Carole Headen, RN, CN-BN, is a nurse navigator for Saint Thomas Rutherford Hospital in Murfreesboro, Tenn. She has served in a navigation role for breast patients since August 2009, and previously worked for the organization as a staff RN on the oncology floor for more than 13 years.
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Q: What is the most important work you do as a nurse navigator?
Carole Headen: In my role as the breast nurse navigator, one of the most important things I do is make sure our patients with an abnormal mammogram are coordinated for their biopsy as soon as possible to reduce the time from detection to diagnosis. We have a rather large population of uninsured women, so I also help coordinate grant funds for their mammogram and then refer those who need a breast biopsy on to our local department of health for enrollment in the breast and cervical screening program for coverage if the patient qualifies. If they do not qualify for that program, then I work on getting them coverage for the procedure through our foundation with the grant funds.
Q: What do you like best about your job?
CH: What I like best about my role is the classes we offer for patients that will be undergoing breast cancer surgery. Each week I teach a class for patients that are preparing for surgery. The class usually lasts about 1.5-2 hours. During that time I go over with patients and their support person the following information:
- breast cancer pathology;
- tumor markers;
- lumpectomy versus mastectomy surgery;
- reconstruction surgery;
- sentinel lymph node mapping and lymphedema;
- what to expect the day of surgery;
- post-op care and drains;
- activity after surgery;
- additional treatments that may be recommended;
- body image and self-esteem concerns;
- post-op supplies and garments; and
- community resources and support programs.
The patients and their loved ones are encouraged to ask questions. The classes usually only have 2-3 patients in them at a time, which puts them face to face with someone else that is also preparing for surgery but the group is still small enough that they are comfortable in asking questions. The ladies and their loved ones give great feedback about how the class has really helped them and that they feel better prepared for the next steps.
Q: What value do you think nurse navigation provides?
CH: I think nurse navigators provide the additional support that cancer patients need at the time of their diagnosis and throughout the continuum of care. We are that one person among a multitude of providers that they can go to with questions and concerns, and we help with providing information about resources and support programs. As navigators, I feel we are there to ease some of the tremendous burden that a cancer diagnosis has on patients and their families by making sure they understand the treatments that are being recommended and also are aware of those resources they can tap into to provide financial assistance and other support to remove barriers they may be facing.
Q: What would you say to an organization that is contemplating whether to implement a nurse navigation program?
CH: I would say YES, go for it! Since navigation services are offered free of charge, those organizations that do offer navigation show their extra commitment to their oncology program and the overall experience of their oncology patients. I have heard more than once from patients and family members who may be going through a recurrence or additional cancer diagnosis that “they wish they had a navigator before.”
Return on investment has been proven with our particular program in that we have seen shorter length of stay post-op for mastectomy patients that were navigated prior to surgery versus those that had not met with a navigator preoperatively. Proving that our education and time spent with the patients prior to surgery helped alleviate their anxiety about their procedure and better prepared them for discharge.
Q: What do you hope for as the future for nurse navigation in the United States?
CH: My hope is that soon all U.S. hospital cancer programs will have a nurse navigation program. I also hope that they see the value in our position and expand their programs to cover all tumor types so every newly diagnosed cancer patient will have access to a nurse navigator. I see a role for navigation with chronic illnesses other than cancer, so I would like to see nurse navigation reach into those areas as well.
In our organization, we have expanded navigation from breast, which began in 2008, to lung, brain, and, most recently, GI. We also have a full-time licensed clinical social worker and three patient intake navigators. I hope we continue to expand our program to cover all tumor types as well and possibly be one of the first to expand to other chronic diseases.