Networking is defined as the action or process of interacting with others to exchange information and develop professional or social contacts.1 The Academy of Oncology Nurse & Patient Navigators (AONN+) has promoted this concept since its first meeting in 2009, when 100 navigator-related professionals came together to get a glimpse of what other hospitals around the country were doing to innovate their navigation practice, hear how others are handling some of the same issues, and to establish professional contacts. Networking is key to professional development with lifelong learning, engagement, and maintenance of knowledge to stay up-to-date on changes that affect healthcare practice. The mission statement for AONN+ has always centered around networking for collaboration, leadership, and development of best practices.
Since 2015, to further support the mission statement beyond annual and regional conferences, AONN+ has encouraged local navigator network (LNN) formation in communities at the local, regional, or state level to facilitate communication and education among peers and improve patient outcomes and survivorship. The navigator-led groups function at the local level to provide oncology navigators with access to up-to-date education and support throughout the year. By the summer of 2019, 23 LNNs had been in existence for at least 1 year, and 4 more were being launched as new groups.
The goal of AONN+ is to give some formation structure for establishing an LNN but also allow room for the creativity of the leader(s) to support the common community interests, needs, and goals. The required criteria for starting an LNN include:
- Assemble regularly with other navigators in your vicinity
- The navigator network leader (a member of AONN+) should have experience with team building and a personal commitment to promoting education and career development of oncology navigators in his/her region. AONN+ can assist with a list of members in the area. Reach out to other navigators (patients, nurses, social workers, etc) outside of the lead navigator’s healthcare system and communicate the meeting details
- Champion AONN+ and the local network within the local region. Strive to maintain a roster of at least 50% of chapter members as current AONN+ members
- Set the meeting frequency, but AONN+ asks that a minimum of 4 meetings of the membership be held each year. A meeting report is sent to AONN+ after each gathering, and an annual report is filed with the national organization at the end of the calendar year
These required criteria provide a minimal structure for the network but allows self-government and local group individuality to work efficiently and effectively in networking. For example, AONN+ does not set a minimum number for membership in less populated areas and encourages groups to have their own identity, such as the location of the state area, a major city, or a creative name if covering several healthcare facilities.
AONN+ is available to provide additional nonfiscal support, such as ideas for membership connections, leadership structure, meeting ideas, and communication. When launching the LNN, the leader(s) are encouraged to reach out to all navigator types (patient, nurse, social worker, etc) in the local region and to go outside of their healthcare system. For the initial meeting of the network, AONN+ sends out the LNN’s first invitation to AONN+ members in a 50- to 75-mile radius. With this collaborate invite system, AONN+ members as well as those who are not national members are made aware of this networking opportunity. The LNN leader is instructed to capture the responding e-mails to start a list for future meeting invites because AONN+ no longer facilitates coordination of meeting communication after the first invite. The LNN leaders are encouraged to include a statement on all communication (letter, social media, e-mail, text) encouraging sharing of the invitation with others who may be interested, are new to patient navigation, and/or are not yet members of AONN+. The leadership information is displayed on the AONN+ website with contact information to increase awareness of the local unit for navigators in the area.
Again, with respect to the different sizes of LNNs, the leader decides which leadership structure will best enhance their region. It does not have to be formal with president, vice president, and secretary with bylaw support. It can be a leader and an additional coleader if that fits the group. AONN+ suggests the LNN identifies a scribe or secretary who can record LNN meeting activities since a meeting report is required by AONN+ after each gathering to highlight positives and learning opportunities. Also, an annual report is required to capture successes and challenges for the LNN as well as to provide the national organization with leadership changes for the website. If the group is large enough, a membership chair is proposed for recruiting new members and/or a program chair to coordinate or facilitate local LNN activities.
Multiple meeting ideas are given to the new leader. Most networks start off by sharing local, regional, and state resources, and many carry this forward as a recurring agenda item. “The required sharing time at each meeting has been very beneficial to many, with sharing resources for our patients throughout the state.” Other successful concepts are “win” stories where the group goes around with introductions and has members discuss recent positive navigation experiences, or “Pitch In and Networking” events where they share stories about working with other navigators and discuss what works and what does not. These are not company-sponsored evenings but just a time to network and talk among navigators. Some review continuing education (CE) webinars on the national organization website, and members go online after the meeting and get CE credit. Many leaders connect with a vendor at the annual or midyear national meeting to create support for a local program. The program can be disease- or product-related. “The pharmacology representatives are so very supportive and are willing to support any of our meetings. We have a waiting list for upcoming meetings.”
