Over the past few months, my ACCCBuzz blog posts have covered navigation documentation tools, orientation needs, patient education, and the value that navigators bring to a cancer program. Navigators support patient-centered, coordinated, streamlined access to care. But what about the support navigators themselves need in order to provide the best possible care for the patients and their families while juggling a host of other responsibilities? This was a hot topic of discussion during a recent Academy of Oncology Nurse & Patient Navigators (AONN+) Navigation Metrics Subcommittee meeting.
My answer to this question takes me back 4 years. At that time, I was director of the oncology clinical program at the Helen F. Graham Cancer Center at Christiana Care Health System, which had been in existence since 1998. I had registered nurses working in the navigator role, and I knew I needed to enable them to function at the top of their license.
Throughout my career, I have been an advocate for all healthcare professionals to work at the highest level as outlined by their professional license in their state. In my present position as a manager at Oncology Solutions, LLC, I have been involved with assessing navigation programs across the country. Navigators I’ve spoken with have shared the complexities of their role and how frustrating their job becomes at times due to the amount of paperwork and the hours spent scheduling and coordinating appointments. Unfortunately, some of these clerical responsibilities have taken the place of assessing and educating patients and their families.
In my opinion, if a nurse or social work navigator is making appointments or faxing, they’ve become a very expensive clerk. Although these clerical tasks are very important, they need to be delegated to an appropriate staff member so that nurse and social work navigators can provide the services as outlined in their professional license.
Here are some practical steps that administrators can take to support the role of navigator at your cancer program or practice:
- Create job descriptions that incorporate national organizations’ core competencies, position statements, and certification domains for navigation (eg, Oncology Nursing Society, Association of Oncology Social Work, National Association of Social Workers, and Academy of Oncology Nurse & Patient Navigators)
- Educate the team on the AONN+ evidence-based navigation metrics and include these in your navigation orientation process
- Create reports and metrics that include measurements of patient experience, clinical outcomes, and return on investment
- Support the professional role of your staff (social worker, registered nurse, registered dietitian, genetic counselor, nurse practitioner, etc) and ensure that they have clerical assistance so they can function at the top of their license
- Assist with creating process maps to efficiently manage patient transitions across the care continuum and increase staff productivity
- Mandate daily huddles to increase communication among the team and to ensure that you are decreasing duplicative services for patients and their families
- Create clear policies, procedures, or guidelines for your navigation program (distress screening, interventions, etc)
- Establish guidelines for when to open and close a navigation case as well as guidelines for referral to the navigation program
- Develop documentation tools and patient decision-aid tools to increase staff productivity
- Create discrete reportable fields in electronic medical records for reporting with minimal narrative
- Utilize internal and external resources to assist with coordinating care for patients while using your experts (ie, pastoral care, financial representatives, community agencies). Many of these internal resources can be found in your volunteer department
Navigators need to function at the top of their license. Administrators can support this by being cognizant of the roles and responsibilities assigned to their navigators. As appropriate, provide clerical support to ensure your navigator is functioning as outlined by navigation core competencies, position statements, certification domains, and national guidelines.
For more on this topic, read “Barriers to Administrative Engagement in Navigation Programs,” published online March 2018 in the Journal of Oncology Navigation & Survivorship.