Ruth Van Gerpen MS, RN-BC, APRN-CNS, AOCNS, is an oncology nurse navigator and clinical nurse specialist in oncology for Bryan Health in Lincoln, Neb. She has been in oncology nursing for over 30 years and served as a nurse navigator since 2010.
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Q: What is the most important work you do as a nurse navigator?
Ruth Van Gerpen: For the patient and family, the unknown and the fears often associated with the word “cancer” are magnified with each day of waiting for an answer or the determination of the next step. Patients don’t feel they can make plans as everything stops and comes to a standstill. A navigator serves as a constant point of contact to answer questions, listen and provide reassurance. I tell my patients that my business card has no expiration date.
However, some of the most important work I do as a navigator is to minimize the delays with diagnosis or initiation of treatment through coordinating tests, appointments or referrals and ensure patients receive pathology or test results as soon as available, including on weekends, to help alleviate the unknown by confirming the suspected or rejoicing in the unexpected.
Q: What do you like best about your job?
RVG: The most rewarding part of my role as a nurse navigator is the difference I am able to make for patients and their families at a time when they are confronted with uncertainty and anxiety, whether it’s allaying fears, providing a patient or family with the information to make a decision that is right for them, offering the necessary resources to address concerns or needs, giving a reassuring hug or wiping a tear, celebrating another year disease free with a patient or helping a patient achieve the hope of dying well.
Q: Can you share any particular patient stories or experiences that demonstrate the value of nurse navigation?
RVG: Recently, a young man was admitted with a several day history of increasing abdominal and flank pain. A CT scan showed a large retroperitoneal mass and extensive metastatic disease throughout chest and abdomen. Several enhancing lesions in the brain were also identified. Biopsy confirmed choriocarcinoma. Initially, my focus as his oncology nurse navigator was helping the patient, his brother and father understand the extensive nature of his disease, recommended chemotherapy regimen and associated side effects.
Early barriers complicating his care included no health insurance, no job, no transportation (other than a bike) and limited social support. Applications for Medicaid were initiated, referrals to American Cancer Society for Road to Recovery transportation assistance were completed and a surprise visit with his two children, currently in foster care, were arranged. Due to a few missed appointments for chemotherapy and follow-up scans, his oncologist requested that I increase my contact and follow-up with the patient and keep him posted. My contact has included reminder calls the day before a scheduled appointment, sometimes the morning of (to make sure he heard his alarm go off) and the day after to verify he understands the next steps and the importance of adherence to his treatment plan. The highest compliment I have received from the oncologist and this patient is that “You really do care. You’re like the mom I haven’t had.”
Nurse navigators serve as a guide, advocate, educator, resource and liaison throughout all aspects of the cancer journey for the patient, family and care providers. The value of nurse navigation: priceless.
Q: How do your colleagues view nurse navigation and care coordination?
RVG: When our oncology nurse navigation program expanded to provide services to all inpatients currently in treatment or recently diagnosed with cancer, our care management staff expressed concern of duplication of services and were skeptical as to the added value of navigation. The ability to differentiate the role of a nurse navigator and a care manager/discharge planner and articulate the benefits were key to excellent collaboration, which has resulted in enhanced coordination of services and patient care.
The oncologists, hospitalists and other providers value the coordination, communication, resources and support that is consistently and continuously provided to their patients. Our services are now requested.