Susie Herndon, MSN, RN, OCN, is the GI cancer nurse navigator for the Sarah Cannon Cancer Institute at Henrico Doctors’ Hospital in Richmond, Va. She has served in this position since September 2015.
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Q: What is the most important work you do as a nurse navigator?
Susie Herndon: The most important work I do as a navigator is to create connections. In today’s business-driven health care system, medical offices are busy and often chaotic places. They are full of good people who sincerely want to help patients but who are often overwhelmed by the workloads required to meet productivity standards. Similarly, patients are overwhelmed, not only by a new and stressful cancer diagnosis but also by being suddenly flung into the chaos of our churning health care system. They often have no significant previous experience to use as a guide for navigating the frustrating and complex spider web of medical offices, hospitals, pharmacies, and insurance restrictions.
As a navigator, I assess what people need and then connect them to the resources and the people who can help them. With a knowledge of the National Comprehensive Cancer Network (NCCN) treatment guidelines, I am able to connect patients with radiation oncologists, medical oncologists, and surgeons in the correct order to facilitate diagnosis and treatment. Learning what resources are available to patients locally, nationally, and online (e.g., American Cancer Society, online colorectal support groups) allows me to connect patients with appropriate, reliable, and evidence-based resources and correct misinformation. I connect cancer patients with social workers, chaplains, palliative care services, and dieticians who can help address issues causing physical, practical, and spiritual distress. I also connect medical facilities with each other and help improve communication and flow of information between the offices. This improves the overall patient experience by creating a sense of order and cohesiveness out of the chaos.
Q: What do you like best about your job?
SH: I previously worked in a medical oncology office and, while I loved it, I realize now I only understood one small piece of the cancer care continuum. I love working with our patients, but what I love even more is being able to support them thoroughly by having a full understanding of what is involved in their entire cancer journey, not just a single piece of it. I have gleaned that knowledge and perspective because I have had the opportunity to work with a multidisciplinary group of providers and staff. By coordinating and attending tumor board conferences, I am continually learning about the process of cancer diagnosis and treatment. This allows me to help explain the process to the patients in a way that helps assuage fears and manage their expectations.
As part of my job, I have built relationships with pathologists, surgeons, and interventional radiologists, just to name a few. By listening and cultivating relationships with physicians, their staffs, and other medical colleagues, I have learned the processes, priorities, and patterns important to each unique player in our local cancer community. Learning continuously and working collaboratively with a variety of health care professionals are my favorite parts of the job because they give me the tools I need to help create a smoother experience for our patients.
Q: What value do you think nurse navigation provides?
SH: Navigation is often considered a soft service: It is less tangible and, since it is not directly reimbursable, its positive financial impact is less obvious than other health care services and procedures. However, the value of navigation is becoming more obvious in cancer care. Navigation is an important component in the Centers for Medicare & Medicaid Services’ (CMS) Oncology Care Model as well as a requirement for hospitals seeking accreditation through the American College of Surgeons’ Commission on Cancer. Additionally, the Academy of Oncology Nurses and Patient Navigators has recently published a set of standardized navigation metrics which will hopefully allow us to create better business cases for navigation and demonstrate our financial value to institutions and health care communities.
Nurse navigation improves the patient experience the same way having a tour guide and interpreter enhances the experience of a tourist in a foreign country: a navigator is a guide who speaks the local language and has knowledge of the local customs. While it is possible to visit another land and have a positive experience without a guide, the experience is richer and smoother with someone who has intimate knowledge of the country and culture.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
SH: I recently worked with a patient from initial suspicion to treatment. Navigating her drew on all aspects of my experience, from inpatient and outpatient oncology to chemotherapy infusion to clinical research coordination as well as on many of the multidisciplinary relationships I have cultivated. The patient’s gastroenterologist initially contacted me following a colonoscopy finding of a gastric mass. I contacted the patient, answered some of her questions, listened to her fears, and expedited an appointment for imaging and a surgery consult. Her imaging revealed not only masses in her stomach and colon but also in her pancreas. The consensus was that she required a major surgical intervention because of her risk for bleeding. I was able to help support and encourage this otherwise fit and healthy woman. I visited her in the hospital after surgery and followed up with her after her final diagnosis of stage IV pancreatic cancer. Not surprisingly, the diagnosis led to many new questions and fears. I was able to assist her with scheduling an appointment with a local oncologist as well as with obtaining a second opinion consult at a renowned academic hospital out of state.
When she decided to participate in a local clinical trial, she contacted me on a Saturday to express her frustration at not being randomized to the experimental drug. Drawing on my clinical trials background, I spent an hour talking with her about the advantages and disadvantages of continuing in the trial on the standard of care treatment arm. I knew the research nurse working with her well and communicated some of the patient’s concerns to this nurse in advance of her Monday appointment. As a navigator, I had the knowledge, tools, connections, and time to be there for the patient when she needed support and was able to help make the path through diagnosis, surgery, a second opinion, and treatment as part of a clinical trial as seamless as possible.
Q: What technology do you use in your position? What tools do you wish you had?
SH: In nearly every aspect of our lives, we use technology 24-7. We anticipate being able to communicate most needs at any time by text, email, or social media. This is particularly true for younger generations.
Health care is the exception. In health care, we still rely heavily on faxes and phones. People want to be able to communicate with providers and their offices as quickly and efficiently as they communicate with their banks and grocery stores; however, the reality is they often get stuck in frustrating, circuitous phone trees when they call their doctors’ offices.
My most useful piece of technology is my work cell phone. It allows me to be available to my patients at unusual hours and from remote places. It also offers the patient the option to call or text. It is a personal decision to respond to my phone at off-hours, but I have found it is an incredibly useful way to offer the extra support many of these patients need. I have received texts expressing concerns or fears at 10 p.m. that I’ve been able to address quickly, thereby alleviating a small amount of stress just by being accessible. No patient has ever abused this.
One piece of technology I hope to see in the future is something that allows universal communication of electronic medical records between individual practices and hospitals. When patients fall through the cracks in the health care system, it is usually the result of poor communication and complete records not being available as the patient moves from provider to provider. Oncology care normally involves multiple providers and waiting for records to be faxed between offices. As a navigator, I use my resources to try to expedite the process, but it would drastically improve the patient experience if transferring records was less cumbersome.