The house was dark and silent in the early morning hours of that mid-October day in 1978. Just 6 weeks into the University of South Florida (USF) nursing program, today was the day—my very first clinical rotation. At last, I would be taking care of patients, albeit under the watchful eye of my clinical instructor, which felt a little intimidating and yet was also a comfort, all at the same time.
My brand new, blindingly white polyester dress, white nylon stockings, and shiny new Nurse Mates (no scuffs or bloodstains yet) had been carefully laid out the night before. My laboratory coat, with the USF School of Nursing patch securely sewn onto the upper sleeve, and, of course, my nursing cap with green and gold velvet stripes indicating I was a USF student nurse, were ready to be worn for the very first time. As I donned these sacred vestments of my first step into the world of professional nursing, I wondered to myself, “Will I always feel this excited and this honored to put on my nursing uniform and go to work?”
My mind wandered back across my journey to this point. I had been well into an English major in college when my daughter was born. Not having had much familiarity with the medical world, giving birth and the entire hospital experience around that event changed my life. I knew exactly what I wanted to do with my life (besides being a mom, of course). The fire in my soul was burning intensely, and there was nothing I wanted more than to become a nurse. With laser-focused intensity, I made my way through all the math and science prerequisites and applied for the nursing program. I never doubted for a minute that I would get one of the 65 available seats, even knowing there were more than 200 people applying for them. I did make the cut, and I dedicated myself to learning everything about, and excelling in, my quest to become a nurse.
Four years after graduation, with solid inpatient medical–surgical experience under my belt, the unexpected happened. Out of the blue, I landed a nursing position in a freestanding (nonhospital-based) radiation therapy center. I was completely hooked, head-over-heels in love. I realized almost immediately that this is what I was meant to do and where I was meant to be. I never looked back, and from that time on, oncology was it for me. I loved everything about it. I found that people who choose oncology as a career are compassionate, caring, and a joy to work with.
Also, I can honestly say I have learned something every day from the patients, these courageous and inspiring individuals, and it has always been an honor and a privilege to care for them and their families. My own life has been enhanced in so many ways because of the interactions and relationships with my patients over the years. I am so grateful for the opportunity to have cared for them and, hopefully, to have made a difference.
I learned about patient navigation firsthand early on, before there was even a name for it. There were no support services in a freestanding oncology practice in the 1980s and 1990s, so as nurses, we wore many hats. We were social workers, dietitians, chaplains, financial counselors, support group leaders, and much more. Besides caring for patients and managing treatment side effects, we arranged transportation, provided psychosocial support and nutritional counseling, facilitated support groups, and prayed with patients and families.
After years of practicing in this setting, I took a position in a hospital-based radiation oncology department in the late 1990s and was astonished to find that I had all sorts of resources: social work, a dietitian, chaplains, and even a dental hygienist. But still, as nurses, we assessed and triaged patients and ensured that they had the resources they needed to successfully navigate the cancer continuum. Formal navigation services began to evolve, and patients and their families were benefiting tremendously as they welcomed support and education during their cancer journey from nurses, laypeople, and survivors.
My career evolved as well, and I found myself taking on more leadership roles in cancer care and less direct patient care. I continued to focus on patient support and education services—support groups, Look Good Feel Better, and integrative care services—which have always given me great joy, and, I think, made the cancer journey just a bit easier for my patients and their families.
Navigation in Today’s World
Today, as a member of a Catholic Health Initiatives National Oncology Service Line team, I am part of a national healthcare company. My projects include the opportunity to collaborate with more than 100 bright, talented, and committed navigators across our close to 50 cancer programs, which are spread from coast to coast. As a group we have explored best practices around navigation and published the Navigation Program Resource Guide: Best Practices for Patient Navigation Programs, which provides evidence-based principles and processes for our navigation programs. We have built navigation functionality into our oncology electronic medical records so that navigators can efficiently and effectively document their work, communicate with other cancer care team members, and electronically track and report program data. Our navigators come together on a quarterly basis for networking, education, and sharing of best practices. Although I no longer provide direct patient care, I treasure the opportunity to now care for and support those who do touch patients.
I joined the Academy of Oncology Nurse Navigators shortly after it was established, and I have been a dedicated member ever since. The benefits of membership have greatly enhanced what I can offer navigators across our cancer programs in terms of resources and best practices. I have been a member of the QOPI Committee for 2 years, and it is an honor to network and collaborate with like-minded professionals. I was privileged to have the opportunity to present Navigation Basics at the 2014 Academy of Oncology Nurse & Patient Navigators (AONN+) Conference in Orlando, and it was a joy to meet the AONN+ leaders and many of the navigators serving patients across the country.
I think we have navigation just about right in the complex world of oncology; however, during the recent illness of a family member, it became very clear that this type of service is needed in many other areas of healthcare. I entered the world of cardiology with my mother: atrial fibrillation, heart failure, and all the systemic issues that go along with those diagnoses. It was a foreign world for me, and I had to learn a lot quickly. Even with my nursing background, managing this journey has been difficult, and I think about all of the elderly patients who have no advocate and no support. Constantly changing medications, emergency department and wound clinic visits, transitions in care, dietary restrictions, procedures, transportation issues, immobility, medical equipment—the list goes on, and my mom clearly could not manage this on her own. Fortunately, I am here to be her caregiver and advocate, and I am grateful for that ability. It is very evident to me that navigation services are critical for those who are undergoing complex medical care, in oncology and other types of illnesses. Wouldn’t it be great to have navigators whose focus is simply health and wellness?
Coming Full Circle
Having been in a nursing career that I truly love for more than 35 years, I have risen before dawn more times than I can remember (and have cared for patients throughout the night, as well) and put on many different types of clothing. The whites and caps have gone by the wayside (thank goodness) and many of us welcomed the advent of scrubs, which make much more sense when providing direct patient care. I have worn high heels, Crocs, and Danskos, and business suits, uniforms, and wonderful brightly colored scrubs, and I have found that no matter what I am wearing or what role I am in, the answer to that question I asked myself on my very first day of clinicals in 1978 is a resounding yes. I absolutely do still feel the excitement, the anticipation, and the sense of privilege every time I get ready to start my workday. That is surely a blessing, and I am filled with gratitude.