Post-Conference Session Summaries

Developing and Implementing a Successful Nurse Navigator Program in Your Community

Instructional Session 25, presented on Friday, April 27

Michelle Schneider, BS, RN, OCN^®, began the presentation by explaining that “nurse navigators” are known by many different names, but they “all pretty much do the same thing:” help patients and their families navigate the maze of cancer care. The shift from inpatient to outpatient settings has made navigating the maze more challenging than ever. Deciding between treatment options, scheduling appointments, securing referrals, and dealing with psychosocial issues can be very overwhelming. The nurse navigator can offer valuable support, guidance, and instruction in all of these areas.

Schneider and the other presenters focused primarily on the breast cancer nurse navigator role, but most of what they said was relevant to many different cancers. Nurse navigators need to ensure that patients understand the information being delivered to them. Schneider explained the importance of effective communication because patients often only focus on what is most important to them (e.g. will they be able to live at home, will they lose their hair). She also stated that getting from diagnosis to treatment entry in the outpatient setting is “a very lonely road” now, unlike in the past when patients routinely were hospitalized for days of testing and were able to ask questions of their nurses throughout their stay.

Schneider also stressed that oncology nurses need to “reach out to patients early” as they await their initial diagnosis, so regardless of the diagnosis outcome, they have a positive experience with the oncology community. Schneider concluded by emphasizing the importance of building strong relationships with other care team members, keeping communication lines open with patients, and maintaining truly “patient-centered care.”

Cindy Wise, RN, MSN, OCN^®, provided an overview of the various roles of the nurse navigator in the specific area of breast care, including breast care coordinator, breast care nurse, imaging nurse, and breast health specialist. Individuals in these roles promote breast health and education in their communities by offering outreach programs; contacting patients during particularly stressful periods; offering access to resources and information about clinical trials; and serving as liaisons with the healthcare team.

Wise also touched on performing the breast cancer nurse navigator role in nontraditional or virtual settings. Such settings involve patients who have to navigate among different care sites or have little direct contact with the nurse navigator, instead communicating via telephone, the Internet, or mail. Services in nontraditional settings can be delivered in physicians' offices, freestanding centers, satellite offices, and outpatient hospitals. Wise concluded by discussing the advanced practice nurses' role in navigation, indicating that they should provide timely and appropriate care along the breast care continuum, integrate best practice standards, implement quality improvement, and incorporate research into the care plan.

The final speaker, Darcy Burbage, RN, MSN, AOCN^®, discussed implementing quality improvements and measuring outcomes in nurse navigator programs. She first cited literature indicating how patients have benefited from the involvement of breast care navigators in terms of greater patient satisfaction, education, and involvement in clinical trials. Burbage defined quality improvement "as actions taken, processes implemented, or services created to improve patient care" and listed areas of measurement such as pathology turnaround time, waiting time between biopsy and actual surgery, and rates related to recurrence, readmission, mastectomies performed, and mammography return.

Burbage also explained how to develop a study that will enable care providers to assess the effectiveness of quality-improvement measures, such as determining the scope of the issue and why it needs to be addressed, what data are available for review, and what interventions are needed or should be tried to improve the area of focus. Burbage concluded by citing the success of nurse patient outcome measures at her own institution and by providing a case example that demonstrated how gathering ample baseline data, developing effective strategies for quality improvement, and achieving measurable outcomes can lead to improved care.