Emeline M. McShane, RN, BS, CN-BN, is a Breast Care Partners nurse navigator for upstate New York’s St. Joseph’s Physicians Surgical Services and Hematology-Oncology Associates of CNY. Breast Care Partners is a diverse group of breast health specialists in Central New York, who have partnered together to ensure each patient the best possible breast care available. Its mission is to provide an organized, comprehensive, multidisciplinary, team approach to breast care that is now considered best practice to improve clinical and psychological outcomes for all patients. Emeline has served as a nurse navigator since April 2013.
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Q: What do you like best about your job?
Emeline McShane: The most fulfilling part of my job is being able to provide direct face-to-face patient education. I spend the majority of my patient contact time educating patients (and their families) who have been newly diagnosed with breast cancer. Any cancer diagnosis, or the “C” word as many call it, is overwhelming. After providing a thorough explanation of the type of breast cancer they have, clinical staging, surgical options to be discussed, and timeline/plan of care, I can visibly watch the shoulders drop a few inches and they start to breathe a little deeper. Education seems to empower patients in this position, and I enjoy going through the lengthy list of questions that most bring to their first appointment with their surgeon. Through this process I also gain the patients’ trust. They then feel comfortable reaching out to me at a later time with questions or concerns that come up.
Q: What value do you think nurse navigation provides?
EM: Nurse navigation provides patients with reliable education and a dependable “go-to” contact person. The patients find a source of comfort knowing they have a nurse navigator to call with any issues or concerns. Appointments are streamlined and barriers minimized with a navigator to oversee the plan of care.
With breast cancer, there are numerous surgical options and some choices are left to the patient. Nurse navigation keeps the connection between the patient and the provider very fluid and eases communication about patient treatment decisions.
Q: What is your biggest challenge as a nurse navigator?
EM: One of the biggest challenges I have faced as a nurse navigator is the lack of a precise, defined role. Nurse navigation is still fairly new, loosely defined and sometimes blended with patient navigation, which is carried out by non-clinical staff. It has been difficult to implement the navigator position in a facility that has already developed a call center, referrals department and teams composed of a provider/PA or NP/nurse/MA/AA.
As a nurse navigator, it has been challenging to stay on the front end and help the patient avoid barriers, versus overseeing the process in an audit-type format, ensuring the patient has had all appropriate referrals and appointments scheduled.
Q: What technology do you use in your position? What tools do you wish you had?
EM: Several EMRs and data tracking tools are used in my position. The surgery office and oncology office each have their own EMR. The oncology office uses a separate piece of software to create survivorship care plans. Breast Care Partners, composed of seven entities, uses another data and navigation tool to track patients in the program and navigate them from imaging to surgery to oncology and survivorship. The data is also used for National Accreditation Program for Breast Centers accreditation. There is not a lack of tools, but a lack of interfacing so that data is not entered into four systems, four different times. Interfacing could significantly increase efficiency; however, it is a huge undertaking when connecting numerous entities.
Q: What do you hope for as the future for nurse navigation in the United States?
EM: The value of nurse navigation will prove itself in patient satisfaction alone. The awareness and importance will come with time. In the future, I hope nurse navigation creates its own level of distinction as a standard of care and expands to all acute care specialties.
I think it would benefit nurse navigators to have required training and/or a close working relationship with social workers as well. We as nurses often cross over into the area of social work to help patients meet their emotional and financial needs and remove barriers to assist in completing their treatment.