Jennifer Daugherty, RN, is a lung care nurse navigator for Kirkland Cancer Center in Jackson, Tenn. She has served as a nurse navigator since June 2014.
Q: What is the most important work you do as a nurse navigator?
Jennifer Daugherty: Have you ever been in a situation so unfamiliar and so full of unknowns it almost felt like you were drowning? That’s the feeling my patients experience when they’re sitting in the exam room, waiting on their pathology results and the doctor says the word “cancer.” My patients are immediately submerged into an ocean of unknowns, of tests and labs and “be here for this and there for that.”
Then in I walk. I offer them a lifeline of emotional support, of resources, of education. I talk but I also listen. I listen to understand their stories. I pull the plug on the fear by empowering them with knowledge and by being the one person in which they can confide for any need, any question. Being present and attentive shows my patients I value them — that’s what’s most important. Everyone, cancer diagnosis or not, has the inherent need to feel heard and seen. By doing that simple act, I watch faces full of fear fade to calm and collected.
Q: What do you like best about your job?
JD: Patient advocacy and relationships. Everything I do as a navigator revolves around patient advocacy and relationships. Whether it’s one-on-one patient education, health fairs, community awareness programs, creating new patient services for our area — it’s all to improve patient outcomes, provide better quality of life and ultimately to save lives.
Over the past year, I joined a multidisciplinary team of physicians, surgeons, and administration to build an incidental lung nodule database and lung nodule clinic as well as a low dose CT lung cancer screening service. These programs provide early detection and patient follow up. They have the capability of changing lung cancer’s five-year survivorship from 17 % to nearly 70 % by detecting lung cancer earlier, thus rendering diagnosis at a stage I rather than stage IV. Being an active part of change and forward thinking while improving patient outcomes and building relationships makes me joyful.
Q: What value do you think nurse navigation provides?
JD: The value of nurse navigators lies in the patients’ satisfaction and perceived experience as well as physician satisfaction. And if you think about it, it’s all sort of snowballed together — perception truly is everything.
The navigator closes the gaps for the patient by eliminating barriers to care and by placing value and meaning to the individual’s experience. The patient is able to focus on treatment while the navigator works on his/her behalf by communicating with care providers, addressing emotional distress, and sorting through financial concerns and transportation issues. Having a “go-to person” where no problem is too big or too small instills value in that patient. With patients’ perception of value comes compliance to treatment and follow-up adherence. Then with patient compliance and follow-up adherence comes physician satisfaction. The navigator provides the glue for the experience.
Q: Can you share a story about a patient experience that you feel demonstrates the value of nurse navigation?
JD: A couple months ago I received a referral for 67-year-old male with a newly diagnosed T1aN0M0 squamous cell carcinoma of the right upper lobe. I met with the patient and his family in the pulmonologist’s office following the pathology result visit. This patient verbalized his hesitancy to have any treatment at all. He was heavy with his new diagnosis and overwhelmed, and cried as we spoke about the next steps in treatment planning. I asked him and his family if I could just give them a brief tour of our cancer center, introduce them to our care team, and try to do away with some of his unknown. He reluctantly agreed, but said they would drive instead of walk.
As I waited out front, they pulled up. I greeted them through the open car window and invited them inside. Then he said he just couldn’t do it today — he was tired and wanted to go home. With a smile I said I understood and reminded him of my phone number in his education packet if he happened to think of any questions.
A few days later I received a phone call from one of our thoracic surgeons regarding this patient. Being a stage I, he was referred for a surgery consult by the pulmonologist. Unfortunately, the patient was deemed not medically operable due to other comorbidities and the surgeon was requesting a radiation oncology consult for stereotactic body radiation therapy consideration. Since the patient lived a considerable distance from our facility, I called to verify appointment times that would be best and encouraged him to at least come in for the consult to hear what our radiation oncologist recommended. The patient agreed — though with much apprehension. I set up the consult, and he came in later that same week. After treatment planning, the patient received a total of 54 Gy in three fractions, which is only three days of treatment.
On his last day of treatment, he called me out to the waiting area and thanked me with words and a hug. Without my encouragement and navigating, I know this patient would not have returned to our facility for treatment. The value of nurse navigation lies in each individual patient.
Q: What is your biggest challenge as a nurse navigator? What do you hope for future of navigation?
JD: The medical community across the United States undervalues nurse navigation. Proving our worth seems to be a recurring theme. And measuring relationships and experiences is very difficult. I recently attended the Academy of Oncology Nurse & Patient Navigators 6th annual conference held in Atlanta. Speaking with other navigators from all over the United States, the biggest challenge — hands down — is showing our value in a system set in its ways.
Our worth is proven through our patients: little by little and a patient at a time. The old ways of shuffling patients from provider to provider and expecting the patient to know how to navigate such a complex system is counterproductive. Quite frankly, that archaic approach has caused many patients to throw their hands up in frustration and not seek care at all. The future of patient care and improved patient outcomes lies in a multidisciplinary team approach with the patient in the middle and the navigator leading the way.