Susan L. Coward, RN, BSN, is a nurse navigator for GI oncology at Cone Health Cancer Center in Greensboro, N.C. She has served in this position since January 2016. Coward has served as a nurse for 34 years, and as an oncology Nurse for 28 years.
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Q: What is the most important work you do as a nurse navigator?
Susan Coward: As an oncology nurse navigator, my foremost goal is to expedite my patient’s cancer care. I collaborate with gastroenterology, surgery, medical oncology, radiation oncology, radiology, and pathology to have the patient seen in a timely manner and facilitate the continued workup for their final diagnosis and staging. I am present for their first medical oncology visit to allow me to reinforce what the oncologist has discussed and work with the patient and family in the coordination of the next step. Potential barriers to their care are assessed for, and solutions are initiated via referrals to managed care, financial advocate, clinical social work, dietician, etc.
Q: What do you like best about your job?
SC: It’s extremely rewarding to me to see the patient and family make the transformation from feeing anxious with all sense of control in their life taken to one of feeling empowered and taking an active role in their care. They will enter the cancer center smiling and feeling as if we are their second family. This happens through education with frequent reinforcement and including them in decision making. I really try to get to know my patient and their family personally, not just as a patient. Also, I want to help them maintain a sense of hope by pointing out at least one positive thing at each visit.
Q: What value do you think nurse navigation provides?
SC: Nurse navigation, especially in the oncology field, provides a valuable contribution to patient care as well as for the provider. Navigation can expedite patient care, which helps promote an improved patient outcome. Having experienced nursing coordination will ensure the first visit is as productive as possible in that the physician has the necessary information needed to begin planning the patient’s care. Navigation provides the patient with the additional educational and psychosocial support to help them in their cancer-fighting journey. They feel a greater sense of safety — that someone else is looking out for them and they are not alone.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
SC: Among my fellow navigators at the Cone Health Cancer Center, I could provide so many examples of how patients were touched and helped by all of us on numerous occasions. Our navigators just feel this is what we are “called” to do. Navigation allows us to use all our nursing skills, especially caring for the heart and spirit of the patient. That can often be limited for a bedside/chairside oncology nurse due to time constraints from staffing and all the other tasks involved in documentation of patient care.
I remember a young lady I first met in our multidisciplinary GI clinic with a cancer diagnosis. She was so anxious and afraid, I couldn’t get her to even look at a picture of a PICC line. She declined to attend our chemotherapy education class that all our new patients receiving chemotherapy attend. She was so angry and negative and could only focus on “why did this happen to me?”
I had her come in and provided a private teaching session for her and a family member. Afterwards, I presented her with a small plaque from our “Perseverance Project” that read “Life isn’t about waiting for the storm to pass …. it’s about learning to dance in the rain.” I would meet with her in radiation, encourage her throughout her treatments, and help her focus on any small thing each day to “dance” about. I was there with her when she celebrated her accomplishment by “ringing the bell.” Later, after treatment completed, she came to our GI support group and spoke about how difficult the experience was, but she was proud of herself and never realized how strong she was before. She is now attending our “Finding Your New Normal” group provided for patients after their treatment is completed. It was wonderful to see and be a small part of that beautiful transformation!
Q: How do your colleagues view nurse navigation and care coordination?
SC: Nursing navigation has been in place at the Cone Health Cancer Center for many years, and is viewed in a positive light by our nursing and support staff. We have a strong collaborative relationship and communicate well with each other. The nursing staff and the navigators at our cancer center have a mutual respect and work very closely with one another for the patient’s best interests. The physicians in medical oncology, radiation oncology, and surgery see the navigator as a valued member of the health care team. They depend on me to have their patients seen and have their care coordinated as efficiently as possible. This month, our multidisciplinary GI clinic celebrated its first year and has proven to be of great value to patients and providers.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
SC: The Cone Health Cancer Center has found that the oncology navigation program improves the patient’s experience. We often receive comments from patients that their navigator has been their “angel” and helped them make it through their treatment. I believe having someone to provide that extra one-on-one education and support reflects in improved patient compliance with treatment as well as patient satisfaction.
It means a lot to the patient to know there is that one point person they can always call when unsure of who to ask or where to turn. — we are their safety net. I, for one, take that responsibility very seriously and am honored to do so.