Cheryl (Ramirez) Kifer, BSN, RN, is a children’s nurse navigator for St. David’s Children’s Hospital in Austin, Texas. Cheryl began her career as a nurse almost 30 years ago, working with families in the PICU and NICU. During the last six years, Cheryl has worked at St. David’s North Austin Medical Center in Austin, which is home to St. David’s Children’s Hospital and St. David’s Women’s Center of Texas. While at St. David’s, Cheryl has implemented the parent discharge and NICU 101 classes, both designed to inform and encourage parents to become active advocates in the care for their infants.
In February 2013, Cheryl officially started her career as a nurse navigator at St. David’s Women’s Center of Texas, leading its Special Deliveries Perinatal Support Program for families anticipating a high-risk delivery or loss. Cheryl used her experience in the NICU and PICU to help guide, educate and support families facing concerns after being diagnosed with a high-risk pregnancy. In February 2016, Cheryl became the children’s nurse navigator, continuing perinatal high-risk care coordination. In this role, she acts as a liaison between St. David’s Women’s Center of Texas and St. David’s Children’s Hospital for continuity of care.
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Q: What is the most important work you do as a nurse navigator?
Cheryl Kifer: The most important work I do as a nurse navigator is to help return some sort of control to families. When faced with a sudden hospitalization or challenging diagnosis, many parents feel out of control, helpless and hopeless. My goal from the first meeting with a family is to discover what they know, what they have concerns about and how best I can help them become an involved partner in the medical care of their infants and children. Even in situations where loss or a short life are predicted, I assist the family in discovering how to use their voice to advocate for their child. I translate the complex medical language into terms they can understand, and I help them sort through and make sense of the maze of health care options. I am honest with them, never robbing them of hope, but truthful that medicine cannot always “fix” our bodies.
When a mother is diagnosed prenatally with a baby who, statistically, has little hope of leaving the hospital, the need for a navigator is incredibly important. These parents need myriad support, prenatally, including coordinating specialists; developing an advance directive birth plan that articulates how the infant will be cared for; support for the extended family members, including grandparents and siblings; and assisting the social worker with coordination of care following delivery with religious rituals, hospice care and even funerals.
CK: What is your biggest challenge as a nurse navigator?
CK: One of the greatest challenges I have faced as a nurse navigator is the general lack of knowledge about the role of a nurse navigator. Many people only encounter a nurse navigator if they happen to have had a family member diagnosed with cancer. I am very fortunate to work with a visionary leadership team, including St. David’s Children’s Hospital Director Misty Rowlison and Yvette McDonald, assistant CNO of St. David’s Women’s Center of Texas. Both remarkable leaders are passionate patient advocates, and they value the importance of informed care. Under the support and direction of Misty and Yvette, I am able to provide a caring, educated point of contact to patients during one of the most frightening times of their journey as parents. It has been only through their support and encouragement that we have initiated and grown a children’s nurse navigator position.
Q: What value do you think a nurse navigator provides?
CK: Any person facing a complex plan of care would benefit greatly from the assistance of a navigator. Just like the definition of the word, a navigator guides and helps the person “reroute,” as necessary. A nurse navigator helps patients understand their diagnosis, treatment and plan of care. Most patients will cope with their situation better after meeting with the navigator, leading to a feeling of empowerment and support.
Parents often turn to the Internet for answers, and they are left with a jumble of information that may or may not be appropriate for their situation. As the nurse navigator, I translate medical language into a language the parent and patient can understand. I help them understand how our hospital policies and procedures work, as they pertain to their diagnosis, and I help develop a plan of care. They are much more likely to be compliant if they are included in creating the plan of care. I hear almost daily, “I can’t believe we found a team of health care professionals including a nurse navigator who can help us and really care about us as a family.”
Q: How do your colleagues view nurse navigation and care coordination?
CK: When I describe the role of a nurse navigator to my colleagues, most of them are overjoyed. Being in an intensive care situation when dealing with either infants or children puts a nurse “in between” a mother and her child. Often, the parent has to witness painful procedures or treatments. This can create not only incredible anguish for the parent, but also a protective reflex. This often causes a great deal of conflict between staff and parents. However, with support and education from a nurse navigator, the parents understand the treatments, medications and tests, and they are involved each step of the way. Families who have met with a navigator are much more likely to work with the staff, and the staff appreciate the cohesive teamwork.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
CK: I smile when I read this question. I would encourage piloting a nurse navigator program and asking patients, families, physicians and nursing or support staff to provide feedback on their experience. I think the work will speak loudly for itself! I can say without doubt that the work I do with families, especially those faced with a complex diagnosis or short life with their child, is absolutely the most meaningful work I have ever done as a nurse.