Teaching Chemotherapy Administration to the New Oncology Nurse

Last spring, I attended a chemotherapy and biotherapy course. Most of the nurses attending had administered chemotherapy for years, but a group of nurses new to oncology sat at the far end of the table. By the end of the first day of class, none of them had spoken a single word after the morning's introductions.

Concerned, I approached the instructor. She had noticed their lack of participation too and told me these nurses had expressed feeling overwhelmed by the amount of knowledge needed to safely administer chemotherapy.

I'm new at this

I recalled, years ago as a pediatric ICU nurse, admitting a patient in anticipation of tumor lysis syndrome (TLS). Although chemotherapy certified nurses administered the chemo, I was responsible for the patient's well-being in the ICU. I asked a lot of questions, probably too many. Weary of me, the oncology nurse coordinator remarked, "You worry too much. It's just chemo."

Somewhere between the coordinator's cavalier attitude and the paralyzing fear of nurses unfamiliar with oncology is the middle ground for teaching chemotherapy and biotherapy administration. Here are some suggestions:

1. Fear is the nurse's friend. Fear makes you look up medications and regimens you are unfamiliar with administering. It makes you ask a more experienced coworker for help. It makes you call the oncologist for clarification of orders when you are unsure, but don’t let it paralyze you. Fear is your friend. Embrace it.

2. Build on what you already know. Safe administration of all medications, including chemotherapy, is founded on the cornerstone of The Five Rights:
   • Right Patient
   • Right Medication
   • Right Dose
   • Right Route
   • Right Time

3. Right Now is what my husband, a hospital pharmacist, jokingly refers to as the "sixth right," as in, "the doctor wants the chemotherapy given right now." While promptness is a virtue, chemotherapy administration is similar to teaching a small child to safely cross a street: "Green means go when safe." Don't give the chemo until all of the double checks are completed.

4. Teach evidence-based practice, not your old war stories. None of us older nurses are as entertaining to new nurses as we think we are. As a preceptor, keep your pearls of wisdom short and relevant to the teaching situation.

5. “Knowledge isn't knowing everything but knowing where to find it,” said my ninth grade algebra teacher. Teach new oncology nurses the value of looking up medication administration information in your facilities' policies and up-to-date references. Here are some useful online reference links:
   • Cancer Management Handbook for iPad
   • Chemoregimen
   • UpToDate

What helpful advice would you offer new oncology nurses? What oncology references do you find particularly helpful?