Role of the Oncology Nurse Navigator Throughout the Cancer Trajectory

Navigation in oncology has demonstrated benefits for people at risk for or diagnosed with cancer. These include a shorter time to diagnosis and start of treatment, increased patient and caregiver knowledge, better adherence to recommended care, and improved quality of life. In addition, benefits to healthcare institutions include cost reductions through reduced rates of emergency department visits and readmission, and adherence to recommended treatment and follow up. The goal of navigation is to reduce cancer morbidity and mortality by eliminating barriers to timely access to cancer care, which may be financial, psychological, social, logistical, or related to communication, language, literacy, and equity of health care delivery (Gordils-Perez et al., 2017; Munoz et al., 2018; National Academies of Science, Engineering, and Medicine, 2018; Temucin & Nahcivan, 2020; Yackzan et al., 2019).

The Oncology Nursing Society ([ONS] (2017) defines an oncology nurse navigator (ONN) as “a professional RN with oncology-specific clinical knowledge who offers individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers. Using the nursing process, an ONN provides education and resources to facilitate informed decision making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum” (p. 4).

Effective navigation models use a variety of healthcare and non-healthcare (lay) personnel. The field of patient navigation requires a standardized core set of competencies (Valverde et a., 2019). ONS has developed ONN competencies (2017) to serve as a guide for navigation training for oncology nurses.. The ONN provides added benefit because they are uniquely qualified to provide specific clinical support to patients and caregivers, such as comprehensive assessment, general and focused education, and decision-making support. The ONN has the skills and knowledge to coordinate quality, patient-centered care through effective communication with the interprofessional cancer care team.

It is the position of ONS that 

• Navigation services should begin with prevention and screening activities and facilitate care transitions through diagnosis, treatment, survivorship, and end-of-life care. 
• The ONN should practice in accordance with the ONS Oncology Nurse Navigator Core Competencies as applicable to their practice. The core competencies of the ONN role include coordination of care, communication, education, and professional role.
• The ONN role can be tailored to meet the needs of patients in each care environment but should fulfill the tenets of the ONS-defined competencies. 
• Nurses in ONN roles should possess comprehensive oncology expertise, as evidenced by certification through the Oncology Nursing Certification Corporation or other oncology nursing certification accredited by the National Commission for Certifying Agencies.  
• The ONN advocates for adherence to evidence-based clinical practice guidelines and pathways and participates in the collection and analysis of patient outcome data to optimize patient and organizational outcomes.
• Determination of ONN workload and allocation of resources should be based upon data from reliable and valid metrics, including health system standards and measures sensitive to the ONN contribution to the navigation process.

Download this position statement.

Statement Type

Nursing Practice

References

Gordlis-Perez, J., Schneider, S.M., Gabel, M., & Trotter, K.J. (2017). Oncology Nurse Navigation: Development and implementation of a program at a Comprehensive Cancer Center. Clinical Journal of Oncology Nursing 21(5), 581-588. 

Munoz, R., Farshidpour, L., Chaudhary, U.B., & Fathi, A.H. (2018). Multidisciplinary cancer care model: A positive association between oncology nurse navigation and improved outcomes for patients with cancer. Clinical Journal of Oncology Nursing 22(5), E141-E145.

Oncology Nursing Society. (2017). 2017 oncology nurse navigator core competencies. Retrieved from https://www.ons.org/sites/default/files/2017ONNcompetencies.pdf

National Academies of Sciences, Engineering, and Medicine. 2018. Establishing Effective Patient Navigation Programs in Oncology: Proceedings of a Workshop. Washington, DC: The National Academies Press. 

Temucin, E. & Nahcivan, N.O. (2020). The effects of the nurse navigation program in promoting colorectal screening behaviors: A randomized controlled trial. Journal of Cancer Education 35(1).

Valverde, P.A.; Burhansstipanov, L., Patierno, S., Gentry, S. Dwyer, A., Wysocki, K.L., Patterson, A.; Krebs, L.U., Sellers, J. & Johnston, D. (2019). Findings From the National Navigation Roundtable: A Call for Competency-Based Patient Navigation Training. . Cancer:...

Yackzan, S. Stanifer, S., Barker, S., Blair, B., Glass, A., Weyl, H., & Wheeler, P. (2019). Outcome measurement: Patient satisfaction scores and contact with oncology nurse navigators. Clinical Journal of Oncology Nursing 23(1), 76-81.  

Credentialing including navigation:

Optimal Resources for Cancer Care. ACoS CoC Standards 2020. https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx

National Accreditation of Breast Cancer Programs (NABCP)– Standards Manual (2018). American College of Surgeons.
https://www.facs.org/-/media/files/quality-programs/napbc/napbc_standards_manual_2018.ashx