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Common nursing problems are related to the primary disease and disease-
or treatment-related symptoms, and include:
- Protective mechanisms: Alterations in mobility,
skin integrity (including GVHD), and neurologic status; and myelosuppression
- GI and GU Function: Alterations in elimination
and nutrition
- Cardiopulmonary Function: Alterations in
ventilation and circulation
- Oncologic Emergencies: hypercalcemia, DIC,
SIADH, sepsis, tumor lysis syndrome, hypersensitivity reactions,
cord compression, ICP, cardiac tamponade, and SVC syndrome
- Quality of Life: Sexuality, pain, fatigue,
altered body image, coping.
Staff nurses support the organizational mission
and the Cancer Center investment in clinical research. In tandem
with the Cancer Center Protocol Office and the Research Nursing Director,
staff nurses participate in the administration of all phases of
clinical trials on which their primary patients may be enrolled.
The Infusion Unit nurse is responsible for patient education, medication
administration, symptom management, and documentation of toxicities
for those patients participating in clinical trials as those patients
receiving standard regimens.
Patients are followed throughout the entire
trajectory of their illness: diagnosis and treatment, rehabilitation,
long-term follow-up, and when necessary, palliative care. There
is a strong commitment to primary nursing. Patients readily identify
the nurse most involved in their care. However, all disciplines
are involved in providing care and are as diverse as the range of
needs patients express. These disciplines include social service,
nutrition, psychiatry, palliative care service, pain service, occupational
and physical therapy, and chaplaincy.
PATIENT CARE DELIVERY MODEL
Nurses are committed to primary nursing
and work in a collaborative practice model with physicians and nurse
practitioners, in the Division of Hematology-Oncology.
Nursing care is guided by institutional and
national standards. These standards of care include those developed
by the MGH Department of Nursing and the national standards of care
developed by the Oncology Nursing Society with the American Nurses
Association.
Nurses who are assigned to the Infusion Units
will be certified in chemotherapy administration and blood product
administration as described by the MGH Center for Clinical and Professional
Development (CCPD).
TEAM MEMBERS
Registered nurses (RNs) who are certified
in the administration of chemotherapy and blood products work in
collaborative practice with oncologists and nurse practitioners.
Critical Care Technicians (CCTs), directed by the RN, support the
RN in delivering patient care. An Oncology Care Coordinator is available
to assist the nursing/medical staff with planning patients' complex
home care needs, including home IV therapy, prescription drug reimbursement,
and facilitate referrals. Secretarial staff support the overall
operations and scheduling.
Nursing Directors, a clinical nurse specialist
and an operations coordinator make up the management triad. This
team is responsible for establishing standards for care, initiating
quality improvement projects, and setting/supporting the overall
tone for patient care. To inquire about
positions available on this unit, contact Jeff Hickey at jjhickey@partners.org.
SCHEDULING PRACTICES
The unit budget is prepared and negotiated
annually prior to beginning of the fiscal year using current and
historical data and trends in volume (workload) and resource utilization
and in concert with unit, departmental, and hospital goals and projections
(personnel budget, FTE budget). Performance against budget is reviewed
and adjusted during the fiscal year as needed based on major changes
in activity, resource requirements, goals, or projections.
STAFF ORIENTATION
Nurse orientation to the Infusion Units
requires a minimum of six weeks. New nurse employees to the MGH
will be required to attend Hospital New Employee Orientation, General
Nursing Orientation through The Norman Knight Nursing Center for Clinical & Professional Development, and a unit-based
orientation. Transfers from other nursing units within MGH where
chemotherapy administration is included in the scope of practice
will require orientation to the Infusion Units.
RNs are expected to have completed both Hospital
Orientation and Nursing Orientation and the associated competencies
before proceeding to Unit orientation. Successful completion of
Unit-based orientation requires (but is not limited to) completion
of chemotherapy, blood product, research, and ambulatory infusion
competencies.
CCT Orientation requires a minimum of four weeks.
CCTs are expected to have completed both Hospital Orientation and
Nursing Orientation and the associated competencies before proceeding
to Unit orientation.
Practice Assistant orientation requires a minimum
of four weeks. Orientees are expected to have completed Hospital
Orientation before completing the Unit orientation.
EDUCATIONAL AND DEVELOPMENT OPPORTUNITIES
Infusion Unit staff nurses support the
organizational mission and the Cancer Center investment in clinical
research. To that end, nurses are provided with education from the
Research Nursing Director and designated clinical research nurses,
which includes didactic information and clinical precepting. This
is done on an individual basis because of the growth in the number
and complexity of clinical trials, the evolving nature of experimental
cancer therapies, and the Infusion Unit's commitment to disease-focused
treatment teams. Thus, the disease-related collaborative practices
develop proficiency in the trials associated with their clinical
focus.
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