How We Practice

At MSK, our guiding principles are constant throughout the various 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. By participating in peer review, MSK nurses continually embrace opportunities to help one another grow in our professional practice.
• 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 promote a spirit of inquiry across the organization in all practice settings.
• 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, and 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 doctors and other members of the care 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

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.

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 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:

Caring, Healing, and Innovative Environment

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.

Leadership

Leaders understand the principles of RBC and support its implementation, empowering frontline staff and removing barriers to care.

Teamwork

The MSK Department of 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.

Patient Care Delivery — Primary Nursing

Relationship-Based Care 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 relationship between nurses, patients, and families 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 a patient’s care plan.

Outcomes

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 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.

Resources

Nursing practice at MSK supports shared responsibility between frontline managers and direct care staff for the fiscal health of the unit. Being good stewards 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. It serves as a forum to ensure communication within and across the department. Across the divisions, council membership represents all practice areas. Council activities align with departmental and organizational goals.