RE:Connect

ONS Congress 2009: Was your Abstract Accepted for a Poster or Podium?

Everyone here is excited because yesterday we started to hear if our abstracts were accepted for posters, podiums or sadly not accepted at all.  I am happy to announce that several of my colleagues had their abstracts accepted including one that I personally mentored who submitted an abstract for the very first time and was accepted for a podium. Not only is the staff ecstatic that they will soon be headed to sunny San Antonio, but they are eager to share their knowledge and expertise of their selected topics with oncology nurses all around the world.  It's nice to know that something you do everyday could be used by another institution, practice or oncology nurse to improve patient care, satisfaction, outcome, safety, quality..........the possibilities are endless.  

Once the excitement is over everyone will indeed settle down to create their posters and podium presentations. Graphics will print several revisions of posters, slides will be edited up until the final moment for podiums and presenters will have rehearsed their presentation a million times prior to Congress. Although it's a lot of work, in the end it will all be worth it.  The sense of pride and accomplishment an oncology nurse feels after attending Congress is indescribable and every oncology nurse should experience it at least once in their career.

CONGRATS to those that were accepted and I'll see you all in San Antonio!!!!!    

Oral Chemotherapy Guidelines

I recently received an email from ONS asking members to review a document outlining the safe practice and administration of chemotherapy. I was excited because I knew that although this is a very important topic it had not been addressed on such a large scale. Closer to home our Best Practices and Nursing Research Committee had just finished a project that examined our own practices around the administration and monitoring of patients on oral chemotherapy and had developed guidelines and resources to assist nurses in clinic practice. A review of the literature supported the need for our project as neither Canada nor the USA had practice guidelines developed. While nurses were responsible for the education of patients on oral chemo not all provided written materials nor were they aware of all the necessary monitoring/toxicities of the drugs.

For whatever reasons the practices surrounding the administration, patient education and follow up of patients on oral chemotherapy vary signiificantly from intravenous practice. There is a set process that must be followed for a patient to receive IV treatment, the first of which is consent. Formal consent is not usual practice with oral chemo. Often nurses are unaware the prescription has been provided until after the patient has left the clinic making patient education difficult. Patient selection is a critical piece of the process yet the reasons physicians choose the oral route may not reflect this. Adherence to the regimen relies on patient understanding but who is assessing understanding. Many believe that the elderly are good candidates for oral chemo yet memory deficits, poor visual acuity, lack of physical hand strength, and altered absortpion of the drug may not be considered. When providers do not factor in these obstacles adherence declines.

At our centre with the help of our pharmacy department we have developed a Provider Checklist to ensure standardized practice and an Instruction Sheet to attach to the prescription to clarify the dosing and monitoring required while on treatment. This Instruction Sheet also serves as documentation for outside community pharmacies and GP/family physicians who may also be involved in the patient's care. We are currently waiting for physcians support for the project before beginning a pilot of the resources. I encourage all ONS members to go to the website and review and comment on thhis document, patient safety is at risk.

As the Transition Continues...

Although I expected the transition from being a nursing student to a graduate nurse to be difficult, I did not expect to have quite the trouble transitioning from my role as a nurse extern (or carepartner). I am used to working alongside nurses and helping them out every opportunity I get. I would take the patient's vital signs, get needed supplies for procedures, transport patients and basically do anything the nurses needed me to within my scope of practice to help the nurses day run as smoothly as possible. While working as a nurse resident, I am assigned to a preceptor who is supposed to teach me about their unit and help to orient me to all the different tasks that will be expected of me.

Over the last couple of weeks, I have found myself functioning as if I was still a carepartner, offering to run and go get supplies when in fact there already is a carepartner assigned to the unit who should be utilized to do these tasks. I am the one who is finally in this role as a nurse who needs to stay in the room with the nurse to learn how to care for the patient. In my mind, I thought I was being very helpful, but when I sat back and thought about my time on the units, I realized that I was shorting myself valuable time in which I needed to learn. I have since made it a point to make myself stay right there next to my preceptor the whole day. Of course, I can go get my own supplies, but I guess this is really the start of where I learn how to delegate in my new role.

