How to Become a Hematology Nurse
March 15, 2021
Hematology nurses specialize in treating patients with blood diseases and cancers. It may not be the best-known or most popular of specialties, but it's an important one. Millions of people develop blood disorders each year, and like all patients, they benefit from competent, specialized care.
Throughout most of history, humans have been stunningly ignorant of how the circulatory system works. For thousands of years, blood and its purpose were shrouded in mystery. Bloodletting was employed to restore balance in the body. It was thought that people could have 'bad blood' and that blood was consumed by organs, then restored when one ate. We were bloody clueless.
The human circulatory system was finally mapped in the 1600s. Since then, our understanding of blood and hematologic diseases has improved dramatically. Today, we know much about how the circulatory system works and how to treat conditions like hemophilia, leukemia, multiple myeloma, and sickle-cell disease. That knowledge doesn't make receiving a diagnosis any less stressful for patients, however.
Doctors may create care plans for patients with hematological conditions, but hematology nurses usually spend more one-on-one time with those patients, answering their questions and offering comfort when they are frightened. They may also serve as de facto patient advocates in hematology because they're able to pick up on subtle clues about how patients are responding, or not responding, to prescribed treatments.
Some hematology nurses work exclusively with adults, others with children in pediatric hematology, and still others with both groups. Regardless, all nurses in hematology do more than just deliver infusions and take vital signs. It's a challenging specialty for many reasons and it's not for everyone.
In this article about how to become a hematology nurse, we'll explore the following questions:
- What is a hematology nurse?
- What do hematology nurses do?
- Where do hematology nurses work?
- What types of skills are needed to become a hematology nurse?
- What are the educational requirements to become a hematology nurse?
- Are there certifications for hematology nurses?
- What is the career and salary outlook for a hematology nurse?
- Should you become a hematology nurse?
What is a hematology nurse?
Hematology nurses—sometimes called blood and marrow transplant (BMT) nurses, oncology-hematology nurses, or malignant hematology nurses—are registered nurses (RNs) who have been specially trained to provide nursing care for patients with blood diseases and cancers. Nurses in this specialty care for patients with conditions like:
- Bone marrow disorders
- Von Willebrand disease
- Idiopathic thrombocytopenic purpura
- Sickle cell anemia
- Myelodysplastic syndromes
- Bleeding disorders
- Paroxysmal nocturnal hemoglobinuria
Because blood health can impact every system in the body, symptoms, treatments, and outcomes associated with blood disorders vary widely. Registered nurses and advanced practice nurses (APRNs) working in this specialty must know a lot about many different conditions and be comfortable working with patients who need very different types of treatments.
What do hematology nurses do?
When you become a hematology nurse, your day-to-day duties will be driven by the needs of your patients, the type of facility you work at, and whether that facility further specializes in the diagnosis and treatment of a specific condition (e.g., hemophilia, sickle cell anemia, or blood cancers). Depending on where you work, you might participate in bone marrow biopsies or blood and bone marrow transplants or administer chemotherapy and other infusions. That said, you will spend at least some of your time:
- Taking medical histories
- Performing physical exams
- Recording patient symptoms
- Monitoring patients
- Helping to develop treatment plans
- Answering patient questions
- Administering medications
- Educating patients before discharge
- Collecting blood samples
- Inserting catheters
- Managing patient pain
- Helping to perform diagnostic tests
If you're an APRN, you may also develop treatment plans on your own, prescribe medication, and order or perform diagnostic tests.
Nurses in hematology may spend more time with patients than any other professional in the department, and as you can see, they do more than just provide medical care. In this role, you'll help patients and families understand:
- Their diagnosis
- How the condition is treated in medical facilities and at home
- What the future may hold for them
Where do hematology nurses work?
Hematology nurses can be found in many settings, including:
- Blood disorder clinics
- Pediatric oncology and disease clinics
- Doctors' offices
- Cancer patient treatment centers
- Specialty nursing units
- Oncology specialist clinics
When you become a hematology nurse, you'll be able to work in any setting where patients are treated for blood-related illnesses, disorders, and cancers. It's not unusual for hematology nurses to work in oncology or for job listings to call for hematology/oncology nurses. Keep this in mind as you think about your education and what certifications you'll eventually pursue.
What types of skills are needed to become a hematology nurse?
You need sharp clinical skills to become an RN, but that's not all it takes. You'll also need:
- Compassion and empathy: Receiving a blood disorder or blood cancer diagnosis can be frightening and demoralizing for both a patient and their family. Hematology nurses must be sensitive to this and understanding when patients or caregivers are sad or scared. You must do what you can to reassure them without giving false hope and give them the information they need without overwhelming them.
- Listening and communication skills: One element of your job will be sharing highly technical medical information in ways laypeople can understand so you can guide patients on their treatment journeys. Sometimes, however, being a good communicator will mean closing your mouth. Remember, you can learn a lot about your patients' conditions by really listening to what they're telling you.
- Attention to detail: In both hematology and oncology (a closely linked specialty), nurses must keep their eyes open so they don't miss minute but important changes in their patients, issues with medication delivery or dosages, and problems with medical equipment. This is not a job where you can switch to autopilot.
