Heather A. Hannon, RN, MSN, CBCN, OCN, ANP-BC, is a GI cancer nurse navigator for the Sarah Cannon Cancer Institute at Johnston Willis Hospital in Richmond, Va. She has served in this position since November 2013.
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Q: What is the most important work you do as a nurse navigator?
Heather Hannon: Learning of a new cancer diagnosis or cancer recurrence can be an extremely stressful time for patients and families. I find that one of the most important pieces of my work as nurse navigator is providing support and education as well as serving as a primary point of contact during this time period. Patients are often asked to digest a plethora of new and unfamiliar information when they are first diagnosed — and in a very short amount of time.
I think another important part of my role is helping patients better understand and process the information they are receiving so that they are able to move forward and make decisions about treatment and also feel comfortable with those decisions.
In addition, we know that cancer is best treated using a multidisciplinary approach, and it is not uncommon for a cancer patient to receive care from up to eight different cancer experts throughout their cancer journey. As a nurse navigator, I am the one constant throughout the cancer journey. Patients report that they find it reassuring to know there is someone who has advanced knowledge about their specific type of cancer and is available to answer questions, offer encouragement, connect them with vital resources, and provide a listening ear whenever they might need assistance.
Q: What do you like best about your job?
HH: As a cancer nurse navigator, I find it an honor and privilege to work with patients and families at very meaningful and significant moments in their life. In my role, I have been blessed to witness some of the most amazing acts of kindness and love, and I am reminded on a daily basis of what’s most important in life. My patients are constantly inspiring and teaching me.
In addition, I love the variety that comes with the role. I enjoy meeting one on one with patients and being an integral participant in weekly tumor boards. The nurse navigator role also provides me with an opportunity to be involved in program development and nursing research. I greatly enjoy being part of an interdisciplinary team and being involved in cancer care across all disciplines. Although my primary focus is GI oncology, I have experience in many areas of cancer care, including medical oncology, bone marrow transplant, pain management and palliative care, and gynecologic oncology. As a nurse navigator I get to draw from all of this experience.
The field of oncology is rapidly changing, and it is exciting to be in a role that allows me to be involved in all aspects of this. As coordinator for our multidisciplinary cancer conference, I especially enjoy bringing new studies and treatment options to the table. It’s the perfect example of watching evidence become practice.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
HH: This past Thanksgiving I received a call from a gastroenterologist who was new to town and had just started seeing patients in the office. One of the first patients he came across was a young man in his 40s who presented with anemia and a worrisome abdominal mass on CT. The gastroenterologist wasn’t sure about next steps or how to go about setting the patient up for further evaluation.
A physician colleague mentioned our tumor board, which I co-facilitate with our surgical oncologist, and suggested the GI physician reach out to me. The GI doctor called me on a Tuesday, and we were able to gather everything needed and present the case on Thursday, just two days later. Due to the concern for obstruction and perforation, our conference team decided it would be best to proceed with resection of this patient’s abdominal mass and obtain biopsy at the same time.
During conference, I was able to introduce the gastroenterologist to several members of the cancer center team, including the surgical oncologist. I was able to arrange for the patient to meet with the surgical oncologist and myself in the office the following morning (Friday). The patient proceeded to surgery early the following week, less than four days after being presented at tumor board.
As it turns out, pathology showed this to be a primary adenocarcinoma of the colon. Due to the patient’s young age, I was able to ensure he received genetic testing during his post-op recovery. I also worked with the surgeon and medical oncologist to ensure that the patient started chemotherapy within the recommended time frame. The surgery was extensive, and the patient’s spleen had to be removed.
During the post-op period I assisted the patient with obtaining the recommended immunizations for asplenic patients. I was excited to adapt the information from this case to help create pre-op teaching material for patients undergoing distal pancreatectomy and splenectomy.
Lastly, unfortunately, the patient’s sister was diagnosed with breast cancer a few months later. Since the patient and I had developed such a close relationship, he called me when she was waiting for her biopsy results. I was able to provide support and education to the patient’s sister and husband, and ultimately they ended up transferring care to our facility because they felt so comfortable and confident with our team and facility. The patient has also continued to be an active member of our GI support group, encouraging and helping others who are just starting their journey.
Q: What is your biggest challenge as a nurse navigator?
HH: Sometimes I find it challenging to balance the expectations others might have regarding my role. The nurse navigator position varies so much from one hospital system to the next and even within a facility, and I find that practitioners don’t always have a good understanding of what services I provide and the value I bring to the table as a navigator.
For example, when I first stepped into the role there were a few practitioners I worked with who thought of me more as the person who provided coffee and A/V support at conferences. Although I do consider myself a coffee connoisseur (or maybe coffee addict is a better description), I think we all can agree the nurse navigator role has far greater potential than this.
There are also plenty of misconceptions regarding navigation. I have encountered practitioners who are reluctant to reach out to the nurse navigator for fear that the navigator will try to take the place of the radiation oncology nurse or chemotherapy/infusion center nurse. I see every interaction I have with a practitioner as an opportunity to provide education about the nurse navigator role. As a result, I find that I am constantly championing the value of navigation — usually through the use of real life examples.
There is no better way to engage a practitioner than sharing patient stories with them that highlight the benefit of the nurse navigator, such as showing how the navigator can positively impact timeliness to treatment and provide information and support that allows the patient to engage in and adhere to the treatment plan.
Q: What do you see as ways or opportunities to improve nurse navigation?
HH: As a board certified adult nurse practitioner, I believe there is tremendous opportunities for advanced practice nurses (APNs) in the world of nurse navigation. I find my expertise and training as an APN are a perfect fit for the role of nurse navigator, especially when there is high suspicion of cancer and the patient is in the process of being worked up.
As an APN, I am able to assist in the identification of any additional testing or studies that need to be performed as part of the initial workup. This helps guarantee physicians have everything they need at their disposal so that they can provide patients with the information necessary to make decisions about their treatment.
I also find my APN skills are of tremendous value helping triage patients. Not only am I able to identify and put in place key pieces of the initial workup, I am also able to identify who is a candidate for neo-adjuvant chemotherapy, who should see a medical oncologist right away, and who needs to be seen by both surgery and medical oncology in the same day.
As a nurse practitioner, I am also able to assist with the hospital’s survivorship clinic and can provide genetic education/testing/counseling.
I think there is tremendous opportunity to continue to set high standards for the nurse navigation role, and to make certain that there is some consistency in the role and that the role is one that utilizes the nurse to their full potential.