A Nurse Navigator’s Value for the Patient and the Health System

January 2019 Vol 10, No 1
Kristin Hand, MSN, RN, OCN
Abramson Cancer Center at Pennsylvania Hospital
University of Pennsylvania Health System
Philadelphia, PA

Oncology nurse navigators (ONNs) benefit from clearly defining their value for their organizations. Supporting patients and their families through a cancer diagnosis, treatment, and disease recurrence stands as an apparent value to patients. However, nurse navigators struggle when defining their complex economic value within health systems. Supportive relationships and targeted assessment to direct referrals are 2 aspects of the ONN role that demonstrate value and opportunity cost for patients and systems. Individualized assessment and expert knowledge of care to optimize resource use also benefit both the patients and the health systems. Understanding these aspects of the ONN role and their opportunity costs enables navigators to comprehend and leverage their value.

Supportive Relationships with Patients and Their Families

Following a cancer diagnosis, patients contend with a large healthcare team and complex care processes. They may not know how nurse navigators can help them or their families. I find that building relationships and using my nursing assessment skills to identify opportunities for navigation helps define my value for patients and the health system. Asking thoughtful questions prompts patients to talk about themselves and helps me identify potential barriers to care. Using assessment data, I discover opportunities to improve and individualize the patient experience. The ONN/patient relationship, although valuable to the patient, also provides the economic value of keeping patients within a single health system. With a nurse navigator as a guide, patients avoid misdirected care and utilize resources appropriately.

Assessment-Directed Referrals

ONN assessment-directed referrals are another way nurse navigators offer economic value to their health systems. Through assessment, ONNs address patient barriers before they become impediments to treatment. ONNs, employing clinical oncology expertise, are able to understand the connection between a particular patient’s identified barriers and optimal health outcomes. Understanding a patient’s situation within the clinical context of their cancer diagnosis enables ONNs to make timely referrals within the health system that are directed to meet the identified needs of the patient.

The following case study highlights the value of the ONN for both the patient and the health system.

Case Study

James, a 74-year-old man with newly diagnosed rectal adenocarcinoma, had a new patient appointment with the colorectal surgeon. Although a CT scan of the abdomen and pelvis was done at an outside hospital, the surgeon also recommended a staging MRI of the abdomen/pelvis and a return visit to colorectal surgery after completion of neoadjuvant chemoradiation. The ONN contacted the patient to help with care coordination of the MRI, medical oncology, and radiation oncology appointments and to assess the patient’s understanding of the care plan recommendations.

Nurse Navigator Findings

The patient preferred that the ONN talk with his wife. After offering understanding and empathy for their situation, the ONN completed her assessment. She discovered the patient is dyslexic and is experiencing memory loss with poor recall. The patient lives approximately 2 hours from the cancer center and has a very supportive wife and son. The ONN suggested their son be present for appointments. Most striking to the ONN, the wife said her husband might not want to undergo any treatment at all.

Interventions

After reviewing the plan of care, the ONN provided education about medical oncology and radiation oncology, explaining that both specialties are recommended for James’ diagnosis. The ONN then proceeded to coordinate same-day medical oncology and radiation oncology appointments to reduce travel time and ensure their son could be present. The ONN further offered a geriatric assessment with the palliative care nurse practitioner (PCNP) to evaluate memory loss and develop a stronger sense of the patient’s goals of care. This appointment was similarly coordinated with the oncology appointments on the same day.

Outcome

The patient visited medical oncology and palliative care on the same day and then decided to consult with a radiation oncologist closer to home. At his appointment in medical oncology, James and his family discussed treatment recommendations for oral capecitabine in combination with radiation. Meeting with the PCNP enabled James and his family to clarify his goals to prolong life while avoiding hair loss and a colostomy. The PCNP assessed James’ decision-making capacity and helped him complete an advance directive.

Opportunity Cost

The experience of James and his family displays the economic principle of opportunity cost for nurse navigators. Without the nurse navigator, this patient would not have had a palliative care visit scheduled the same day as his medical oncology appointment, and the health system would have missed out on this revenue. The nurse navigator showed concern, talked with the patient’s wife, and took time to learn about the patient. The patient could have decided to consult with medical oncology closer to home, but the nurse navigator coordinated the appointments and made things seamless for the family. The patient could have refused care and ended up in the emergency department or a primary care office, which highlights how ONNs help avoid the risk of misuse and overuse of healthcare overall.

Conclusion

To offer value both for patients and organizations, ONNs use their clinical judgment and assessment skills and their knowledge of the healthcare system. They are able to identify opportunities for navigation as well as potential barriers and concerns for the patient. With their clinical knowledge and experience, ONNs understand the link between their assessment findings and the patient’s health outcomes. As demonstrated in the case study above, meeting patient’s needs and connecting them with the resources available to them at the right time can have a positive impact on the patient experience and a positive economic impact for the organization. The influence of a nurse navigator keeps patients within a single health system and avoids misuse or underuse of resources. ONNs who understand their own value to patients and health systems cultivate awareness and leverage that value.

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Last modified: January 14, 2019

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