Has anyone else found the transition from being a student nurse or carpartner to becoming a nurse difficult? If you have, how did you approach the situation? What did you do differently in order to learn how to delegate?

To Twitter or Not to Twitter

I would consider those of you who "tune in" to our Re:Connect blog to be somewhat on the cutting edge, technologically speaking.

With the communications explosion, we are limited only by our imaginations.  A recent report caught my attention and I am amazed by the application of technology.

Please visit the link and comment as I am very curious to read your impressions!

http://www.cnn.com/2009/TECH/02/17/twitter.surgery/index.html 

 

Are you able to effectively address the fertility needs of your patients?

As the oncology nurse what do you say to the 30 year-old female newly diagnosed with breast cancer or the 25 year-old male newly diagnosed with testicular cancer when they ask you if they will be able to conceive a child once their treatment is completed?  Do you instruct them on the use birth control during treatment and stress the importance of preventing pregnancy? Are you knowledgeable enough to review the risks, benefits and offer possible alternatives for patients wishing to conceive after treatment?

Sometimes the urgency to initiate chemotherapy and/or radiation treatment to a patient can leave their fertility needs unaddressed.  Other times we simply forget to provide continuous education to men and women of all ages about the importance of preventing pregnancy while on treatment.  My institution is developing a program to ensure all patients receive information about the effects of cancer treatment on fertility and the options available for fertility preservation.  What do you do at your institution when faced with similar situations? Is there a referral you can make or a consult you can call for the patient to discuss fertility preservation? If not, do you feel knowledgeable enough to offer this kind of advice to the patient?

Any comments you can provide would be greatly appreciated.

Just a Little Set Back

I am sorry to report that I have some bad news. I found out last week that I did not pass the NCLEX. It is such a disappointment and you would not believe the numerous emotions that I am experiencing. Last week, I felt pretty terrible about myself. More than anything, I felt incredibly embarrassed and frustrated. I've been fighting back tears everyday I have worked since I found out the news. I know as soon as one of my colleagues or preceptors asks me if I have passed boards, all the emotions will come streaming back. I was so looking forward to being able to only focus on one thing for the time being- instead of school and tests, and work and everything else. But, for the next 45 days, I get to study more, which I am so tired of!

On the bright side of all of this, I still have my job. I know of some other hospitals here in town that fire you if you do not pass the first time. I have made a plan to move on from all of this. Even though I feel incredibly discouraged, I will be meeting with a tutor that hopefully can help me find areas of weakness in testing and help me to improve. I know that I struggle a great deal with test anxiety, but I honestly felt that I went into the NCLEX very confident and calm. I don't really know how to not be anxious the second time around. I guess this truly is what the average graduate nurse goes through after school. I keep thinking that I probably could have studied more. I could have waited a little longer to take the test and maybe then I wouldn’t have failed. I could have done a lot of things differently. I am trying to remind myself that I was successful at Belmont and I know I have what it takes to be a nurse, I am just discouraged. I have pushed myself very hard to get where I am right now and I know that in itself makes me successful..
 
I think that anyone who has failed at something quite substantial in life would feel the exact same way I am feeling. It has been very hard to be around the other nurse residents, hearing them talk extensively about the NCLEX everyday and then hearing that everyone around me has passed.  I know it is not the end of the world. I am not going to let one test control my emotions and the fate of my nursing career. I know that many others do not pass the first time around and go on to become amazing nurses. I know I will pass the second time. Soon all the sad feelings will surpass and I will push myself to pass the test. It was very hard telling all of you that I did not pass. But, I thought if other graduate nurses are reading this blog, that it could help them to know that not everyone passes. I would also love to hear from others what they focused studying on. Any advice or encouragement would be greatly appreciated!

