Jill McNeely, MSN, RN, CBPN-BC, is a breast health navigator at Novant Health Rowan Medical Center in Salisbury, N.C. She has served as a nurse navigator since November 2010. Earlier this year, McNeely was named to the Great 100 annually acknowledges North Carolina nurses for excellence in patient care and dedication to the nursing profession. McNeely was selected for the Great 100, an annual list to “recognize and honor registered nurses in North Carolina for their commitment to excellence and to promote a positive image of the nursing profession.”
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Q: What is the most important work you do as a breast health navigator?
Jill McNeely: The most important work for me as a nurse navigator is unquestionably education and support. This is a difficult time for a woman and her family. In a matter of days she goes from her normal routine to the uncertainty of a diagnostic workup and the possible turmoil of a cancer diagnosis. My job is to provide some calm amid the storm. I truly believe knowledge is power, and it is my job to share that knowledge with my patients so they can make informed decisions about their care.
Survivors will be bombarded with new scary words and phrases, unfamiliar providers, treatment modalities, and new medication names, to say the least. They can turn to the navigator for clarification of information knowing that there is no silly question but a kind and compassionate person to help navigate their care.
In the midst of many appointments at different locations with different providers, the nurse navigator can be the one constant the patient can turn to for educational and emotional support throughout their journey. Additionally, the navigator can also be that point person for the multidisciplinary team to make sure communication to all parties flows smoothly and that nothing falls through the crack and delays treatment.
Q: What do you like best about your job?
JM: I like being able to see a patient move from uncertainty to “okay, I’ve got this” as I educate her along the way. Education can remove much of the patient’s fear of the unknown.
I also love being able to witness the kindness and compassion that all our team members show our patients throughout the continuum of care, not because it is their job but because that is how they treat everyone. In these times of strife, it is reassuring to witness the goodness in people.
I come to work every day knowing I can make a difference and that feels good. I am able to see God’s love in the caring of others. My faith is important to me, and given the opportunity, I am able to share that hope and love. I wear a small cross on my lab coat as an outward sign of an inward faith and strength.
Q: What value do you think nurse navigation provides?
JM: Value has several different meanings. If we look at the word “value” meaning significance, I know that I make a significant difference for the patients I serve and the people I work with.
If you look at the word “value” from a monetary standpoint, my value to my employer is substantial. If a patient is indigent and or uninsured, I make the referral to our local Breast and Cervical Cancer Control Program (BCCCP) so she may be qualified for Medicaid. Without that referral prior to diagnosis, she would not be eligible for this important medical coverage and the physicians and hospital would provide services to the patient under their charity care programs. BCCCP coverage can save the hospital and physicians as much as $200,000 for a patient who is receiving surgery, chemotherapy, radiation, and related care.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
JM: We had a patient come in for a diagnostic mammogram, referred by her family physician because the physician found a mass in the patient’s breast. The patient did not want a biopsy because she did not want the “needle to spread it all over her body.” I spent significant time educating this patient on the biopsy procedure, assuring her that the procedure would in no way cause the tumor, if malignant, to metastasize in her body. She had known this mass was in her breast for two years but did nothing about it because she did not want to burden her family with caring for someone with breast cancer, which she was convinced she had.
Finally, this patient agreed to the biopsy, which showed the mass to be a complex cyst. She was finally relieved of her worry and fear. She did need a surgical excision due to the extent of the area and I was able to assist her in making those arrangements.
Q: What is your biggest challenge as a nurse navigator?
JM: When I began in this role about eight years ago, the biggest challenge was educating physicians on how I could support them in their care of their patients. Fast forward eight years and now my biggest challenge is time. There seems to never be enough hours in the day to call existing patients, see new surgical patients, follow up with patients going through chemotherapy, teach newly diagnosed patients about their cancer, attend meetings, write grants, serve my community as the breast health educator, and answer emails. But I do the best I can, knowing tomorrow is another day.
Q: What do you see as ways or opportunities to improve nurse navigation?
JM: The electronic medical record (EMR) has both improved and complicated navigation. Gone are the days of a phone call to talk with the patient, write the date and a few lines in a paper chart and go on to the next one. Now we have an EMR, which has wonderful capabilities but can also be cumbersome in documentation.
The other opportunity is keeping up with changes in treatment. In an ever-changing medical field, it is difficult to keep current and relevant.
Q: What technology do you use in your position? What tools do you wish you had?
JM: I use all of the current technology: computer, EMR, social media, etc. As the population of breast cancer patients gets younger and younger, I must be able to use technology in order to stay relevant to a different generation. I am very fortunate to work for a company that believes in current technology and equips me with what I need to do my job.
What technology do I wish I had? A crystal ball!
Q: How do your colleagues view nurse navigation and care coordination?
JM: I can say that the view of navigation has grown over the years. I know the majority of my colleagues understand that my position helps their position and that together we can provide excellent care for our patients.
I think we need to make sure that community partners also know how we can help them to improve the care of their patients. Over the past five years, I have seen the understanding of navigation grow from regularly hearing, “You’re a what?” Now I hear, “You’re a navigator!” It’s an awesome feeling.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
JM: Visit several different models of nursing navigation and then design your program to fit your needs. What works for one does not work for others.
We began with a steering committee to form a breast team. This team was made up of representatives from breast imaging, nursing, surgery, and cancer treatment. We developed an algorithm for care and grew from there.
I am a little biased, but I think nurse navigators are a great addition to any care team. Nurse navigators streamline care and save money, but most importantly they increase continuity of care and patient satisfaction.
Q: What do you hope for as the future for nurse navigation in the United States?
JM: My hopes are that navigation continues to grow as a profession and discipline in the nursing community. Since nurse navigation is much more than just nursing, it would be a natural progression to see additional coursework and training in social sciences as an adjunct to nursing knowledge. Nurse navigation is seated in the “caring model of nursing,” holistically caring for patients and their families. Compassion, teamwork, personal excellence, and diversity are, and always will be, the cornerstones for excellence in nurse navigation. As we go forward, my hope is that we will build on that foundation.