Jennie McLaughlin Tarica, MSN, RN, CBPN-IC, is the breast cancer nurse navigator for the Sullivan Breast Center at Sibley Memorial Hospital in Washington, D.C. Jennie has worked at Sibley Memorial for more than 30 years. She has held a variety of oncology-based roles. She developed and managed Sibley’s first oncology inpatient unit and became an education and training specialist in the area of oncology and pain management. She has also served as the pain management specialist with responsibilities that included staff education and leading an anesthesia-based pain consultative service and outpatient pain clinic. Jennie has served as the breast cancer nurse navigator for Sullivan since 2008.
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Q: What is the most important work you do as a nurse navigator?
Jennie McLaughlin Tarica: The most important aspect of my job is being a resource when the patient has questions or concerns. Most patients find it so helpful to be able to email or call me and get an immediate answer. Patients often feel their questions or concerns need to be addressed by their doctor. They can appreciate, however, that doctors are busy, but the reality is they expect the attention from someone. Patients like the idea that I am an extension of their doctor, and if I don’t have the answer, I have direct contact with their doctor wherever he or she may be. Feeling this sense of connection and that their questions and concerns are important makes the patient feel well cared for. Keeping the communication going keeps the patient anxiety level to a minimum. This helps everyone in the long run.
I am a resource for patients throughout the continuum of care. If a woman suddenly discovers a lump and goes online to find a breast center or breast specialist, she will enter our website and find my role and contact information. Patients find this most helpful in assisting them in figuring out what they should do.
I have had website inquiries over the weekend. Although finding a lump is not an emergency to me, to this woman it sure is as it can be very scary. One particular weekend, I was able to calm the young woman and her husband by calling them and reassuring them that it was okay for this to be worked up on Monday. I spoke with them about seeing their primary care physician (PCP) first to get a good clinical breast exam and then told them the doctor could order the most appropriate breast imaging for her. It just happened that her PCP’s office was open on Saturday and he was able to see her and in the same building she could get an ultrasound of her breast. The young couple called me that evening and could not thank me enough for being available on my personal time to help through this crisis.
My demographic of patients don’t have questions from 8:00 a.m. to 4:30 p.m., which is a traditional day shift. They work; they are parents taking the children to activities. We need to do our best in providing information in a variety of ways.
Q: What do you like best about your job?
JMT: The best part of my job is the reward I get from seeing women who are frightened and scared turn into empowered women taking control of the care. When I speak with women on the day they have been given the diagnosis of cancer, there are a lot of tears and fear. If I can continue to be available and provide information, they will be in such a better place the day they see their first consultation with a specialist. When the anxiety is minimal, they are in a better position to be able to listen to the breast surgeon during this first visit and then they are off to a great start in this unexpected journey they find themselves on.
Q: What value do you think nurse navigation provides?
JMT: Nurse navigation can provide value to an organization in many ways. Navigators can be the first impression a patient develops of an organization. If we can demonstrate that we care and appreciate how they are feeling from the very beginning, even if it’s by phone or email, they will stay within our organization and become empowered and in control of the process. The sense of control we are able to provide during a time when one can feel out of control is so valuable.
A nurse navigator can provide downstream revenue by encouraging patients to complete their testing within our institution. This helps with continuity, and the patient truly feels part of a multidisciplinary team.
Assisting with scheduling of follow-up imaging within our institution can keep patients moving forward in terms of developing the best treatment plan and helping patients feel less anxious about how to figure out how to do this on their own.
Everyone on our breast cancer team believes that when a patient is in our department and requires some follow-up testing, we make the appointments for them while they are with us. Sending a patient home to figure this out just isn’t fair, nor how we want work.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
JMT: One of the ways I see the value of nurse navigation is when I get a call from a woman who was referred to me from another patient I worked with. Finding a lump or receiving a diagnosis of cancer is hard enough, but to try and figure out what you need to do is so stressful. Sometimes a frightened woman calls and says, “I was given your name because my friend told me how awesome you were in helping her figure out what to do” — hearing directly from someone who heard what a great help a navigator can be is so amazing.
I am always so touched when patients finish treatment and come to my office unannounced just to say hello. It is so rewarding to see them feeling well, ending this process and feeling good about their experience. The reason for their visit is they often just want to say thank you and explain how I had an impact during their journey. These visits give me the shot in the arm I need to continue on and know I am doing this well
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
JMT: Organizations that are contemplating implementing a navigation program often get caught up in the budgets, FTEs and ROI. When you look closely at all the points of contact navigators can have with a patient and how they make an impact, organizations begin to see that impact.
An organization should continue to remember that the navigator is really for the patient. Help keep administrative duties to a minimum. Make the navigator a part of the team and the process to improve your overall program. For any organization, the implementation is rocky in the beginning because once you have found the right person, everyone wants a piece of that person. Start the role in one area and have follow ups every six months, continuing to tweak the role, if necessary.
The navigator also needs to be flexible. You want to make sure you hire someone that is flexible, knowledgeable in the area being served, adaptable to change and can see the value to changing this up a bit to provide better care coordination for the patient.
I am often called by new nurse navigators to provide insight on how Sibley started its navigation efforts. During the eight years I have been in my role as the breast cancer navigator, my role has changed twice. All of these changes were challenging, but it has always made the navigation process stronger and a way to set the standard for future navigators at my organization.