July 29, 2008

Infusion Therapy Offers a Niche for Nurses

DALLAS -- As more medications become available on an outpatient basis, the boom in infusion centers bodes well for nurses wanting to work in this niche.

Infusion therapy is the intravenous administration of antibiotics, chemotherapy, pain control, nutritional support or other medicines.

There are infusion centers in doctors' offices, hospitals and free-standing clinics. And some nurses travel to provide infusion as part of home health care.

"The patients are happy to be an outpatient and realize that up until recently, they would have required hospitalization for treatment, and find this a real improvement for their quality of life," said Linda S. Cole, a registered nurse at Presbyterian Hospital of Dallas.

Cole, who works in the outpatient clinic, has been an infusion nurse since 1988. In her previous position, she was an inpatient oncology nurse.

While infusion nurses deal mainly with cancer patients who require chemotherapy, they also provide antiviral therapy, hydration and electrolyte replacement, immunosuppressants, catheter care and more. They also monitor patients for severe reactions.

Sarah Lowry views herself "first and foremost as an oncology nurse." But her initial encounter with infusion involved lupus, not cancer.

"I was about 5 years old when my best friend's mom had lupus and was on hemodialysis for renal failure," said Lowry, 24, a registered nurse at Baylor Regional Medical Center of Plano, Texas.

"This friend always had the best and most upbeat attitude, and I remember thinking that I wanted to take care of people like her when I grew up. I mistakenly thought that hemodialysis was a treatment for cancer, because I thought that lupus was cancer."

As a teen, she learned that lupus is a nonmalignant condition. But by that time, she had long set her sights on cancer care and decided to stick with it.

Chemotherapy infusions vary greatly in time and precautions. Some medications take only a few seconds to administer, others require several hours. And for certain medications, patients are sent home with a portable infusion device.

"Sometimes, when people are too sensitive to the medication, or it is not safe to send home with them but it will take longer than outpatient office hours, the patients come into the hospital for the infusions," Lowry said.

With the scarcity of hospital beds and more cancer treatments occurring in outpatient settings, infusion nurses stay busy on the job.

"You can never have too many hands helping out," said Jessica Bailey, 25, an infusion room nurse at Children's Medical Center Dallas.

Guiding youngsters and their families through tough times makes her role rewarding. "The most challenging part of my job is finding enough hours in the day to accommodate all the patients and keep everyone satisfied," she said.

Children are often afraid of the needle stick before infusion. To create a comfortable environment, the hospital's Center for Cancer and Blood Disorders provides movies, games and toys.

Adults also can be squeamish about the needle. Having a caring nurse tell them the medication's name, dosage and potential side effects can help. Patients are monitored closely during infusions, said Mary McCray, 61, a clinical coordinator at Methodist Dallas Medical Center. The variety includes kidney patients who need outpatient surgery.

"Mornings are busiest, where we can have four to five admissions within an hour," she said. "It can be challenging at times to get everyone admitted and prepared for ordered procedures and treatments."

Finding a balance between enough qualified staff and patients is a constant concern, said Cora Vizcarra, president of the 6,000-member Infusion Nurses Society and a self-employed consultant in Indianapolis. (The Infusion Nurses Certification Corporation awards a credential to nurses who meet criteria and pass an exam, she added.)

Nurses in their 20s may gravitate toward infusion because it generally offers weekday schedules that allow them to enjoy weekends and holidays off. But at least a year or two of more supervised experience is necessary to better meet patients' needs in this fast-paced environment, said Presbyterian's Cole.

"This is definitely not a good first job out of school," she said.