A nurse navigation program was created at the Curtis and Elizabeth Anderson Cancer Institute (ACI) at Memorial University Medical Center in Savannah, Ga., around 2002. It was initially comprised of two nurse navigators. The program was reorganized and expanded in 2012 to better meet the needs of the organization’s patients.
The program now has five nurse navigators, including a nurse manager who also provides navigation services to the gynecologic/oncology cancer patient population. Three of the navigators have earned their national certification in oncology (OCN) and two are scheduled to test for their certification later this year.
The nurse navigators serve patients with the following diagnoses: breast (covering both diagnostic and treatment), esophageal, gynecology/oncology, GI, head and neck, hematologic, lung, and melanoma. Four of the ACI’s navigators are focused on the treatment phase of the care continuum and one is the breast diagnostic nurse navigator (BDNN). The BDNN connects with patients at the point of an abnormal mammogram and supports them through resolution of the abnormal results. Although these are the navigation specialties, all patients with any cancer diagnosis who are referred to navigation will receive navigator services to assist them in their cancer journey.
The organization’s latest study was completed to measure the value of the nurse navigation program evaluated patients’ time from surgical referral to surgery. Based on the concept of precision medicine, the ACI created algorithms to identify breast cancer patients who need additional testing or consultation after their initial diagnosis. By using the algorithms early in the referral process, the BDNN determines which patients will benefit from having the additional results at the initial surgical consultation. She then schedules the necessary procedures and combines the appointments to save the patient time, money, and added stress often experienced when the time to treatment is extended.
Since implementing this new workflow, the time from diagnosis through adjuvant therapy has decreased by 25 percent. Patients are beginning treatment more quickly and avoiding preventable process delays. Maximizing individual patient care coordination has both improved the patient experience and increased patient satisfaction.
History and Future
Karen Terry, MPH, CHES, director of operations for ACI and Vivian Palefsky, RN, MSN, OCN, manager of navigator services for Memorial Health University Medical Center, spoke with NurseNavigation.com about the history and future of the navigation program.
Q: Why did your organization start a nurse navigation program?
A: Our organization recognized that receiving a cancer diagnosis can be a frightening and overwhelming time of life, and the administration wanted a personal, professional solution. The process of testing and treating cancer patients is a challenging journey for many patients. Our hospital has increased the number of specialized physicians and cutting-edge technology to address the patients health care concerns and needs.
While this has provided more successful ways to treat cancer in our community, there is more information to understand and appointments to coordinate at such a potentially stressful time of life. Our administration and physicians realized that the patient journey had become more complex and more difficult to organize, plan, and coordinate care. The oncology nurse navigation program was reorganized to work in tandem with the ACI’s physicians, social workers, and other health care team members to assist patients in better understanding their disease and treatment options, and assist in ensuring a coordinated, streamlined experience.
The goal of guiding the patients through the maze of appointments and treatments is to decrease the patients’ fears and allow them to increase their focus and energy on treatment, recovery, and survivorship. It is also intended to provide a point of contact for the patients to decrease confusion regarding which office to call with questions and improve communication among the disciplines.
Q: What role does navigation and your navigators play in supporting your organization’s mission?
A: Our organization’s mission is “With compassion, we heal, teach, and discover.” The oncology navigation program utilizes the organization’s mission as its core goal. Our patients can be reassured that the nurse navigators will assist them in getting answers to their health care questions, suggest available alternative therapies to promote healing of spirit, mind, and body, and work with the physicians and clinical trials team to ensure that each patient is screened for eligibility for trial participation.
Q: What is the most important value your program provides?
A: The most important value is to provide individual care focused on each patient’s needs and concerns. For some patients, the nurse navigator’s value is in helping them understand disease process and treatment or provide a “roadmap” of consultations, tests, and treatments. For others, it’s coordinating their appointments or connecting them with financial and social resources. For some, it’s having an unbiased, non-judgmental professional to listen to their concerns and help them work to resolve their issues or to make the best decisions that fit into their belief system. The role of nurse navigation is very multifaceted and requires nurses to use their education, experience, compassion, and problem-solving skills.
Q: What does your organization do to support the program?
A: Our organization supports navigation by recognizing the importance of nurse navigators and providing the funds to hire and maintain a navigator team for oncology patients. It also encourages navigator team members to practice at the top of their license by having or working toward national certification in oncology and to stay updated in cancer care by attending continuing education workshops and conferences.
Q: What plans do you have to further grow your program?
A: It is imperative to grow the navigation program to fit the needs of our patients, community, and health care team. Since navigation is a relatively young profession, growth and development are expected as more research and best practices are disseminated. As health care dollars dwindle that support programs like navigation and as technology continues to transform the way patients are tested and treated for cancer, navigation will need to stay vigilant to meet those yet unidentified changes and challenges.