LuAnn Roberson, RN, BSN, CN-BN, SD, is a nurse navigator for breast care at Abrazo Arrowhead Campus in Glendale, Ariz. She has practiced as a nurse navigator for 10 years, and has set up navigation programs in the outpatient, mobile, and hospital settings. Roberson was one of the first 100 nurses certified as breast nurse navigators by the National Consortium of Breast Centers.
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Q: What is the most important work you do as a nurse navigator?
LuAnn Roberson: A diagnosis of breast cancer is life altering. The opportunity to plant hope in the life of someone who is newly diagnosed is seminal to their wellbeing and increases their success in treatment. By laying a strong foundation of education, emotional, and spiritual support, I see my patients rise to the challenge, empowered to make informed decisions that are right for them.
The nurse navigator’s intervention also shortens gaps in time between diagnostic imaging, biopsy, and treatment stages. Being well connected with multidisciplinary team members makes for smooth and timely coordination of care for the patient, which greatly decreases their anxiety.
Q: What do you like best about your job?
LR: Being a navigator reminds me why I chose nursing as a career: the personal, healing relationships with my patients. Navigating gives me the opportunity to put to use the training I have received as a certified nurse navigator, counselor, and minister. Understanding each patient’s particular needs and barriers allows me to personalize the care I provide. I love being their “medical translator” — educating my patients about their diagnosis on their level of understanding and comfort, making complicated concepts easier to grasp. Breast disease is a very personal issue, and I respect my patients for allowing me to come alongside them on their journey.
Q: Can you share a few patient stories you feel demonstrate the value of nurse navigation?
LR: A patient’s diagnostic imaging indicated a probable cancer. The imaging, core biopsy, pathology result, patient education, and referral to a breast surgeon were coordinated within a four-day span of time — something which, without navigation, may have taken up to three weeks. The patient knew that all providers were working together to give her the best care in the most timely fashion. She can now begin treatment for her breast cancer, knowledgeable and confident in her team. She was grateful to have my contact information and know that I would be available to her throughout her treatment. Navigation improves timeliness of care, decreases anxiety, and empowers patients through education and support.
Recently, a patient with special needs required my services as a navigator. There was a need for general anesthesia for a simple core breast biopsy due to the patient’s severe developmental disabilities. Other facilities had declined the procedure, but utilizing the navigation process, we made it happen! I spoke at length with the caregiver and mother of the patient to assess her needs and barriers to care, then coordinated with the ordering physician, surgery scheduler, anesthesiologist, pre-procedure and recovery nurses, radiologist, and mammography technologist. All team members were educated about the patient’s needs, and each provided the skills from their specialty. The procedure went smoothly, and it was gratifying to see the patient, mother, and caregiver leaving our facility with smiles. The patient needed the service, the professionals on the team were willing, and the navigation process put the pieces together to provide personalized care for this unique patient. I continue to maintain contact for further steps in her treatment.
Q: What is your biggest challenge as a nurse navigator?
LR: Since breast cancer is a highly publicized disease, there is much misinformation and unfounded fear about mammography and treatment options. It is a challenge to address such a broad spectrum of information and misinformation. There are many myths and misunderstandings to dispel and instead provide current, evidence-based education to my patients and to our community. There have been many wonderful advancements in the early detection and treatment of breast cancer. It is a challenge to bring the good news of 3D mammograms along with the availability of specialized breast radiologists and breast surgeons to our community.
Q: What technology do you use in your position? What tools do you wish you had?
LR: The direct patient interaction I have is amazingly low tech. The art of a face-to-face conversation with a newly diagnosed breast cancer patient is my gift to the patient. They must know that they have my full attention, not divided between them and my computer. The preparation for these conversations involves my computer for research, recordkeeping, and printing resources for my patient particular to their diagnosis. I hope to soon include a video wallboard in my office to assist in the education process through anatomical diagrams.
One tool I wish I had is a better system of data and recordkeeping that addresses the different phases of navigation.
Q: What do you hope for as the future for nurse navigation in the United States?
LR: With increasing advances in the detection and treatment of disease, uncertainties in insurance, and confusing treatment pathways, the need for nurse navigation will continue to grow. Navigators stand in the gap between the complex world of medicine and the patients who are in need of a professional qualified to help them through the maze of diagnosis and treatment. Patients need to be aware of the availability of nurse navigators and what they can provide.
It is my hope that those in healthcare leadership will increasingly see the importance of navigation and commit to the important service it provides to those we value most: our patients.