs the time commitment. Seeking out committee work is also a means of networking locally, regionally and nationally. 

On another note, being involved in the nomination process of a friend and colleague for an award is equally rewarding. It is important that we recognize the outstanding work of our colleagues. Day to day we often get caught up in the details of projects/clinical work or research and fail to see the bigger picture and the impact the work has on patient care and the profession of nursing. Often Awards Committees have to seek out nominations as the number of packages submitted is not in keeping with the exceptional work being done.

I'm not sure why we don't recognize our peers for awards. Is it because we lack the time necessary to complete the forms? Or because we are intimidated by the process itself?

This past week our CEO came through the clinic setting encouraging staff to nominate co-workers for an "Applauding Values Award". I was the first one to say I don't have time but later that afternoon I sat back and read over the award criteria and a friend's name and work quickly came to mind. In a matter of minutes I had emailed 3 colleagues and we had a nomination package ready for submission. In writing about my colleague I became energized and enthusiasthic about the work being done by our department.

Rewards and recognition go a long way to improve morale and I encourage everyone to nominate a colleague for an award or simply acknowledge outstanding work on a one to one level.

A New Year Means a New Way for Pharmaceutical Companies

In July 2008, the Pharmaceutical Research and Manufacturers of America (PhRMA) issued a revised Code on Interactions with Healthcare Professionals (HCPs). The voluntary revised PhRMA Code became effective January 1, 2009 and has already significantly impacted the marketing strategies for complying pharmaceutical companies. The most important revisions are those relating to sales representatives’ ability to provide HCPs with off-site (“restaurant”) meals and branded items, such as pens, notepads, and other similar “reminder” items. Exceptions include branded items for HCP disease education or for patient education. For example, textbooks, journal subscriptions, anatomical models, and patient handouts are permitted because they are for educational purposes only.  Giving away medical equipment like stethoscopes is prohibited because stethoscopes are primarily designed for patient treatment and are not educational items. As mentioned above, off-site meals are prohibited but sales representatives may continue to host meals in a clinic or hospital setting, provided the meal is in conjunction with an informational session. Also, HCPs who also serve as consultants and/or speakers for pharmaceutical companies must fully disclose this relationship for two years after the relationship is terminated. 

Not all companies intend to comply with the Revised Code. As of 1/6/09, PhRMA lists 39 signatory companies who have announced their intent to abide with the voluntary code; Amgen, Bayer, Celgene, Merck, Novartis, Pfizer, Schering-Plough, and Wyeth are among them.

So, my questions to you are:

1. What changes have you seen in your workplace since 1/1/2009 based on the revised PhRMA code?
2. Do you feel that the revised Code will affect HCPs prescribing practices?
3. Will the pace of drug development be impacted by the Revised Code? If yes, will it slow down or accelerate the process?

For additional information, view the Code on Interactions with Healthcare Professionalsor view the side-by-side comparisonof the PhRMA’s Original Code (2002) and Revised Code (2008) available on the blog siteof the law firm of Reed Smith, LLP.

Career Decisions

I hope everyone had a wonderful holiday season and is well rested for the New Year! I appreciate everyone's thoughts and comments about how they prepared for the NCLEX. Today I received my authorization to test number and finally scheduled my date to sit for boards. I take the NCLEX at the beginning of February. So, I have ample time to prepare, which I am very happy about.

I've only been graduated for a couple of weeks, but there are numerous things that a new graduate nurse has to think about. Currently, I've had to make the decision of whether or not to choose the critical care or acute care track within the pediatric nurse residency program I will be starting at the end of January. I am very conflicted with this decision for many reasons. First, I feel very passionate about pediatric oncology and this area is eventually where I would like to end up in my career and eventually pursue further education. However, I am very interested in working in the pediatric intensive care unit. I find both fields of nursing to be both mentally and physically challenging. I am torn though, because I feel like if I went into oncology right out of school, I would become too specialized in one area of nursing. I feel that if I started out in critical care I would have the potential to see everything under the sun and learn a great deal of information that would better prepare me to become specialized in oncology later on in my career. Even though oncology is under the acute care track, I would still be able to spend a couple of days in the oncology unit. I was able to find out that the amount of time I spend on each unit does not necessarily determine if I am matched to a particular unit.

So, I mailed my information of my choice to start the critical care track yesterday. But then today I started freaking out. I wondered if I made the right decision. Am I disregarding what my true passion is...to work in pediatric oncology? Did I just sign up to go through a year of hell in the PICU, because it is going to be extremely difficult? Am I smart enough to be working in critical care? It is amazing the doubt that runs through my head everyday because this transition of going from a nursing student to a graduate nurse is scary. It is a time of uncertainty of which I am trying to learn to adapt to.

Even though my decision is already made about which track I selected within the residency, does anyone have any thoughts about graduate nurses becoming specialized from the beginning of their careers? For the other bloggers, did you all start out your career in oncology and if so have you ever worked in any other units or regret your decision?

Reimbursement for Conference Attendance

Hi - hope everyone is well-rested and relaxed after the holidays!

Has the current economic situation resulted in a decrease in educational resources?   

Let's answer the following questions to get a snapshot of what's going on around the country....

In what state do you practice?

Are you allowed time off from work to attend one or more conferences?  Are you paid for that time?

Do you cover all expenses related to conference attendance?

Do you recieve partial reimbursement to attend one or more conferences?

Do you receive full reimbursement for one or more conferences?

Have you been notified that reimbursement will be decreased this year?  If so, is conference reimbursement decreased (from 2/year to 1/year) or cancelled altogether?

Thanks for taking time to answer these questions.  With enough response, this may provide benchmarking data as well!

FDA Approvals

As the year end grew near, my email account seemed to be inundated with FDA approval notices for oncology drugs and supportive treatments. Often I only quickly scan these memos because they don't apply to my practice, and I know that access will be limited because of the high costs associated with them.

In Canada, access to new drugs is dictated by the provincial government, with each province's formulary differing from the next. In our publicly funded system, patients do not have access to the newest and latest treatments that we see advertised in these memos. Cancer agencies cannot provide access to these treatments because granting funding for even one new treatment changes the landscape for all.

While I am excited when I read about the amazing work of scientists and clinicians toward targeted therapies and improved quality of life, I am also saddened to know that it may be years (if ever) that we have access here in Canada. Even the latest findings from clinical trials can be difficult to implement.

Every year, our physicians attend the annual ASH(American Society of Hematology) meeting and come back with enthusiasm. By the end of the week practice is beginning to change BUT within a few weeks or months we start hearing that these new combinations of regimens are costly, often combining one or more monoclonal antibodies to improve progression free survival rates. Thankfully, at our centre each case is considered on a case by case basis and more often than not funding is granted but the period of time when we must wait to hear can be frustrating.

So, each time I see an FDA approval notice in my inbox the first thing I wonder isn't 'whose life might this effect?' but rather 'will this drug ever make its way into my practice here in Canada?'