Janelle Gorski, MSN, RN, ANP-BC, AOCNP, is a nurse navigator in the cancer center at Sentara Martha Jefferson Hospital in Charlottesville, Va. She has served as a nurse navigator since 2012.
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Q: What is the most important work you do as a nurse navigator?
Janelle Gorski: Nurse navigators across the country are charged with identifying and mitigating barriers for patients accessing the health care system. In my opinion, this is without a doubt the most important part of nurse navigation: identifying needs not only on a programmatic level, but on an individual level with each patient interaction.
Our cancer program identifies several goals related to patient care each year, and navigators help to address many of them. We provide services in a wide range of areas, including smoking cessation counseling, coordinating a lung cancer screening program, delivering survivorship care plans, addressing barriers related to oral chemotherapy, and assisting with enrollment in clinical trials. I like that the navigator roles here are flexible enough to address priority needs for both our patients and staff.
On an individual level, addressing barriers comes from a keen assessment of patient needs. As providers and clinical staff face increasing demands for their limited time, a navigator can provide appropriate referrals for patients to receive the psychosocial support that they need. And, though hard to quantify, sometimes navigators support by simply listening or providing information during a time of need.
Q: What do you like best about your job?
JG: At the start of each day, I never know who I will have the chance to help. I enjoy meeting new people and trying to understand how I can best help them. If I can’t directly assist with a particular difficulty, I like the problem solving that goes into that. No two days are alike, but there’s almost always some satisfaction in knowing that I’ve supported others in a time of need.
Q: What value do you think nurse navigation provides?
JG: The value of nurse navigation is often difficult for me to describe, particularly because the three navigators at our hospital function in such drastically different roles. But what is our common value? We advance the quality of care provided at this cancer center. “Quality care” is often defined by the accreditation standards that we meet, studies of quality, or other external sources. Our navigators are an integral part in the activities that external organizations define as comprising quality care.
On the other hand, my patients would tell you about quality care somewhat differently — through the lens of personal experience. One of the kindest letters I’ve received from a family recounted a time when I was able to help with constipation. At the time, I considered this a very straightforward encounter. But with sensitive listening and careful assessment, I was able to provide advice to the patient that, according to her letter, significantly affected her quality of life on that day. So navigation adds quality not only at a system level, but at the individual patient level as well.
Q: What is your biggest challenge as a nurse navigator?
JG: One of the biggest current challenges for me is identifying patients who might benefit from nurse navigation. Direct referrals from colleagues will always be valuable, but automating certain referral triggers can cast a wider net.
We have found some creative ways to work within our current electronic systems to identify patients most likely to benefit from nurse navigation. In the near future we will change our electronic medical record, and I’m quite hopeful that a new system will allow improved tracking of certain patient populations (e.g., those with a certain diagnosis, those receiving a particular treatment, those who smoke). No matter the exact process for identifying patients, ongoing refinement is needed.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
JG: The nursing process — “assess, plan, diagnose, implement, and evaluate” — certainly provides a good framework for implementing a navigation program. Thoughtful planning is never wasted. Looking to other institutions for best practices has been particularly helpful to our hospital.
As always, ongoing evaluation is key in adapting to changing patient needs. In an evolving field, we must be ready to try something new!