Being new to oncology navigation can undoubtedly be intimidating and overwhelming, but perhaps most important, many rookie navigators simply don’t know where to start, according to Deidra Hamilton, MSN, RN, OCN, ONN-CG, a nurse navigator (and cancer survivor) based in Las Vegas, NV.
“When I was new to navigation in 2011, I was scared half to death,” she said at the 2022 AONN+ Midyear Conference in Austin, TX. “But my boss told me to hop to it, so I had to learn how to jump like a grasshopper.”
According to Ms Hamilton, it’s paramount that navigators realize they can’t take on everything that’s asked of them. “About 6 months in I realized that I cannot do everything,” she recalled, “and that maybe I needed to figure out where to start.”
Where Do You Start?
Define the Process
To avoid overlap, start with role delineation: mapping out the specific roles and responsibilities of the clinic nurse, the patient navigator, the nurse navigator, etc. “This also helps other people in your facility to understand who does what,” she pointed out. “For example, role delineation might help others realize that the nurse navigator isn’t the person who accesses ports; it’s the clinic nurse.”
Perform a Gap Analysis
Using metrics like time from diagnosis to treatment, removal of barriers to care, and number of interventions, a gap analysis serves to assess the current and future needs of a navigation program. “After a gap analysis, you can then implement steps on how to move forward,” she noted.
Define YOUR Scope of Practice
“Scope of practice is a huge one,” said Ms Hamilton. “You always want to avoid ‘scope creep’ and duplication of services.”
She recalled when she first started out and would often help the chemo nurses with double-checking their chemotherapy, consistently losing precious time out of her day.
“They would call me down to do a 2-person check of their chemo, and I loved them, so I went down and did it,” she said. “But then my navigation world stopped for at least 30 minutes, and we—as navigators—don’t have 30 minutes to spend like that.”
Explaining Your Role
The first step in explaining the role of the navigator is identifying your target audience, be it a patient, a physician, or an administrator. “A CFO is going to want different information than a physician or an administrator,” she advised.
Work on an elevator speech. Keep it short (around 30 seconds), focus on a key point, and most important, make a connection with your target. “People are going to remember you by the connection that you make with them, so practice, practice, practice,” she said. “You get better at speaking in short segments when you do it more often.”
Arranging Your Day
According to Ms Hamilton, you should first assess how your navigation intervention is “triggered” before figuring out how to arrange your day; this can be role-dependent or health system–dependent.
For example, a trigger might be a direct referral from a physician, or a software program that sends an alert when a newly diagnosed patient is entered into the system. “These software-driven navigation programs can be extremely handy when you’re in a very large hospital system,” she noted.
Next, hone in on your triage abilities. “Use the nursing process that was beaten into you in nursing school, assess the urgency of interventions needed, and anticipate the patient’s need,” she said.
She gave an example of a new navigator arriving to work with 3 voice mails waiting: one is from a patient who has treatment this afternoon but no transportation; one is from a patient who has questions about their chemotherapy next week; and one is from a physician who wants to submit a case for tumor board.
“Whether or not you had a plan for that morning, those 3 voice mails will get you started,” she said. “And I know what we would all do first; we’d get that patient to their care.”
Resources for New Navigators
According to Ms Hamilton, the Oncology Navigation Standards of Professional Practice, recently published in the Journal of Oncology Navigation & Survivorship, can be a particularly helpful tool for new navigators in determining what triggers navigation for them, based on their specific role.
Additional resources for new navigators include the AONN+ Navigation Metrics Toolkit and the George Washington Cancer Center Oncology Patient Navigator Training.
“Make sure that you dig into these resources,” she urged. “And share your favorite resources with your fellow navigators, because there is a litany of them.”