Melissa DeSimone, RN, BSN, OCN, CBCN, is the breast cancer nurse navigator at Karmanos Cancer Institute at McLaren Northern Michigan hospital. DeSimone has been a nurse for almost 10 years, the majority of which have been spent working in inpatient oncology/hospice, oncology infusion, and now nurse navigation. She has been in her position as breast cancer nurse navigator since March 2015. DeSimone is nearing completion of her Master of Science in nursing education. She was selected to be part of the Oncology Nursing Certification Corporation (ONCC) Test Specification Committee to assist in the creation of the next version of the Certified Breast Care Nurse (CBCN) Exam.
Is there a nurse navigator you think should be profiled by NurseNavigation.com? Let us know!
Q: What do you like best about your job?
Melissa DeSimone: The single-most enjoyable part of my job is empowering patients through education. A new cancer diagnosis can be daunting and terrifying for many patients, and navigating the continuum of care can be very overwhelming. I enjoy working to ensure that each patient understands every step of the process, from the time of diagnosis through treatment. I want patients to know they are active participants in their care. When patients understand the treatment plan, they have a greater confidence in the care, providers, and team as a whole. I am fortunate to have the opportunity to foster that confidence through patient education.
Q: What tools do you wish you had to work with?
MD: When I started in this position, I would often have patients turn to me after their initial medical oncology appointment and say, “What did the doctor just say?” I found myself writing a synopsis of the appointment for patients to take with them. Many times, patients had difficulty processing the massive amount of information they are receiving at the initial visit.
As a result, I partnered with one of our great hematologist/oncologists, Elena Coppola, DO, to create a comprehensive patient education flowsheet and care plan. This tool reviews every aspect of the pathology report, including receptor statuses, genomic testing, and staging. It outlines every step of the plan of care, including surgery, chemotherapy/targeted therapy, radiation therapy, and endocrine therapy. With this tool, every facet of treatment is summarized and numbered, as applicable, in order of occurrence for each individual patient.
The care plan is reviewed with patients by the nurse navigator at the conclusion of the initial medical oncology appointment and patients are given a copy to take with them. I am currently studying the efficacy of this tool for a quality improvement project through our cancer committee. So far, we have increased patient level of understanding of their diagnosis and treatment plan from 82.5% without the tool to 95.4% with the tool. It is very energizing to be able to quantify the impact we are making.
Q: What value do you think nurse navigation provides?
MD: A nurse navigator is an asset to a cancer program, playing the role of patient advocate, teacher, and facilitator of care. Perhaps most importantly, I am a caring clinician that patients have in their corner throughout the treatment. I work to remove barriers to care and assist in making referrals to any number of resources such as the following: transportation, support groups, survivorship programs, counseling, lodging, financial assistance, dietician, physical and occupational therapy, certified mastectomy fitters, and social work.
A navigator can create better outcomes for patients and increase timeliness of treatment. For example, last year, I assisted in the creation of a reflexive genomic testing policy for patients at our institution meeting criteria agreed upon by the cancer committee. This policy has helped to expedite testing and decrease time to treatment for many patients.
Being a navigator has afforded me the unique opportunity to work with many different departments, and allowed me to see patient care from a different perspective and thus facilitate process improvement.
Q: What is your biggest challenge as a nurse navigator?
MD: My biggest challenge as a navigator has been identifying where I am most useful and defining my role. When I accepted my position, there was no job description and everyone had a different understanding of what navigation was. As a result, I looked for every book on navigation and training course I could find to try to answer the question, “What is navigation?” What I quickly discovered was that navigation has a different definition depending on who you ask. Every navigator I spoke to had a different role. Every institution and community had specific needs that the navigator was working to address.
In short, I learned that my navigation role would be defined by the needs of my patients, but had to be specific enough to allow me to be successful in that role. I am lucky to work with great physicians and management who have helped me to identify the navigation needs at our institution to determine where my time is best spent.
Q: What do you hope for as the future for nurse navigation?
MD: I hope is that in the future, knowledge of nurse navigation will grow so that this area of work is widely accepted. It would be wonderful for all oncology patients to have access to a navigator and for navigation services to be reimbursable.
I am very lucky to have my position funded by a generous donor through the McLaren Northern Michigan Foundation. In the future, it would be great for the value of this type of work to be realized so that positions like mine can be seen as necessity rather than luxury. I am fortunate to work in a community and for an organization that truly values patient navigation.