Two nurse leaders offer their top tips

1. Set up routine processes and algorithms so nurses can more easily make decisions about treating immediate patient needs.

The most effective nurses are the best-supported nurses. Providing proper training and developing routine processes and algorithms empower nurses to make decisions about treatment when appropriate. Opportunities for quick physician consultation also provides nurses with the support they need.

At Mount Carmel Health System, nurses interact with physicians five days a week in daily rounds. There are weekly interdisciplinary team meetings that further strengthen this interdisciplinary collaboration. At the meetings, the team discusses cases in more detail, shares information, solves problems and learns from each member. A palliative care physician is on-call 24 hours per day, seven days per week.

At Massey Cancer Center, there are 18 evidence-based algorithms in place which are reviewed every year and approved by the attending physicians for palliative care patients on our unit. Trained nurses on the unit can use the algorithms to promptly treat dsypnea, anxiety or pain, for example, which makes them better able to respond quickly to patient and family needs. Patients get immediate treatment and positive outcomes without needing to wait for the doctor. The nursing staff knows they are giving the right treatment in a timely fashion.

2. Create a culture of flexibility and responsiveness to patient needs.

Even with good processes and procedures in place, there may be uncertainty and gray areas. For instance, understanding a patient's goals of care can be time consuming and complex. However, these conversations are critical to providing appropriate care. By focusing on and setting a patient's goals of care, it's much easier to know how to proceed. If you're wondering whether to draw a lab on a patient or provide antibiotics to an elderly person with aspiration pneumonia, there is no right or wrong textbook answer. The answers should be determined by whether these actions meet the goals of care.

Guidelines in a unit or on a service are necessary, but they should not be viewed as hard and fast rules. Here are two cases from Massey Cancer Center to illustrate the point: