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Nurse Navigators Face Increased Workload Due to Furlough

May 14, 2020 | What Would Lillie Do?

Name: Kacie
Position: Other
Subject: Survivorship Class

Question:
Hi Lillie, I am a nurse practitioner (NP) working at a multidisciplinary cancer center for more than 6 years. I will be taking on a survivorship role as an NP and wanted to know if you could recommend an online course for education or the best way to get up to speed with survivorship needs.

Thank You,
Kacie Carter, FNP

Answer:
How exciting!! Good for you, and good for the cancer survivors you will be supporting! Jennifer Klemp, who is a member of our Leadership Council, created a training program for exactly this purpose! I was honored in getting to develop some of the content of the modules with her. Visit this page to get started!

Also, visit the Commission on Cancer website to see the changes in the cancer survivorship standard that went into effect in January 2020. Survivorship care plans are no longer required. Focusing on providing education for survivors is the priority. Nutrition, exercise, adherence to screenings and to taking meds as prescribed, along with education about genetics risk, how to manage lingering side effects, how to recognize late effects, and new research published in the field of the survivor’s cancer type, all need to be the focus. All cancer survivors worry about fear of recurrence. Providing them with stress reduction techniques can help them to focus less on worrying about the “what if it comes back,” and instead, enjoying their life that was saved. Consider, also, stage IV breast cancer survivors who, due to the new drug categories for ER-positive, HER2-negative disease are living as long as a decade, or even 2 decades, who somehow need to be incorporated into survivorship programs. We want them to still be getting their annual physicals, flu shots, etc.

Give thought to working with PCPs in the community as well, so they can learn from you what to be watching for when their patients return for long-term follow-up. For example, many PCPs would not know that the drug Herceptin can cause cardiac toxicity up to 10 years after the patient received their last dose (something just discovered a few years ago). For instance, if the PCP had a patient diagnosed at age 34 who had Herceptin as part of treatment, and now presents to their community provider at age 42 complaining of shortness of breath when climbing stairs, that is a red flag that it may be cardiac related.

I am excited for you, and know that you will feel very fulfilled in your new role!


Name: Mary
Position: Nurse Navigator
Subject: Navigator Furlough

Question:
We are 3 nurse navigators covering the needs of all cancer patients at Tucson Medical Center, a community Hospital in Tucson, AZ. Thoracic, GI/GU, and Breast Certified Navigators also cover patients with other cancers from diagnosis throughout their cancer journey. We have been told (without discussion or leadership) that we must cover each other while working 1 of every 3 weeks, which is an absolutely impossible task. We each have a large and continuous number of patients we follow. Please, please help us find us an approach to this situation that will not leave our patients all but abandoned as we face this unrealistic furlough. Our director was fired almost a year ago and has not been replaced. We do not have a point person who knows or values what we do. We have many patients who would speak up for us, but we don’t know how to ask. The director in charge of this decision does not value what we do, but he really doesn’t know what we do. Please help us. It will be extremely valuable to our hundreds of patients who mean so much to us.

Answer:
Oh my goodness. Ideally you would have a physician as a champion for you right now. If there is no champion at this juncture, then the 3 of you need to quickly compile some statistics (which I actually hope you regularly maintain anyway) showing:

  1. The volume of newly diagnosed cancer patients you see and navigate in a given month.
  2. The type of barriers you identify and how you resolve them. Give stats on these too—if you each see 25 newly diagnosed patients a month, how many have barriers to care (19), what are the barriers (transportation and financial), and how are they resolved (taxi vouchers, ACS Road to Recovery, Patient Advocate Foundation to help with utility bills, Red Devils to help with paying for hormonal therapy prescriptions). Record the amount of time spent doing EACH of these tasks.
  3. Among these same 25 newly diagnosed patients each of you navigated last month, how much time was spent educating each patient along with a family caregiver (45 minutes, 60 minutes, etc; all done face-to-face or also done by phone)?
  4. Now, document how many patients you are continuing to navigate who are in the midst of their various phases of treatment. Once again, how many patients navigated monthly, services provided, frequency of in-person or phone contact, issues that required your attention, and how you resolved the issues.
  5. Ideally, you should each be able to present an annual report that documents how many new patients you supported, ongoing patients undergoing treatment you supported, navigation and support services you provided, and the time it took, all on an aggregated basis. This should be done by the type of cancer, and then tallied.

The problem is that without people knowing what you do, they won’t value it because they don’t know to value it.

In addition, the person who told you and your colleagues to dump all of your patients onto one another obviously isn’t aware that there is a need for navigator specialization. Breast cancer is different from prostate cancer and from brain cancer, etc. For example, I personally don’t know the clinical trials available for patients with brain cancer because I specialize in breast cancer. However, the oncology nurse navigator taking care of patients with brain cancer needs to know what they are and be able to screen a patient for them.

Currently, the person who gave you these new marching orders is assuming that only 1 oncology nurse navigator is needed for your entire cancer center. Without data, she won’t be able to understand it any differently. Getting patients on discounted drug programs, enrolling them in clinical trials, making sure they have referral appointments, educating them about the various treatment options the doctors have presented to the patient and helping her decide which one she wants to do, providing financial resources when needed, helping the patient work with her supervisor to create a flexible work schedule so that the patient can work during treatment (since she has no paid time off), ensuring patients are adhering to oral treatments as prescribed, etc, etc, are just a snapshot of what I suspect the 3 of you are doing for your patients. DATA drives a better understanding for those in the dark about oncology navigation.

Presently, in the midst of this pandemic, there is even a greater need for navigation because many cancer patients will have their chemotherapy put on hold due to the risk of neutropenia, which could set them up to catch this virus. Newly diagnosed cancer patients are even having their surgeries delayed so operating rooms can be used as ICU rooms.

Therefore, arm yourself with statistics, accompanied with 1 patient story from each of you, and how the patient feels that she could not make it through this experience without your support. In addition, start recruiting someone to be your champion among the doctors on your team.

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