Hilary Turnberg, RN, BSN, CEN, is a pancreatic cancer oncology nurse navigator at Virginia Mason Medical Center in Seattle. She has served as a nurse navigator since January 2016. In July 2017, Turnberg joined the Pancreatic Cancer Action Network (PanCAN) Scientific and Medical Advisory Board (SMAB).
Q: Why did you want to serve on the SMAB?
Hilary Turnberg: I feel that PanCAN is an invaluable resource for accurate information, support, and hope for anyone diagnosed with this complex disease. As a pancreatic cancer nurse navigator, I care for people who are suddenly blindsided by this diagnosis. I am on the frontline guiding them through the complexity of the diagnostic process and the variety of barriers they may contend with on that journey. I am actively supporting the resources patients already possess and facilitating their access to resources available in my institution and in the community.
I feel that PanCAN is a partner in my work and in my patients’ journeys. I rely heavily on the information and support that this organization offers to each individual in my care and to the people who love them. Being part of the SMAB and also serving on the SMAB patient services subcommittee is an opportunity to represent the voice of patients and caregivers as PanCAN works to enhance and improve that support.
Q: What do you hope to accomplish as a member of the board?
HT: I hope to do the following:
- Explore/enhance/embrace the role of patient services as they relate to PanCAN research and treatment initiatives “Precision Promise,” “Know Your Tumor,” “Patent Registry,” “Clinical Trial Finder,” and others.
- Promote outreach for utilization of PanCAN resources amongst a wide variety of patients, regardless of geographical, ethnic, or socioeconomic background. This includes reaching out to non-urban centers of care.
- Promote community provider and hematology/oncology RN awareness of PanCAN at various care centers so more patients — especially those who are less internet-savvy or far from urban centers — are aware of the resources offered to patients and their caregivers.
- Explore partnering with the Academy of Oncology Nurse & Patient Navigators (AONN+), Oncology Nursing Society (ONS), and other nurse navigation and oncology nursing organizations to support increasing patient and caregiver awareness of PanCAN.
Q: As a nurse navigator, what expertise and experience do you feel you bring to the board?
HT: I worked as a certified nursing assistant in home health and home hospice care prior to graduating with a bachelor of science degree in nursing in 2005. I went on to specialize in emergency nursing for more than seven years, and spent several years in emergency and critical care nursing at Virginia Mason Medical Center in Seattle before transitioning to an RN care manager role in Virginia Mason’s Outpatient Oncology Clinic in 2015. I have been the pancreatic cancer oncology nurse navigator at Virginia Mason since January 2016.
My experience in each of these settings has given me many opportunities to develop as a nurse and to witness and learn from the pivotal health transitions my patients and their loved ones have grappled with. I am always a work in progress, but my role in each setting helped me to develop a foundation of clinical judgment and critical thinking, technical and scientific knowledge, patient-centered communication and teaching skills, and the confidence to advocate for my patients and collaborate across disciplines to improve patient experiences and outcomes.
As the pancreatic oncology nurse navigator at Virginia Mason, I have had the honor of providing all my nursing knowledge, skills, and caregiving art to support people at a frightening and bewildering juncture — helping them navigate the complexity of their diagnosis, the healthcare system, and the challenge of this sudden encroachment on their rich and complex lives.
With this daily witnessing of what they go through, I have a rare perspective on the SMAB. I am the only nurse among my PanCAN staff, scientist, and medical colleagues there, and I am able to share what I have learned from my patients about what they need from the organization and their clinical caregivers. I’m also able to share the perspective of my nursing and social work colleagues, and contribute to discussions about program development and clinic/provider and facility outreach.
Q: Would you recommend more nurse navigators consider opportunities to serve on boards?
HT: I strongly recommend this!
First, it is an opportunity for patient advocacy. Nurse navigators can offer highly valuable expertise on boards that are designed to develop and enhance patient services and care. The wide range of skills nurse navigators possess, their broad perspective on the complexity of the healthcare system, their resourcefulness and problem-solving skills, their interdisciplinary approach to care, and their ability to channel the voice of the patient throughout the care continuum are all invaluable to peers on a board. I was nervous about my lack of experience in that setting at first, but many of my colleagues on the SMAB have expressed their appreciation of my contributions to the board’s discussions. It is another avenue for patient advocacy and my PanCAN staff, physician, and scientist colleagues have recognized and voiced the value of having a nurse on the board who can share patient perspectives.
Second, it is an opportunity for development. Working with other experts in your field, especially those of different disciplines, is a wonderful chance to learn and grow your practice and possibly your career. It can also help build leadership and communication skills and give you an opportunity to see your field on a macro level that you may not get within your own institution.
Furthermore, it is a chance to learn how other care providers and institutions are addressing many of the challenges our own patients face in a diverse array of healthcare systems.
And, personally and professionally, it is a chance to be inspired and energized by the expertise, talent, and dedication of others who are striving to support, treat, and cure people every day. This is especially true because many of your peers may have a personal story that led them to serve on the board. My work with the SMAB helps to nourish and drive my practice, and inform my goals for my work and for my program.
Q: What is the most important work you do as a nurse navigator?
HT: Multidisciplinary care coordination and patient and caregiver education are the most important aspects of my work. The diagnosis, staging, and treatment planning for patients with pancreas cancer are very complex, and patients are often overwhelmed. I serve as a guide for the patient and I actively bridge communication between the various specialists involved in an extremely complex process.
Education goes hand-in-hand with the care coordination. I explain the rationale behind the many steps along the way, and provide personalized teaching about the ramifications of diagnosis, what various treatment options are, and what to expect from those treatment plans and regimens. I have learned that even with the most ominous prognosis, patients can feel supported and empowered by the coordination and teaching I provide.
Q: What do you like best about your job?
HT: I enjoy the complexity of linking my patients’ needs to the services and care providers that will help them receive thorough and expert care with adequate support along the way. This complexity involves assessment, care planning, communication with patients and the multidisciplinary team, and the therapeutic and educational approach that evolves for each unique patient and family. This is highly personalized care tailored for individuals based on clinical findings, their health literacy, personal and support resources, and coping style. It is personally and professionally gratifying to use my skills to guide patients through logistical hurdles and help them to understand their diagnosis and care process so they can focus on whatever matters most to them during an uncertain time.
Q: What do you see as ways or opportunities to improve nurse navigation?
HT: I’m very excited to see more institutional recognition of the value of nurse navigation, and multiple organizations and publications like NurseNavigation.com for nurse navigators and patient navigators. There are many leaders in the field working on building professional support for these evolving roles. AONN+ has recently released metrics that practitioners can employ to validate the benefits of their own programs, and to contribute to research and development of best practices in this growing field.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
HT: First, clearly define role responsibilities for navigators in your various service lines. Clinical pathways vary, as do referral patterns and treatment/survivorship pathways. There is no one-size-fits-all model for impactful practice and optimal patient care.
Next, adequately and appropriately staff the roles so that members of the team can work at the height of their scope of practice.
Also, ensure that nursing staff is supported by ancillary staff for clerical, scheduling, and non-licensed clinical tasks so that nursing time can be devoted to that all-important nursing process — assessment, diagnosis, planning, implementation, and evaluation. Do this not just to provide excellent service and improved outcomes for patients and their loved ones, but also to support efficient utilization of organizational services and resources, to enhance professional and program development, and to bolster staff satisfaction and retention in these highly specialized and effective roles.