Kimberly A. Foster, MBA, BSN, RN, is a registered nurse oncology navigator for Wellstar Douglas Hospital in Douglasville, Ga. She has served as a nurse navigator since March 2015.
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Q: What is the most important work you do as a nurse navigator?
Kimberly Foster: WellStar Douglas Hospital recently opened a Specialty Teams and Treatments (STAT) Clinic for patients with lung cancer or abnormal thoracic findings. The STAT Clinic allows patients to see all members of the treatment and support team in one place in one afternoon rather than going from office to office trying to gain a consensus on treatments.
As the nurse navigator for the STAT Clinic, I guide patients through the process, from finding out they have a spot on their chest x-ray through diagnosis and treatment. I am the consistent person they can contact at any phase of the process to ask where to go next. As part of my role, I work with other specialties and programs to get patients the diagnostic and treatment procedures they need as efficiently as possible.
A patient might encounter a two-week delay when scheduling an appointment on his own. When I get involved, the patient sees the next provider or has the next procedure in a few days. WellStar already had STAT Clinics in Marietta and Austell (in Georia) so it was great to bring this service to our neighborhood.
Q: What value do you think nurse navigation provides?
KF: Years ago, my mother was diagnosed with breast cancer. I remember feeling lost and frantic about who to contact and where to turn. Sometimes we just wanted to vent or to talk about one of the possible solutions we had found. A lot of my patients are like that. I am the one person in the health care system who can listen to them and list the pros and cons of all the input they received from their family and friends, the Internet, news, and their doctors. I make time for them to vent. I also provide information about resources available in our community. You would be surprised at how many eligible patients don’t know about area services that could serve them whether they are ill or not.
Before coming to WellStar, I was the director of Medicaid quality for our state. I worked a lot with the Centers for Medicare & Medicaid Services on projects designed to improve the safety and quality of our healthcare system. In that role, I became intimately familiar with how the Triple Aim of Healthcare will impact reimbursement policies and practices.
Within the WellStar Health System, my role truly embodies the Triple Aim. I work directly with the patient to improve the patient’s experience of care. I help the population of thoracic cancer and breast health patients within our system to improve their health. Finally, I guide patients and providers to efficiently use healthcare resources, thus reducing the cost of care.
Q: What do you see as ways or opportunities to improve nurse navigation?
KF: Nurse navigators need to continue to define our specialty and show benefits to providers and payers. We need to identify meaningful and related metrics. If nurse navigators improve the patient experience, and reimbursement follows that experience, then we need to tie our metrics to that benefit. If we save money by reducing unnecessary healthcare visits or procedures, then we need to document that. Many of the navigators I work with have anecdotal reports of their successes but those who reimburse for care want hard numbers to back up those reports.
Nurse navigators also need to identify firm protocols that work across settings. Right now, many of us make it up as we go. The navigator who trained me said, “There isn’t any one or wrong way to do this. Just do what feels right to you.” That’s not a specialty! Other specialties have strong principles that guide their patient interactions. They have policies and procedures that you can follow no matter where you work. Nurse navigation needs those same tools. I am working with a group from the Academy of Oncology Nurse & Patient Navigators (AONN) to bring evidence into our practice. That’s the key for us as a specialty.
Q: How do your colleagues view nurse navigation and care coordination?
KF: I am lucky enough to have arrived at WellStar when the idea of nurse navigation began to take off in our organization. During one of my first get-acquainted meetings with a physician, he asked me how he could get a nurse navigator for his specialty (prostate cancer). Right now, our health care system is working to add navigation across the system and for more specialties. I cover both breast and thoracic cancers for the Douglas hospital. There are nine other navigators in the WellStar Health System who cover the most prevalent disease sites: breast, thoracic, GI, GU, and melanoma. Amongst us, navigators are also available to other specialties and areas on an as-needed basis while we work to expand coverage to other areas.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
KF: Start small with only one or two specialties. Get a good handle on the navigation process. Have your navigators learn your organization’s system, the way things work from the patient perspective, and how to make it work more efficiently. Send your navigators to as many conferences and trainings as you can. Implement best practices and customize them for your system. Also get a few of your physicians to champion your program. Keep good metrics of how your navigators improve the patient experience, increase patient retention, and increase downstream revenue. Pretty soon, you will need navigators in other specialties.