Development of a New Nurse Navigator Program

November 2019 Vol 10, No 11
Patricia Simmers, MSN/Ed, RN, OCN
MountainView Hospital

Background: Since the inception of navigation programs in 2001, a variety of programs have been developed across the country. It has been shown that patient navigation can improve timeliness to care and resolve barriers in a fragmented healthcare system.1 Common components of a navigation program include processes to reduce delays in patients receiving treatment and provide patient-centered care.2 For this reason, a navigation program was developed at MountainView Hospital.

Objectives: To improve timeliness to care in lung cancer patients by implementation of a nurse navigation program.

Methods: Steps to navigation implementation included a literature review on program development, navigator role development, building partnerships with physicians and the community, and overcoming barriers to navigation implementation.

Research was completed accessing resources from the Academy of Oncology Nurse & Patient Navigators and the Oncology Nursing Society. The navigator received onboarding and navigation training through the Sarah Cannon Cancer Institute. A community needs assessment indicated the greatest need was in navigating patients diagnosed with lung cancer. The navigator initiated relationships with the pulmonology team, the thoracic surgery team, the inpatient and outpatient oncology units, and community oncology clinics. Community outreach efforts included collaborating with the American Cancer Society, the American Lung Association, the Lung Cancer Research Foundation, and the American Society of Clinical Oncology. The navigator educated internal medicine residents, surgery residents, and new graduate RNs on the role of navigation at hospital residency and education programs. A General Cancer Support Group was started to provide support, education, and resources to patients and their caregivers.

Results: Since the inception of the role, over 100 lung cancer patients have benefited in some way. The biggest patient needs have been in the areas of education on diagnosis, treatment, symptom management, and emotional support. Although no timeliness data were collected prior to implementation of navigation, by removing barriers to care from January through June 2019, the median days from diagnosis to first treatment was 23 days. Barriers to development of a nurse navigation program include lack of sufficient guidance and training, a silo effect, and infrastructure barriers in administration, staff, physicians, and patients. Locating a physician champion in the disease process is beneficial, as it helps with structuring navigation processes.

Conclusions: The literature provides little information on how to structure and develop a new nurse navigation program and its effectiveness in meeting patient needs. Outcome measures in care timeliness, patient satisfaction, and potential barriers need to be researched and investigated further.2 Differences in approach are clearly present and are dependent on the type of cancer being navigated.3 Although patient feedback has been positive, a patient satisfaction survey would be a beneficial tool to measure future success of the program.

References

  1. Horner K, Ludman EJ, McCorkle R, et al. An oncology nurse navigator program designed to eliminate gaps in early cancer care. Clin J Oncol Nurs. 2013;17:43-48.
  2. Koh C, Nelson JM, Cook PF. Evaluation of a patient navigation program. Clin J Oncol Nurs. 2011;15:41-48.
  3. Gilbert GE, Greene E, Lankshear S, et al. Nurses as patient navigators in cancer diagnosis: review, consultation and model design. Eur J Cancer Care (Engl). 2011;20:228-236.
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Last modified: August 10, 2023

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