Patricia Gambino, RN, MSN, is a gastrointestinal (GI) nurse navigator for the University of Pennsylvania Health System‘s Abramson Cancer Center. She has been a GI nurse navigator at the Abramson Cancer Center of Philadelphia for almost 18 years. In 1999, when she started at the cancer center, her title was patient support specialist. Gambino’s title was transitioned to nurse navigator when her department reorganized and the role of nurse navigation was better defined.
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Q: What is the most important work you do as a nurse navigator?
Patricia Gambino: Supporting the patient during his cancer journey is the focus of my role as a nurse navigator. At the initial diagnosis, the patient is terrified. Both the patient and the family need support in knowing the next step. Being able to teach the patient about his disease — the necessary testing to confirm that disease and the options available for treatment — are all part of the educational process which starts with the nurse navigator. Since I am very aware of my team, I am able to coordinate such care expeditiously and appropriately.
Q: What value do you think nurse navigation provides?
PG: An essential part of my job is triaging patients’ medical situations. Sometimes what patients think they need is not what they need. It takes time to really assess exactly what the patient needs and what provider is most appropriate in meeting these needs. To do this correctly, the navigator has to have an in-depth knowledge of the population they are navigating. In fact, through triaging, I might suggest that the patient NOT come to our institution, as there is really nothing novel we can offer them (especially when patients are calling from out-of-state).
Since I am a GI nurse navigator, I need to know everything there is to know about GI malignancies. Therefore, continually updating my knowledge base is essential. Interfacing with all disciplines involved in caring for GI cancer patients is needed so I know what services are available within our institution.
For instance, the GI oncology team meets once a week to discuss patient cases. At this meeting there are the pathologists, radiologists, surgeons, medical oncologists, radiation oncologists, clinic nurses, research nurses, nurse practitioners, physician assistants, social workers, geneticists, and dietitians. Through these detailed discussions of the cases, the entire team gets to know available options available to patients, including research trials.
The added benefit to these meetings is that we get to know the team on a more personal level. It is always helpful to put a face to the person you have been corresponding with on e-mail.
Q: How do your colleagues view nurse navigation and care coordination?
PG: It has taken time, but the team has grown to realize the value of nurse navigation. Our nurse navigators are very respected at our institution as evidenced by requests from other service lines to have a nurse navigator be part of their team. The team relies on the nurse navigator to expedite care coordination and help alleviate barriers that may impede such coordination. My colleagues respect my judgment and knowledge of GI malignancies.
Q: What do you like best about your job?
PG: Since I am privileged to meet patients when they are first diagnosed, I get to really know patients and their family over the years during their cancer journey. While the most intense interaction is at the time of diagnosis, patients still call me at times of increased stress for reassurance and guidance.
The other part of my role as a navigator that I enjoy is interacting with and teaching volunteer students about cancer and its effect on both the patient and his/her family .Patients are continuously facing financial devastation from their treatments. Insurance is expecting more out-of-pocket expenses to be paid by the patient . Because I work at a busy academic center, I have been able to enlist student volunteers from area colleges to help patients apply for community grants and from foundations whose missions are to help patients undergoing cancer treatments . Patients are so appreciative of the students’ help, and it adds a personal touch to their care.
Q: Can you share some “words of wisdom” about your role?
PG: Get to know your team. Constantly interact with your providers (e.g., surgeons, medical oncologists, radiation oncologists, nurse practitioners/physician assistants, administrative assistants, new patient coordinators). When coordinating care, make sure your referral is appropriate so that the providers get to respect your judgment and support. Attend as many in-services as possible so you know, as a navigator, services that are available within your institution.
Volunteer to be on committees whose mission is to improve patient care.
Try to keep up with the clinical trials that are available for your patients; know when they are eligible and not eligible.
Be involved with community outreach. I was recently honored at yearly gala of an organization that provides respites for cancer patients and their families — For Pete’s Sake Cancer Respite Foundation. I was given the inaugural Gratitude Award for my involvement with this organization for the past 17 years. There were 600 attendees at the gala, including several from my institution who congratulated me on receiving this award. This provided an opportunity for those in attendance to learn one of the values of nurse navigation.