For Healthcare Professionals: Pre- and Postoperative Nursing Care

Patients arriving for surgery at Memorial Sloan-Kettering are assigned a team of nurses at the Presurgical Center (PSC).

During pre-admission testing, a nurse practitioner completes a medical history, physical exam, pre-anesthesia evaluation, blood work, and EKGs. Two days before surgery, the nursing staff at the PSC reviews the patient’s medical records to assure completion of all preoperative requirements. 

One business day before surgery, a PSC nurse provides preoperative screening via telephone. During the call, the nurse completes a high-risk assessment, provides preoperative patient education, and establishes an individualized care plan that includes recommendations to assist the patient during his or her postoperative recovery. 

On the day of surgery, a nurse in the PSC evaluates the patient to ensure that all preoperative requirements have been met. In addition, an anesthesiologist may place an epidural catheter preoperatively to control postoperative pain. 

Following interventional radiology procedures and same-day surgery, nurses monitor the patient’s status in the PSC until he or she is stable enough for discharge. All patients recovering in the PSC receive postsurgical education and discharge instructions.

Twenty-four hours after discharge from the Surgical Day Hospital, every patient receives a follow-up telephone call from a PSC nurse.

Immediately following surgery, endoscopy, or high-risk interventional radiologic procedures, patients are admitted to a post-anesthesia care unit (PACU). The nursing staff here provides advanced care to patients to ensure a safe and efficient recovery from anesthesia and sedation.

PACU nurses, some of whom are perioperative clinical nurse specialists, work closely with pharmacy, social services, surgery, respiratory therapy, and other staff members as dictated by a patient’s condition.

While a patient is in the PACU, the registered nurse assigned to the family updates them on developments and facilitates postsurgical conferences between surgeons and families. Patients are discharged from the PACU to their homes or directly to an inpatient unit.

Memorial Sloan-Kettering’s 13 acute inpatient units serve as hubs for disease management teams focused on the following areas: bone, breast, central nervous system, gastrointestinal, genitourinary, gynecologic, head and neck, hepatobiliary, and thoracic tumors; hematology;  leukemia; lymphoma; melanoma; pain and palliative care; pediatric cancers; and soft tissue sarcoma.

Within each team, physicians, consultative specialists, registered nurses, and allied healthcare professionals function collaboratively to achieve the best possible outcome for each patient. There are various levels of nursing expertise within the acute care setting, including advanced practice nurses (clinical nurse specialists and nurse practitioners), many of whom are nationally and internationally recognized in their specialties by organizations such as the National Cancer Institute, the Oncology Nursing Society, and the American Society of Clinical Oncology.    

Nurse practitioners work on many acute care units and collaborate with a patient’s primary physician and unit practice nurses to assess patients and provide medical intervention and documentation to report treatment responses, toxicities, and adverse events to medical staff.

Nurses in acute inpatient and surgical care are required to maintain core competencies that include the following:

• Extensive didactic knowledge in the care of cancer patients
• Proficiency in evaluating psychomotor skills
• The ability to administer medications and treatments via many different methods.

Nurses who are subspecialized in wound ostomy, diabetes education and wound management, IV placement, and chemotherapy administration care for patients with these complex needs. 

Memorial Sloan-Kettering's intensive care unit is equipped to address the unique needs of cancer patients, providing ventilatory management and continuous invasive monitoring of vital signs. There are 20 beds in this 18,000-square-foot facility, and each patient occupies his or her own 300-square-foot private room.

The ICU staff includes two levels of nurses: nurse practitioners who collaborate with physicians in the care of patients, and bedside nurses, who have special training in the care of ICU patients.

Our ICU nurse to patient ratio is 1:1 or 2:1.

Advanced Design

Nurses were closely involved in the design of our ICU, highlighting their role in improving our ability to treat critically ill patients and enhance the patient and family experience. 

Patient rooms feature natural lighting and electronic glass to increase privacy while decreasing infection and cross-contamination risk.

Ceiling booms allow beds to be rotated enabling clinicians to perform procedures or to accommodate devices such as ventilators, dialysis machines, and ultrasound technologies.

A window between the workspace and the room allows nurses and patients to remain within sight of one another, helping to ease patients' anxieties and enabling nurses to observe seriously ill patients while they work.

Each room also has its own laboratory labeling machine and bar code scanner so staff can immediately label specimens taken from a patient. This greatly reduces the chances of a specimen being mislabeled.

The Step-Down Unit on the 18th floor of Memorial Hospital was created in 2010 to meet the needs of patients too ill to be admitted to an inpatient room but not requiring ICU admission. The unit has 36 beds.

Nurse practitioners provide 24/7 care. The ratio of critical care nurses is 1:3 or 1:4, and each nurse on the unit receives didactic training in critical care and dysrhythmia to meet the special needs of these patients.

Advanced features of the Step-Down Unit include:

• A virtual, surgical advanced care approach
• Consolidation of mechanically ventilated patients
• Specialized care for complex surgical patients
• Bedside cardiac monitoring
• In-room medication work stations
• A dedicated room for morbidly obese patients (those over 350 pounds)

Memorial Sloan-Kettering’s Urgent Care Center (UCC) is a 24-hour outpatient assessment and treatment area for adult patients who require urgent/emergent care. Services provided include:

• Evaluation, initial treatment, and hospital admission or discharge home
• Treatments, including antibiotics and supportive care
• Evaluation of patients transferred from other institutions
• Blood transfusions

The UCC has 13 beds, six single isolation rooms, a medication room, and a transfusion/chemotherapy area with four recliners and two triage rooms. An around-the-clock laboratory, blood bank, radiology, and other services are available.

The unit is staffed with a medical director, attending physicians, nurse leaders, clinical nurse specialists, nurse case managers, registered nurses, clinical pharmacists, patient care technicians, and unit assistants.

Integration of Services

Typically patients are referred to the UCC by their primary physicians, nurses, or oncology fellows and come directly from home, other institutions, or one of our ambulatory sites. Following triage and evaluation by the nursing staff and an attending physician, treatment requirements are discussed with the primary physician or covering physicians. Special consultations are available as appropriate.

Admission and Discharge Guidelines

For patients requiring inpatient admission, assessment data and the initial treatment plan are communicated to the inpatient medical and nursing staffs responsible for the patient’s continuing care.

Referrals to specialists from other healthcare disciplines may be made upon discharge. Case management works with the UCC to identify and coordinate services for patients who need another level of care. For example, patients may be transferred from the UCC to other institutions for specialized care not available at Memorial Sloan-Kettering, including but not limited to treatments for burns, cardiac procedures or CCU care, acute ophthalmologic emergencies, and acute orthopaedic problems not related to malignancy.