Role delineation in oncology navigation can have a significant impact on patient outcomes and job satisfaction for navigators, according to Jennifer Bires, LICSW, Clinical Social Worker and Program Coordinator at the George Washington Cancer Center in Washington, DC.
The term “navigator” is still fairly new and can apply to numerous roles (eg, financial, nurse, or patient navigator). Although its many definitions are still being fleshed out, a growing awareness of navigators and the substantial role they play in patient care has underlined the need for role delineation in the field, Ms Bires said at the 2017 Academy of Oncology Nurse & Patient Navigators (AONN+) West Coast Regional Meeting.
Patient navigation in oncology has evolved as a strategy to improve outcomes in vulnerable populations by eliminating multilevel barriers to the timely diagnosis and treatment. These barriers can be financial (eg, lack of insurance, transportation, or child care), communicative (eg, lack of necessary language skills or cultural understanding), emotional (eg, fear, fatalism), related to the medical system itself (eg, making appointments, finding physicians), or related to fear or distrust of the system.
The Power of Teamwork
Cancer centers often hire either oncology nurse navigators or lay patient navigators, but if different types of navigators learn to work together—each functioning within his or her own scope of training, skills, credentialing, and practice requirements—they work more efficiently, money is saved in the healthcare system, and patients are moved across the continuum in a timely manner, she said.
“Everyone on the team does some navigation, which is why there are issues with role delineation,” Ms Bires said. Depending on a person’s education, background, personal experience, or workplace, different policies and strategies will be applied to the navigation of diverse populations, she noted. “This is where navigation can get confusing.”
Patient navigators tend to deal with more practical problems (eg, housing, insurance, transportation), nurse navigators tend to deal with the clinical aspects of the disease and its treatment (eg, symptom management), and social workers often confront the potential psychosocial impacts of cancer on their patients (eg, depression, anxiety, worry), but all types of navigators should know how to evaluate patients and make referrals to the appropriate member of the team. “There is cross collaboration and overlap between all of these roles, but that doesn’t mean the social worker won’t help with transportation and the nurse won’t talk about the worries of diagnosis,” she said. “Everyone has their own expertise level, but they should work together to meet the patient’s needs.”
Safer Patients and Navigators
According to Ms Bires, navigators should advocate for role delineation because it pertains to their own safety. “As these roles are evolving, it becomes very important that they’re better defined so there is safety in the practice,” she said. “Because it’s a newer role, navigators are asked to do all kinds of things, sometimes things they’ve never been asked to do before.” But role delineation protects navigators from performing tasks for which they have received no training.
Successful role delineation depends on interprofessional collaboration and team-based navigation. Navigators should be able to demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe and effective patient care and should work with other healthcare professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust. “Navigators are like the brokers between the patients and the medical team,” she said. “Being able to provide that link is very important.”
Encourage relationship building so that different types of navigators can outline their roles and areas of overlap, she said. Triage systems help to ensure that patients get through the system effectively and are not faced with even more barriers due to the different types of navigation in the system, and a vital component of making a triage system work is ensuring documentation and communication among the team members. When teams are not well built, triage systems often fail. “There should be a balance and an ebb and flow of making sure the appropriate person is working on the appropriate task, so everyone is operating on the highest level they’re able to,” she said.
She explained that professional boundaries determine scope of practice, so it is difficult to confine the role of the nurse or patient navigator to black and white rules, but institutions and navigators should work toward mutual agreement around what these roles entail, noting that AONN+ can be a valuable resource to use when working toward developing tangible policies.
“We often find that because we have limited resources, we’re trying to cover more than we should,” she said. “Work with supervisors to create well-defined roles and boundaries, and work with your team to make sure those boundaries are going to be supported.” Very few cancer centers are overresourced, but role delineation can help to ensure that the maximum number of patients receives the benefits of navigation services.