Janie Metsker, RN, CBPN, is nurse navigator and clinical coordinator for St. Luke’s South Goppert Breast Center in Overland Park, Kan. She has served as a breast nurse navigator since 2009.
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Q:What is the most important work you do as a nurse navigator?
Janie Metsker: The most important work I do as a breast nurse navigator is being present with the woman during a very vulnerable time. Breast cancer is a life-changing diagnosis that creates chaos in a woman’s life. She needs support, not only from her family and friends, but from a professional nurse who is knowledgeable and can educate her about her specific diagnosis. Also, the newly diagnosed patient desperately needs hope, and while I cannot promise that she will be fine, I can share my personal story in a therapeutic way. When the woman learns that I am a survivor, I can see hope returning to her face.
One of my favorite quotes to share with patients comes from Corrie ten Boom, who was a prisoner in a concentration camp: “In order to realize the worth of the anchor, we need to feel the stress of the storm.” I think this is why women have told me they felt like I was throwing them a life preserver when they felt like they were drowning.
Q: What do you like best about your job?
JM: Nurse navigation is a fairly new role in nursing. When I first learned what a breast nurse navigator does, I was immediately interested. I became a breast nurse navigator in 2009 and it was a beautiful fit for me.
I love connecting with woman on a deep level. The connection is a source of strength when I am present with them, spending time and in the moment. It creates trust and understanding, and ultimately helps them find their path and make decisions. When a patient calls me and says, “I’ve made my decision and here’s why,” I think it empowers them not only to fight their battle with breast cancer but to give it meaning. It humbles me to be part of their journey.
Q: What value do you think nurse navigation provides?
JM: Research supports the benefits of nurse navigation for improving timeliness of cancer treatment, removing barriers to care, decreasing racial disparity and lowering rates of depression and anxiety. There is even evidence that nurse navigation improves survival rates. Navigation is a powerful, patient-centered process that encompasses the heart of nursing by providing caring encounters that develop trust.
Nurse navigation also helps the patient move through the complex medical system and many decisions that she is facing. Several years ago I created a little mnemonic with the word “guides” that shows the work and value of nurse navigation:
- Gives support during diagnosis and treatment
- Understands through listening
- Identifies barriers to care
- Decisions: supports woman with treatment decisions
- Educates patient/family
- Schedules additional tests, appointments
Q: Can you share a patient story or experience that demonstrates the value of nurse navigation?
JM: After the woman receives a breast cancer diagnosis, I like to meet with her as soon as possible to provide emotional support, education and initiate coordination of care. I had a newly diagnosed patient that I met with and quickly realized she had some unhealthy relationships and boundaries in her life. Her breast cancer diagnosis motivated her to make personal changes and consider her own needs and desires for the first time in her life. I was able to help her talk through her diagnosis and to make lifestyle changes. We formed a deep, caring relationship of trust that helped her through chemotherapy, surgery and radiation. She started setting boundaries. She learned how to say, “No.” She decided to eat healthier and exercise. She began to look for meaning and purpose in her illness and suffering.
She had a bilateral mastectomy. When I went to her room after her surgery, we viewed the surgical site together. We cried together. I helped her put on the postoperative camisole with pockets for the drains and get dressed. When she looked in the mirror, her countenance changed completely. In place of the tears, there was a huge smile on her face. The interaction restored her dignity and gave her a new perspective to accept the loss of her breasts. The genuine empathy and care of a nurse navigator engendered trust and the hope she so desperately needed.
Q: What do you hope for as the future for nurse navigation in the United States?
JM: I hope that navigation continues to grow to provide care coordination and support for all cancer patients. Breast cancer navigation has led the way and the benefits are evident. The Commission on Cancer (COC) is requiring navigation for every cancer type for COC-accredited sites. This is a great challenge for cancer programs since navigation services are not reimbursed. I hope that there will be reimbursement for navigation services as we move forward. The value is clear: Navigation improves the timeliness of care and prevents patients from getting lost in the complex medical system. It also increases patient satisfaction. Providing the best patient experience and recognition of the patient’s suffering is what navigation is all about.