Memorial Sloan Kettering’s Department of Nursing provides the highest quality cancer care to patients of all ages across the continuum of care — prevention, risk determination, detection, treatment, symptom management, survivorship, and end-of-life care — and in a wide variety of clinical settings, including:
- outpatient screening centers
- outpatient office practice and treatment sites
- acute and intensive inpatient units, including pediatrics
- urgent care center
- diagnostic and interventional procedure areas
- perioperative units
At MSK, our guiding principles are the constant throughout the different practice settings.
- We provide patient- and family-centered care that is research and evidence based.
- We strive to deliver compassionate, effective, and safe care.
- We recognize the importance of healthy working relationships with colleagues.
- We base our interdisciplinary teamwork and collaborative decision-making on a foundation of trust, mutual respect, open and honest communication, and constant and visible support among our colleagues.
- We embrace learning as a lifelong process that is essential to professional growth and development for clinicians who strive to deliver quality patient care.
- We endeavor to make the most effective and efficient use of internal and external resources.
- We acknowledge that maintaining high-quality patient care requires a continual process involving patients, family members, nurses, all other healthcare professionals, and the community at large.
- We cultivate an environment of professional responsibility, integrity, accountability, autonomy, and resourcefulness. In accordance with the American Nurses Association’s Code of Ethics, we support the conduct of ethical behavior.
- We respect the diversity of our patients, nurses, staff, and the communities we serve.
- We respect diversity of thought and opinion.
- We reward initiative and celebrate achievements.
We provide nursing care in collaboration with physicians and other members of the healthcare team. The scope of our nursing practice is dynamic and changes as health science, health practice, and society itself change. Our professional practice model is Relationship-Based Care and our care delivery model is Primary Nursing.
Primary Nursing, the identification of a nurse–patient/family dyad, promotes continuity of care and the opportunity for trusting, healing relationships to grow. MSK nurses use the Primary Nursing model as the structure for organizing and delivering care to patients and their support system, based on the power of the therapeutic, healing relationships that the model promotes. Primary Nursing fosters safe, high-quality care.
the nurse is knowledgeable
the nurse is accountable
continuity of patient care is a basic precept
These principles provide the bedrock of nursing practice. They ensure patients’ and families’ needs are identified and included in the plan of care and that these needs are coordinated among all disciplines to achieve optimal outcomes.
Our Professional Practice Model: Relationship-Based Care
Our nurses continuously strive to define best practices in Relationship-Based Care (RBC) by focusing on caring and therapeutic relationships with patients and families, collaborative and respectful relationships with colleagues, and optimal work–life balance for themselves. RBC proposes that these relationships promote a healing power for patients and their families, as well as a source of fulfillment for nurses. Our nursing leadership adheres to the following set of attributes, which provide the framework for an RBC nursing practice model:
The care setting encompasses the physical environment as well as the caring behaviors exhibited by staff. Simple, effective caring measures are incorporated into the patient care experience. An example is having a five-minute, seated conversation with the patient early in the care encounter to find out what the most important thing is to the patient during the current care encounter.
Leaders understand the principles of Relationship-Based Care and support its implementation, empowering front-line staff and removing barriers to care. Leaders know the vision, mission, and care philosophy and ensure integration of the principles of Relationship-Based Care into the strategic plans at every organizational level.
MSK nursing supports interdisciplinary collegiality and fosters the interpersonal traits of trust, mutual respect, open and honest communication, and consistent and visible support. Teamwork requires a group of diverse members from all disciplines and departments to define and embrace a shared purpose and to work together to fulfill that purpose.
RBC as a professional practice model supports a primary nursing-care delivery system, with defined principles to maintain caring as the central element of professional nursing practice. The nurse–patient/family relationship is central and drives work allocation, team communication, and management of the work environment. The primary nurse has the authority to take responsibility for, and be accountable for, the development and implementation of the patient care plan.
Delivery of professional nursing services in the context of an organized care delivery model is a comprehensive process. The foundation for a professional practice model is laid when the professional nurse takes responsibility for establishing a therapeutic relationship with the patient and determining the nursing care the patient will receive. Resources are used efficiently when the principles of professional practice and care delivery are clearly delineated and articulated.
We evaluate our performance using nurse-sensitive indicators, patient and staff satisfaction indicators, and outcomes that reflect RBC principles. We measure our performance against several peer groups by participating in external benchmarking databases such as Press-Ganey, the National Healthcare Safety Network, and the National Database of Nursing Quality Indicators. We also set internal target goals for other quality indicators such as extravasations, pain assessment, post-chemotherapy telephone calls, adult health screening, smoking cessation, and more. Achieving quality outcomes requires planning, precision, and perseverance.
Nursing practice at MSK supports shared responsibility between front-line managers and direct care staff for the fiscal health of the unit. Critical thinking about maximal utilization of internal and external resources to provide optimum care for patients is vital.
Shared governance is one of the cornerstones of Relationship-Based Care. MSK nurses believe in fostering an environment that promotes professional responsibility and accountability. Our council structure facilitates shared leadership and supports nursing autonomy.
Chaired by the Chief Nursing Officer, the Nursing Board comprises a diverse group of departmental council leadership, nursing leadership, nurses representing various specialties, and all clinical levels and support staff. The Nursing Board provides oversight and coordinates council and committee activities. It serves as a forum to ensure communication within and across the department and provides final approval for all departmental council recommendations, including nursing policies and procedures and clinical staff promotions.
At the departmental level, individual councils are accountable for clinical practice, professional development, quality, informatics and recognition, and retention and recruitment. Councils in the perioperative division are organized by function and include perianesthesia, intraoperative, radiology, and endoscopy. Across the divisions, all councils are led by nurses with membership representing all practice areas.
Each division has a coordinating council. This council, comprising nursing leadership, council chairs, and co-chairs, is where the partnership between staff and operational leadership transpires. The council integrates activities and ensures that council goals are aligned with the department, as well as the organization.
Unit-based councils led by staff are responsible for implementing the principles of Relationship-Based Care within their practice environment. To facilitate vertical integration within the department, divisional chairs and co-chairs are also members of the departmental council.