- The ability to think quickly and critically: Hematology RNs care for patients with severe disorders. They have to stay calm and collected when a patient is in crisis. You may need to assess, in just a second or two, whether a treatment is working or needs to be discontinued immediately
- A strong support system: You will care for patients who are in a great deal of pain or feel utterly defeated by the suffering they have endured. Patients with whom you've grown close will die. Dealing with stressful emergency situations is simply part of the job. The most successful RNs are those who can compartmentalize and have strategies for dealing with the emotional aspects of the job.
What are the educational requirements to become a hematology nurse?
You may have wondered if a bachelor's degree in nursing is essential to get into the field. There are still nurses who enter the profession with an Associate Degree in Nursing (ADN), but it likely won't be long before a Bachelor of Science in Nursing (BSN) becomes the entry-level standard. More importantly, you may not be able to find a job in hematology (or oncology) without a BSN. If you're already an RN and want to specialize in hematology, there are RN-to-BSN programs that can help you get your bachelor's degree in nursing in less than the usual four years.
If you're new to nursing, you can find highly ranked BSN programs at the following schools:
Few nursing education programs at the bachelor's level offer students specialization or concentration tracks, so you probably won't be able to specialize in hematology during your undergrad years (outside of a clinical rotation in oncology). Still, you should look for BSN programs that offer students the opportunity to take courses in blood disorders or hematology and oncology.
Having a BSN does not, by itself, make you a nurse. You must also pass the National Council Licensure Examination (NCLEX-RN) exam and apply for your nursing license from your state board of nursing. From there, you could go straight into a Master of Science in Nursing program that doesn't require work experience (be aware you probably won't find one with a hematology subspecialization; a nurse practitioner program is a solid choice). Alternatively, you could start working as an RN and then transition into hematology once you've amassed a few years of clinical experience.
If you do go back to school to get your MSN, you'll be eligible for the Oncology Nursing Society's Post-Master's Foundation in Hematology, which is designed in collaboration with the American Society of Hematology to teach advanced practice nurses more about benign and malignant hematologic disorders. The continuing education course covers topics not necessarily covered in most master's in nursing programs, such as:
- Hematologic conditions
- Hematologic emergencies
- Consultative hematology
- Transfusion medicine
- Hematopoietic stem cell transplantation
- Other practical skills relevant to hematology medicine
Are there certifications for hematology nurses?
Yes, though not many. Most are offered through the Oncology Nursing Certification Corporation (versus an organization specific to hematology medicine). You can get certifications like:
- The Hemostasis Nursing Certification
- The Certified Pediatric Hematology Nurse credential
- The Oncology Certified Nurse credential
- The Blood & Marrow Transplant Certified Nurse credential
- The Advanced Oncology Certified Nurse Practitioner credential
- The Chemotherapy and Biotherapy Course credential, which grants a chemotherapy provider card
What is the career and salary outlook for a hematology nurse?
The US Bureau of Labor Statistics (BLS) doesn't track the earnings and job growth for hematology nursing specifically, but it does publish income and job growth data for registered nursing. The median pay for RNs is $71,730 per year; 371,500 new jobs for registered nurses will be added between now and 2028. It's important to remember, of course, that the BLS's long-term projections don't account for short-term economic changes or nursing shortages and surpluses in different areas of the country, all of which may affect job availability.
Very few resources for job seekers track pay trends for hematology nurses. ZipRecruiter, however, has a very thorough breakdown of hematology nurse salaries that found that most hematology nurses make somewhere between $56,000 and $110,500 per year. That's a huge range, and while the average salary ends up being $98,233 per year, how much you'll actually make when you become a hematology nurse will depend on a lot of factors. Are you an RN or did you go back to school to become an APRN? Do you have a BSN or MSN? Where you work (both which state and what type of facility) will also impact your salary and overall earning potential.
You can maximize your income now and in the future by:
- Getting a master's degree in nursing and becoming a nurse practitioner or clinical nurse specialist -Accumulating as many relevant nursing certifications as you can
- Earning a compact RN license that allows you to practice in more states.
Should you become a hematology nurse?
To answer this question, consider how you'd feel working in oncology. Chances are that more than a few of your patients will be receiving cancer treatments when you become a hematology nurse. You may even end up in oncology because there is a significant overlap between hematology and oncology, and some facilities group patients together. You need to be sure you're comfortable working with both populations before you choose hematology nursing as your specialty.
If you do feel called to this work, your career should be a rewarding one. Abby Roth, RN, Outpatient Clinic Nurse, and Sickle Cell Program Coordinator at American Family Children's Hospital, shared what she loves about being a hematology nurse on the hospital's blog: "To be able to educate these patients on their chronic condition, while also encouraging their independence to be an advocate for their health, is very fulfilling."
You also need to think about how well you'll cope with losing patients. Blood diseases and blood cancers are quite severe health conditions, and you will likely end up working with very sick people. Over time, you'll form close relationships with your patients and their families. It can be emotionally draining to watch some of those patients go into decline and pass away. Some people aren't able to fathom how anyone could do that and keep on going. Other people—and you may be one of them—can't imagine doing anything else.
If you've considered these challenges and others and you're still not sure whether you should become a hematology nurse, look for ways to spend some time shadowing medical professionals in hematology and oncology. That should give you some perspective and help you decide whether this is the right nursing specialty for you.
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