KEY POINTS:
Chemotherapy nurses at Auckland Hospital are responsible for the safe administration of a wide variety of drugs in the oncology department.
Once they have gone through the course, nurses have a better understanding of the disease process and the reasons chemotherapy is given to cancer patients. Because of the serious nature of the disease, nurses have to be aware of the potential side effects of the drugs involved and know how to deal with them.
"It is a chemical therapy and not to be treated lightly," says charge nurse Vicki Dolphin.
"Some of the drugs are heavy duty with a wide range of toxicities which vary depending on the dose and type of drug you are administering. Plus, reactions vary in each patient."
Nurses joining the chemotherapy department attend the hospital's two-day cytotoxic study course.
The course teaches cell theory, chemotherapy drugs and side effects.
Also covered is scheduling of treatment, patient orientation and education, and managing problems specific to chemotherapy.
The first day consists of explaining the criteria for being on the cytotoxic register, reviewing the nurses' workbooks, pre-reading and a pre-test.
Oral chemotherapy safety is discussed, then attendees work in groups organising teaching sessions about pathophysiology and nursing management of tumour lysis, chemotherapy induced nausea and vomiting, and chemotherapy induced mucositis (mouth ulcers).
The following week, the groups present back on these topics, then safety aspects of handling chemotherapy are covered. This includes; patient safety, nurses safety, safe transport and checking procedures, what do in the event of a drug or body fluid spill, how to administer vesicant medications, and disposal of contaminated equipment.
A post-test (featuring the same questions as the pre-test) evaluates how much has been learned.
After the two theory days, nurses work with a nurse in the day-stay clinic for a week or two to become familiar with the practical side of chemotherapy administration under supervision, and, if they don't already have the skill, learning how to administer an IV line.
They attend the patient orientation session and get familiar with the hectic oncology environment. All going well, with an audit and verbal presentation of a patient they have cared for - relating drug to type of cancer and how it impacts on that person and family, they are allowed to give chemo.
THE GRADUATE
Michelle Davidson (38)
Staff nurse, oncology, Auckland Hospital
Completed cytotoxic course October 2006.
Has been nursing for 18 years
I have done different types of nursing but not oncology. I chose chemotherapy because I wanted something that was challenging, rewarding and also a specialty.
That was the big thing. I wanted something that I could still have a good career with.
I have a young baby and I also wanted a Monday-to-Friday job and this job is interesting. You can administer and give chemotherapy and then you can work in the clinic answering phone calls.
There are a few facets in the area that we work in, it's changing, and it's a good skill. There is also an acute paitent section, which I haven't worked in yet, and that will give me more experience. Our oncology patients don't go to A&E, they come here.
I found the cytotoxic course really good. I started [as a nurse] in August which was two months before I did the course. It gave me time to do a workbook and to get a base for myself.
The course consolidated that theory and practical for me, and it confirmed that I was on the right track in my knowledge and what I was telling patients, and how I was finding administering chemo.
The qualification is a job requirement. With oncology as a base I can go into palliative care or into a hospice.
It gives me lots of avenues to work from. Having the cytotoxic course certificate, I can prove I have done something professional.
THE EMPLOYER
Fiona Gardiner, clinic co-ordinator
The decision to employ Michelle was based on a combination of her past experience, outstanding references, her apparent maturity and an obvious calm, open and sensitive nature.
Important qualities for this role are an ability to appreciate the vulnerable situations of patients, ability to work as part of a team, good communication skills, good stress management, the ability to work calmly under pressure, maturity and attention to detail.
Completing the cytotoxic course is a pre-requisite to being able to administer chemotherapy. It ensures that essential understanding of chemotherapy administration, the action of cytotoxic drugs and potential risks for the patient are in place before a nurse is involved in actual patient treatment.
Since the chemo course, Michelle has worked alongside and under the supervision of experienced oncology nurses and it is here that the knowledge and experience are consolidated.
