While 2017 is still in its infancy, nurse navigators from throughout the country are already hard at work trying to ensure their navigation programs end the year more successfully meeting the needs of patients.
Five nurse navigators discuss what they are planning to do to improve their navigation programs in 2017. Note: Navigators are listed in alphabetical order by last name.
Kimberly Bielecki, RN, BSN, MBA, oncology nurse navigator for the Norma Pfriem Cancer Institute at Bridgeport Hospital in Connecticut: Oncology nurse navigation at Bridgeport Hospital had been enhanced over the past six months with an “oncology patient navigation” referral system, incorporated into the EPIC clinical information system.
Physicians, which include medical and radiation oncologists, advanced practice registered nurses and physicians who utilize the EPIC system have the opportunity to refer a patient directly to oncology navigation. The navigators are responsible for checking the work queue daily to review the referrals and “assign to user” those patients who should be followed by a specific navigator.
Referrals are diagnosis specific to each navigator. There are four social work navigators and two nurse navigators to whom patients are referred. Three of the navigators are breast cancer specific. The remainder of the patients are followed by the other three navigators.
Patients are also referred by nursing staff at the oncology practices, with information provided in “staff messages.” Follow up on navigation is documented by the navigators in the clinical notes or telephone contact section of the electronic medical record.
Patients are also referred by medical oncology, radiation oncology as well an inpatient referrals when a patient completes a distress screening tool, which is self-administered and focuses on practical, family, emotional, physical problems and spiritual/religious concerns. The navigator utilizes this tool to focus her efforts that the patient has identified as problematic once diagnosed.
Deborah L. Danko, RN, OCN, oncology nurse navigator at Cayuga Medical Center in Ithaca, N.Y.: Within our program we are hoping to implement several improvements.
Reevaluating our survivorship program process and document is number one on our list. Initially, we have created our own document working from some of the best practice documents on the Commission on Cancer website. We are now looking at working with our tumor registry for inputting information, trying to incorporate Journey Forward or another survivorship care plan document and streamline our process.
Of our leadership team, we have requested the hiring of oncology social workers as their expertise is needed for psychosocial issues and counseling. In particular, families with children and sexuality/intimacy concerns can be better served, which is a much-needed service.
In addition, we are requesting another full- or part-time nurse navigator as we have seen increases in our patient numbers and therefore a growing demand to provide financial and transportation services, and required survivorship care plans.
The navigation of our patients has led to better outcomes and increased patient satisfaction. It is recognized that, indirectly, we save money and time. However, it is difficult to justify more staff up front without revenue. The request that we receive for our patients continually increase, as well as our responsibilities for outreach events. Our navigation program team members will be sitting down with our provider group and administrators to discuss boundaries and expectations. I look forward to this discussion, as not everyone is aware of all that we do.
Sharon Gentry, RN, MSN, CBCN, CBEC, breast nurse navigator for the Novant Health Derrick L. Davis Cancer Center in Winston Salem, N.C.:
At the Cancer Center, one of our visionary goals in 2017 will be to compose a survey for our patients, oncologists and referring providers. It will be a team effort among the nurse navigators that will start with a literature review on navigation surveys. This review will allow us to see what worked or was not successful in other navigation programs. It will also allow us to explore different formats such as a Likert scale or open-ended questions.
Next steps will be composing the survey and attempting to ask the questions in a way to get meaningful data for the improvement of our entire program. The old adage: You get what you ask for. A trial of the survey will allow us to see what feedback we receive and whether the questions asked in a meaningful way.
Katherine Mulloy RNC, MSN, breast cancer nurse navigator for Saint Thomas West Hospital in Nashville, Tenn.: I have practiced here for a year, but have 30 years of experience in nursing and breast cancer care as a nurse practitioner. Through my research for a talk that I was giving in September 2016 for the National Mammography Society here in Nashville, I came to believe that the practice of compassionate mindfulness would be a great addition to my program here at Saint Thomas West.
The research suggests that these practices of becoming attentive to our daily actions can help a great deal to reduce stress. When we meet with new cancer patients, we determine a distress score. Their scores can be quite high depending on their resources and life circumstances. The research has encouraged me that by living mindfully every day upon our waking and becoming attentive to the ways in which we handle our stress can make a huge difference in a cancer patient’s daily life.
Take the real life experience of a young woman, mother, wife with three children who learns that she has a breast cancer and will need surgery and treatment. By helping her explore her daily routine during my pre-op surgery class, I have helped her see that just by stopping the things that she is not mindfully doing all day long and the things that she does not have to do will help her save precious energy that will improve her recovery and help her mind and body get through her treatments.
Our social worker is taking a class to become certified in mindfulness. Together, we can fully implement this new concept into our program here. We also offer acupuncture and have a wellness center here that we plan to partner with once our program is in place.
Cheryl Wood, RN, BSN, GI nurse navigator for Saint Thomas Midtown Hospital in Nashville, Tenn.: My colorectal navigation program is still in its infancy, so I’m looking forward to program development in 2017 to include more physician awareness and buy-in. I’ve been in this role since April 2016, so I’ve had a few months to develop my own technique to patient involvement, realizing there are a couple of areas I want to improve and grow.
First, patient resources, specifically knowing what services/aid is actually available. There is plenty of literature pointing patients to a specific organization, resource or foundation (such as for financial assistance), only to find that the foundation is closed, or that you’re redirected to yet another resource, making it difficult to truly find any answers. It’s discouraging and frustrating for me, so I can just imagine how it makes an overwhelmed cancer patient feel. I want to be able to dig deeper into these resources, especially financial, so I can direct patients to clear answers.
Second, patient education. I want to somehow establish a way to be on the front end of educating the patient on his/her diagnosis and explaining treatment, surgery, etc. — but not get into the specifics of chemo/radiation. This will hopefully be included in program development and broaden as discussions with colorectal surgeons occur.