Can Nurses Care Too Much?

Late last week a friend sent me the link to a blog from the Health Section of the New York Times titled "Can Nurses Care too Much?" At first I was hesitant to read it because for years I have heard that nurses working in oncology and palliative care invest too much in their patients and become too attached. What I have always viewed as natural grieving, sadness and perhaps tears upon the passing of a patient, my family thought was a sign of weakness. That maybe I didn't have what it took to be a nurse. Whenever people learn what I do for a living their first response is always, "Well that must be so sad?" In reality,it is a very rewarding and happy work environment.

I was pleasantly surprised to read Theresa Brown's blog about her work as a nurse on a medical oncology ward. Her account was thoughtful and made me proud to be an oncology nurse.

One Giant Leap For Chemotherapy Patient Safety - Let Your Voices Be Heard!!!

How do you or your practice decide what should be included in a chemotherapy order?  What regimen information to provide to the patient and when?  Frequency of patient assessment and chemotherapy order appropriateness based on patient changes?

These and many other chemotherapy safety-related questions are common.  There are many references that may be used to develop safety standards for an individual site; however, these standards are not uniform across practice settings, leading to inconsistency and potential safety issues.

If you have been troubled by any safety issues related to chemotherapy administration, here is your opportunity to make a difference.  The ASCO/ONS Standards for Safe Chemotherapy Administration have been developed and submitted to stakeholders nationwide.  Your opinion is vital!

On December 5, 2008, ONS and ASCO, the American Society of Clinical Oncology, convened a 40-member multidisciplinary workgroup representing diverse practice settings to develop a consensus of chemotherapy standards. 

This group of oncologists, nurses, pharmacists, social workers, practice administrators, and national safety/quality experts represented ASCO, ONS, ACS, National Coalition for Cancer Survivorship, Joint Commission, Society of Gynecologic Nurse Oncologists, National Quality Forum, Hematology Oncology Pharmacy Association, Association of Oncology Social Work, and the Institute for Safe Medication Practices.

The draft standards are:

• focused on patient safety
• relevant to diverse outpatient practice settings providing chemotherapy to adult patients with cancer
• actionable, and
• measurable.

You can review all of the draft standards and submit your opinions until March 13th.  Just check out the ONS website link at http://www.ons.org/clinical/Treatment/Chemotherapy/news.shtml

All submitted comments will be logged and used to select and refine the final standards set.

Feel free to post and respond to comments on this blog after you've read the draft standards and completed the survey.  Let's talk!!

PLEASE take this opportunity to improve practice - one small step by a concerned ONS member, one giant leap for chemotherapy patient safety!

The measure of a nurse

Over the past week, I have been giving much thought to what it means to be a nurse. Specifically, how I will view myself if I were to change to a job where there is less patient contact and more "behind the scenes" involvement. I remember having this same internal struggle 6 years ago when I left the wards to take a position in the ambulatory care setting. I still grieve the loss of some of my nursing skills and miss ward nursing almost every day. Some nurses change environments because there is some aspect of the job they do not enjoy, such as shift work, but for me that wasn't the case. I had successfully completed my courses for my diploma in oncology nursing education and passed certification exam and knew that I wouldn't be using that knowledge as much as I wanted to on a medicine ward with less than half of the patients diagnosed with cancer. At that time I struggled with the change because of the loss of hands on nursing but I never struggled with feeling like less of a nurse because I was still actively involved in patient care just in a different way.

I am now considering taking another position that would not have a clinical component associated with it. For some reason I am not sure that I am ready to make this shift. I know that as nurses we get a lot of satisfaction from the individuals and families that we care for. The most special moments are the ones between the nurse and the patient. They are often unexpected, and derived from ordinary situations. I will miss these moments and I know deep down that the measure of a good nurse shouldn't come from the skills we perform or the efficiency we demonstrate. I welcome your thoughts and experiences on this topic.