In an Oncology Nurse Navigator’s (ONN) career, there are various ways in which the role and success of the ONN is defined. How to measure that success and the person’s perspective of success comes from professional standards and literature.
One definition of the ONN role is one who offers individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers.1 The Commission on Cancer has established that navigation is a process not a person. This patient navigation process is driven by a community needs assessment and established to address healthcare disparities and barriers to care of the patients. The resources to address any identified barriers may be provided either on-site or by referrals to community based or national organizations.2
Putting Knowledge into Practice
Defining success within the role of the ONN or a cancer program’s navigation process needs to be based on measurable areas. The success of this role can be a challenge due to differences in role definitions, changing staff, new cancer treatments, updated computer work processes, and patients’ personal barriers, just to name a few. I have seen my perspective of success change and evolve over the years. My understanding of being successful as an ONN grew as I was able to attend navigator educational conferences. During the Academy of Oncology Nurse & Patient Navigators’ (AONN+) 12th Annual Navigation & Survivorship Conference, defining success in the ONN role was based on national oncology standards. This presentation taught how the success of an ONN begins with identifying the areas to measure.
AONN+ pulled together a multidisciplinary project team that did extensive research and development from literature, national oncology standards, and AONN+ navigation metrics to identify measurable effectiveness of navigation on patient outcomes.
Starting out as an ONN, I observed the patients’ complicated and variable journeys. These observations motivated me to work with our cancer center team to follow a consistent and predictable pattern of care and treatments. Our team priorities were to be successful, and our patients satisfied with their care by starting with biopsy results and moving into the staging and treatment plan. We followed the guidelines set by the National Comprehensive Cancer Network (NCCN). Once this was established, we then worked to open up different methods of communicating this to each patient, their family members, caregivers, and team members. Our team leaders were the oncologists. The pharmacists were also instrumental in providing the printed and Cerner Powerchart versions of the NCCN treatment guidelines for each patients’ treatment plan. Our navigators would meet with each new patient to identify any individual needs and barriers.
Department leadership helped identify the highest priority patient satisfaction areas through Press Ganey reports. The identified areas were used to develop the individualized treatment plans. The communication of each plan started with the pathology, clinical diagnosis, orders of chemotherapy and/or radiation therapy, and any other orders for diagnostics and labs. Our oncologists’ leadership provided the foundation for a clear path which we followed and clearly communicated to each patient, their family members, or caregivers. Together, our navigators and clinic coordinators developed an appropriate schedule of appointments. The appointments started with chemotherapy and/or radiation education sessions. The scheduling of appointments was reviewed to ensure they matched the treatment plan and orders.
The assessment of the patient began and was ongoing throughout their journey in the program. Any needs and barriers identified were communicated and documented with the navigators, financial counselors, clinic nurses, chemotherapy, and radiation staff. It was expected at this point to refer to any outside resources as needed. Any staff along the continuum of care might have identified these additional needs. The consistency of this process brought confidence to our staff in communicating to our patients. This increased the clarity and understanding of the patient during their cancer treatment journey.
Our success was found in the following areas:
- Timely access to care
- Patients’ understanding their appointments and arriving on time to these appointments
- Patient satisfaction
- Involved staff knowing the plan
- Staff consistently providing guidance to the patient, family member, or caregiver.
Our challenge was measuring and evaluating the success of our navigation process. We looked at each individual’s treatment plan, response to care, patient satisfaction reports, and staffs’ response for negativity or deviations from the plan. At any point, when there was an occurrence, we immediately responded to resolve it by problem-solving with team members involved. The patient and our team were updated with any changes in the plan. The conclusions of any variances would lead to discussions in improving communications within the team and also methods of using the Cerner Powerchart processes.
Lessons Learned and Advice for Others
In conclusion, our team found that our oncology navigation process was always improving and evolving as we responded to individuals’ needs and barriers. We had the freedom to change a patient’s plan at any point during their treatment based on identified needs. Also, we found if we had more resources and staff, then we could build these areas identified as measurable goals. The process that could be built is a Plan, Do, Check, Act (PDCA) cycle to provide program totals in each area which could be used to improve our cancer treatment program.
My success as an ONN is intricately woven in the lives of my patients and team members. It was dependent on others and has changed my perspective from self-focused to team-focused for serving and improving each day.
- “Role of the Oncology Nurse Navigator throughout the Cancer Trajectory”; ons.org.
- “Supporting Compliance with COC Standard 3.1: Patient Navigation Process; onco-nav.com: 2017.
Angelia Huels, RN, CN-BN, was the Nurse Navigator for the cancer center at Cox Medical Center Branson in Branson, MO. Angelia has served in the role for multiple years and is a benefit to the oncology patients of the community. She has been critical in the improvement of patient access to care, evidence-based cancer treatment, and quality of life for patients with cancer in the community. She has promoted her professional growth by attending oncology nurse navigator educational seminars and conferences, including the one offered by the Academy of Oncology Nurse & Patient Navigators (AONN+).
Interestingly, Angelia paid a lot out-of-pocket by herself. Due to COVID-19, her organization was unable to fund employee education, so Angelia took the time to apply for a scholarship to attend the AONN+ 2021 Annual Conference and was selected to attend virtually. In 2022, her oncology program was moved from the local hospital to another hospital in the system due to lack of physician coverage. This gave Angelia an opportunity to go back into the cardiac field, which was her first love in starting her nursing career.