Communication revolves around the local as well as the national level. The LNNs are asked to establish and maintain an open correspondence system with all members by developing a directory to share among the group for networking, projects, and publication. They can communicate in different outlets, including local meetings; chat online through platforms such as Facebook, LinkedIn, etc; and meet at the annual conference. On the national scene, all networks will be listed on the AONN+ website; leaders are encouraged to reach out to AONN+ as needed with questions and concerns and to let the national organization know if there are leadership changes, or if the LNN is not able to meet as planned. The Member’s Memo featured in the AONN+ e-mail Navigation News every 2 weeks is devoted to LNN activities, and examples of past LNN activities can be found.
In the fall of 2018, AONN+ was able to provide additional support to existing LNNs based on their individual needs. One LNN leader requested that the national organization send AONN+ events and happenings to the leader(s) instead of the leaders scouring the national website prior to each meeting. This idea started a quarterly newsletter that the LNN leaders receive after the latest Leadership Council and committee cochair meetings. It includes upcoming events, leadership happenings, as well as individual national committee news/requests. The leaders are encouraged to share it with their entire membership. Other support came in the form of an LNN orientation kit that was developed by the AONN+ Chief Nursing Officer and LNN liaison. This kit for new LNNs includes a welcome letter, website posting information, leader responsibilities, meeting ideas, and how to develop the LNN mission, vision, and goals, as well as when to complete meeting forms and the annual report. Lastly, the LNN leaders requested information on setting up an individual LNN Facebook page. In the first quarter of 2019, the AONN+ digital team set up a platform, and all leaders were informed by e-mail on how to make this an avenue to share LNN activities.
The national organization does not require an additional fee for local membership and has no fiscal relationship with the networks. The AONN+ Policy and Procedure (P & P) on financial involvement with LNNs was added in 2019. The P & P states “AONN+ does not support LNNs requesting money as a membership obligation, but they can explore collecting sponsorship from pharma and other healthcare companies or request grant support as needed for local projects. It is up to the individual LNN leadership to make decisions around financial support. If money is collected by any means, AONN+ will not be responsible for its depository or redistribution. AONN+ LNNs may not use AONN+ nonprofit status for accounting purposes.” All the additional support in 2018 was shared with the existing LNNs as it was developed, placed in the welcome kit, and featured in the Member’s Memo.
To support networking on the national level, AONN+ has partnered with like-minded organizations to further improve patient access to and quality of care by forming national alliances.2 As an example, AONN+ and the American Cancer Society (ACS) entered into a National Alliance Partnership agreement in 2018 to bring together 2 organizations that are strongly aligned in their missions and values. The agreement is structured to provide interactive opportunities to experience knowledge sharing, increase innovation, and enhance collaborative engagement to pursue superior quality cancer care. The sharing of the wealth of resources supports navigators in their efforts to help improve the quality of life for cancer patients and their caregivers as they face the psychosocial, emotional, and financial aspects of their cancer experience.
The ACS has a long history of networking and supporting the growth and development of navigation as it championed the pilot program of Harold P. Freeman, MD, developed training, and promoted policy development and research in collaboration with other navigation-related groups. Launched in 2005, the ACS Patient Navigator Program was intended to deliver assistance to patients where they received treatment. The program focus was on the point of the cancer continuum after a patient had received a definitive diagnosis, utilizing the organization’s resources to the needs of cancer patients (eg, transportation, housing, financial assistance, etc), particularly assisting the newly diagnosed and those who faced greater access barriers, the uninsured, and those on federal assistance programs (Medicaid). Since the program inception, ACS patient navigators have reached more than 500,000 patients at hospital sites across the country with a broad representation of many individuals with healthcare background (social worker, nurse, public health, health educator) performing the role of the navigator, but some had no training in this area. The variation in navigation staff prompted ACS to collectively train navigators with a unified curriculum and using a common competency checklist.
