Barbara Van Slyke, RN, BSN, OCN, is an oncology nurse navigator for Bay Area Cancer Center in Coos Bay, Ore. She has served as a nurse navigator since July 2015.
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Q: What is the most important work you do as a nurse navigator?
Barbara Van Slyke: Support the patient. It seems like a simple answer, but in reality it is a very layered answer and includes the summation of what we do. I may be there at the diagnosis to help a patient emotionally. I may be working with someone to coordinate three appointments into one day for a patient who lives 100 miles away and can only afford to drive into the area once a week. I may need to explain and aid a person through the confusing maze of getting onto Medicaid or into disability services. It goes on and on, but it is all about supporting a person and helping to relieve them of at least a portion of all these irritating and confusing barriers that present themselves once you get a cancer diagnosis. If I can help to smooth things out, I can help them relax and be in a more positive place during treatment. I like to think that can help survivability.
Q: What do you like best about your job?
BVS: The whole enchilada. I love the fact that I have so much patient interaction because, as all nurses know, that is what truly appeals to the heart and soul. When I identify myself as the contact person for someone who is overwhelmed with problems, many times I can actually see the relief come across their face. It is an instant and powerful rush of remembering the intrinsic reason I became a nurse.
However, my mind also thrives because I get to work on so much program development and varied projects. The nurse navigator role in my hospital just started six months ago, so I get to develop it from scratch.
In addition, I have learned so much from sitting in on consults and working more closely with the physicians. I have met so many people who work with in our community agencies, and continue to learn about resources we have and don’t have in our community.
I get to work on the development of screening programs and educational programs for staff, patients and the community. I am critically involved in ensuring that we meet accreditation standards.
Q: What is your biggest challenge as a nurse navigator?
BVS: I work with all types of cancer patients, so that means my knowledge must be very broad. I consult with medical oncology and radiation oncology, and am starting to broaden out into surgical oncology. The beauty of having a navigator, if you are the patient, would be to have someone with detailed understanding of what you will be going through and what needs you might have. If I was solely a breast or lung navigator, I could be incredibly detailed. I have to practice more as a generalist because I see everyone.
We also do not have a social worker or palliative care person in the cancer center, so I have the added challenge of being the psychosocial person as well. When a patient is telling me they are hearing voices or are exhibiting paranoia, I wish so much I had an licensed clinical social worker here for that patient!
Q: What challenges do you face by working in a rural setting?
BVS: Practicing in a rural environment can be quite a challenge and not one that you can find much literature or conference material on. Many of our patients are between 50 to 100 miles away from the cancer center. There is very little to offer as far as transportation or housing. A person may need to leave their house at 8:30 in the morning to catch the van up the coast. Even though their radiation time on the table may only be 15 minutes a day, they won’t be back home till 5:45 pm because that is how the route is run. Can you imagine doing that five days a week for five to six weeks? It is not surprising that some people choose to not receive treatment.
I have had to send state troopers to people’s homes to relay messages because many areas do not have cell phone coverage. Unlike cities, we only have one American Cancer Society program — “Look Good Feel Better” — available here for patients.
Q: What do you hope for as the future for nurse navigation in the United States?
BVS: I would love to see what the outcomes will be in 10 to 20 years since we now have nurse navigators providing patients with survivorship care plans and surveillance. In oncology, we have historically not been as involved in monitoring the late effects from cancer treatment as we should have been. Navigators are changing lives in simple ways, such as making sure that someone gets a physical therapy referral when, two months after treatment, they start to have difficulties. We are making those calls to people reminding them they need to get a follow-up CT scan.
I tell my patients that they now have their own “personal nagger” and they laugh, but I can tell they are happy to know that someone on their cancer team will still be looking out for them even years after completing treatment.