The training need was a start to many collaborative efforts ACS has established with outside agencies and professional groups to promote the concept of navigation. From 2006 to 2008, the ACS collaborated with the National Cancer Institute Center to Reduce Cancer Health Disparities and the Centers for Medicare & Medicaid Services to prepare navigators to meet with patients, identify key barriers to patient care, and develop a plan with the patient to address those barriers whether using ACS resources, other advocacy organizations’ services, or local community-based support. The ACS has been providing onboarding and CE training and professional development opportunities to its staff ever since. More recently, as part of a pilot quality improvement project designed to enhance the already significant navigation services, the ACS developed the Take ACTION (Advanced Coaching Training in Oncology Navigation) Program, a professionally developed training experience designed to enhance navigation services to include more tailored patient support and coaching.3
In March 2010, the ACS hosted the National Patient Navigation Leadership Summit where they brought together participants representing more than 65 organizations and agencies.4 The conference was cosponsored by Pfizer Oncology, Livestrong (Lance Armstrong Foundation), Susan G. Komen for the Cure, the Oncology Nursing Society, the American College of Surgeons Commission on Cancer, ACS, and AstraZeneca. The Summit provided a platform to discuss the state of the science, current research, and practice to evaluate the activities and results affected by navigators across the care continuum. A supplement was published from the summit results, “National Patient Navigator Leadership Summit (NPNLS): Measuring the Impact and Potential of Patient Navigation,” which outlined undertakings in the effort to support the growth and sustainability of patient navigation.5
In 2017, the ACS launched the National Navigation Roundtable (NNRT), a national coalition of more than 50 member organizations, and invited individuals from academia, community care, public health, advocacy and survivor groups, professional societies, industry, training, and state and federal agencies dedicated to achieve health equity and access to quality care across the cancer continuum through effective patient navigation.6 A fundamental premise of the NNRT is that collective action among member organizations will be more successful in advancing the field than if they work alone. Together, members work to share information and identify needs and opportunities, while addressing gaps relating to navigation. The ACS is the driving force behind this collective group to disseminate best practices and to enhance the field of navigation overall, and AONN+ is one of the member organizations.
The 2018 National Alliance Partnership Program agreement between ACS and AONN+ naturally led to a collaboration to assist ACS in a Merck Foundation grant project deliverable to develop a paper outlining effective strategies for the development, implementation, and sustainability of LNNs. AONN+ had well-established LNNs that could be leveraged to help ACS with their deliverable and in the process support the growth and sustainability of AONN+ LNNs. As part of the AONN+ and ACS national alliance partnership to advance the field and profession of patient navigation, they collaborated to collect lessons learned from existing AONN+ LNN leaders on the development, implementation, and sustainability of networks with the goal to share the findings, enrich established LNNs, and give guidance to future networks as they originate on the local level.
In this project agreement, the ACS role was to review the AONN+ LNN materials, including the AONN+ website; LNN video; newsletters; Member’s Memos; existing data/insights from annual LNN reports; develop the survey; contribute to a paper summarizing recommendations for the development, implementation, and sustainability of the LNN based on lessons learned from AONN+ LNNs, including successes and challenges; and best practices. AONN+ committed to provide access to the 23 established AONN+ LLNs that had been organized longer than 1 year to collect qualitative real-life experiences on the networking process, review and provide feedback on the survey, push the survey to LNN networks, share existing data/insights from AONN+ LNN annual reports, contribute, review and provide feedback on the white paper, and participate in dissemination and promotional activities for the paper.
As national navigator leaders, AONN+ and ACS were able to demonstrate that networking is about sharing resources to advance the profession of navigation on the local level. The local connections are critical in times of national crisis to stay socially connected in an increasingly isolated world. The community sharing of LNNs is a way to get fresh ideas, valuable resources, more knowledge on navigation, build confidence as a navigator, and gain a different perspective. Interestingly, after the survey distribution in 2019, 2 LNNs formed via virtual format. The LNNs are making a difference in the education and professional growth of navigators!
References
- Merriam-Webster. Networking. www.merriam-webster.com/dictionary/networking.
- Academy of Oncology Nurse & Patient Navigators. Partnerships. https://aonnonline.org/partnerships.
- American Cancer Society. Take ACTION Program. www.cancer.org/health-care-professionals/acs-take-action-program.html.
- The GW Cancer Institute. National Patient Navigation Collaborative Inaugural Meeting Summary. https://smhs.gwu.edu/gwci/sites/gwci/files/NPNCSummary2012.pdf.
- Calhoun EA, Esparza A, Freeman HP, et al. National Patient Navigation Leadership Summit (NPNLS): measuring the impact and potential of patient navigation. Cancer. 2011;117(suppl 15):3535-3625.
- National Navigation Roundtable. Collective Action to Advance Patient Navigation. https://navigationroundtable.org.
