Category V: Professional Roles and Responsibilities

October 2022 Vol 13, No 10 —November 7, 2022

E1 A BOLD New World: Developing the Future of Navigation

Jordan Henderson, BSN, RN, OCN, ONN-CG; Emily Gentry, BSN, RN, OCN, HON-ONN-CG

Academy of Oncology Nurse and Patient Navigators, Cranbury, NJ

Background: In accordance with the Oncology Navigation Standards of Professional Practice Standard 7: Professional Development, “all navigators should assume personal responsibility for professional development to gain and maintain knowledge in the best interest of patients, strive for improved competence within their scope of practice, and incorporate the principles of professional development and life-long learning to address professional practice gaps.”

Mentorship benefits the mentee, mentor, and organization. Benefits include career enhancement, job satisfaction, and self-development. “Mentees are promoted 5 times more often than those without mentors, and mentors are 6 times more likely to be promoted. While 25% of employees who enrolled in a mentoring program had a salary change, only 5% of workers who did not participate received a salary-grade change”

AONN+ recently assessed its membership in a 2021 survey. According to the respondents, 56% expressed interest in participating in a mentoring relationship. Of those who responded, 62% preferred an expert to novice mentoring relationship with program/leadership development, and disease-specific navigation as the top interests for mentorship. To answer this need, AONN+ launched its BOLD: Mentorship Academy.

Objectives: To develop a mentorship pilot program and determine benefits to mentor/mentee.

Methods: AONN+ developed a multidisciplinary mentorship pilot program. Participants were matched based on shared interest in goals and expertise. The pilot phase continued for 3 months.

Mentorship and goal setting tips were provided to the 10 participants through a handbook. Evaluation surveys were distributed throughout the pilot phase to determine expectations, program value, lessons learned, and metrics outcomes.

Results: Both qualitative and quantitative data points were observed with 9 out of 10 participants completing the preprogram and midpoint surveys. Both mentor and mentee expectations included learning mentorship skills, networking, and understanding the navigation role.

All 5 mentors and 4 mentees received institutional support to participate. Challenges that presented consisted of scheduling conflicts, communication issues, and partnership between different disciplines (SW & Nurse). One pair discontinued the pilot due to the mentee not connecting with the mentor.

Participant feedback showcased the value of mentorship for both mentor and mentee with examples of mentor assisting mentee in building a business case for navigation, attaining new knowledge, sharpening leadership skills, as well as a motivation for career change.

The results further reinforced the need for mentorship in navigation as shown by the participants’ feedback and request for knowledge enhancement of programmatic build, navigation workflow, and examining metrics in their respective institutions.

Conclusions: Participant feedback from pre/postevaluation expressed valued benefit of program and lessons learned. With these positive pilot program results, AONN+ will plan to expand the program to all AONN+ members in 2023.

Future AONN+ program considerations will include growth opportunities in disease site, metric application, and authorship. AONN+ will add mentorship evaluation questions to the 2023 AONN+ member survey to assess if participation in mentorship affects member satisfaction.


Antley T. What Is Professional Development and Why Is It Important? WebCE. 2020.

Cronin N. Mentoring statistics: The Research You Need to Know. Guider. to-know#:~:text=Mentoring%20for%20Career%20Development%20Statis tics%3A&text=Mentees%20are%20promoted%205%20times,do%20not%20have%20mentors%20(Source). 2020.

University of Washington. Professional & Organizational Development. Mentoring tools and resources. lence-and-development/individuals/mentoring-tools/.

Shockney LD. Professional oncology navigation task force releases oncology navigation standards of professional practice. Journal of Oncology Navigation & Survivorship. 2022;13(3)72.

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E2 Advancing Nurse and Patient Navigator Engagement and Retention by Designing and Implementing a Professional Career Ladder

Tania Silva Santos, Barbara Quintana, Morgan Nestingen, Marguerite Rowell

Miami Cancer Institute, Miami, FL

Background: Nursing career ladders have proved an effective strategy to address workforce planning, recruitment, engagement, development, and succession planning1,2 and have been successfully implemented in oncology nurse navigator (ONN) and oncology patient navigator (OPN) roles.3 In October 2021, the Miami Cancer Institute (MCI) navigation department engagement scores dropped below benchmark, with navigators commenting on challenges and priorities, including professional development, recognition for expertise, and limited financial benefits. MCI leaders from Navigation and Human Resources (HR) responded by partnering with frontline staff to launch a career ladder initiative.

Objectives: To increase navigator engagement and retention by empowering staff to design a career advancement program for the ONN and OPN roles at MCI.

Methods: The Plan-Do-Study-Act methodology for continuous quality improvement was used throughout this project. (1) Plan: Leaders engaged high-performing volunteer ONNs and OPNs to serve as project stakeholders and co-lead review of existing job descriptions, revision of essential job functions, and partnership with unit Shared Governance. (2) Do: ONNs and OPNs formed 2 parallel project teams that met over a 1-month period with department leaders to collaboratively draft the proposed career ladder. Documents were shared with HR, Compensation, executives, and navigation leaders across the Baptist Health South Florida (BHSF) system to ensure organizational buy-in and achieve optimal financial outcomes. (3) Study: Final drafts were shared with all department navigators during a monthly team meeting where strategies and options for career advancement were presented, and staff were able to voice questions and recommendations. (4) Act: Following final approval, the career ladder was implemented at MCI and adopted across the BHSF system, empowering staff to advance with near-autonomy. MCI Navigation leaders partnered with the Academy of Oncology Nurse & Patient Navigators to identify certification candidates, host staff-led study groups, and pay up front for local certification exam fees. During evaluations, leaders provided 1:1 coaching on professional advancement opportunities.

Results: In March 2022, department engagement scores increased significantly versus both baseline and benchmark scores in the following areas: role fit (my role is an excellent fit with my strengths), leader feedback (my direct leader provides me with feedback that helps me improve my performance), and career advocacy (my career development is actively supported by someone in my organization); each of these areas was designated as high or very high priority driving overall employee engagement, which also ranked and has since sustained above benchmark. In addition, ONN and OPN retention rates were maintained at 100%, and the department observed a 0% vacancy with a growing “wait-list” of interested future navigators.

Conclusions: The BHSF Navigation career ladder was successful in increasing employee engagement, as evidenced by engagement scores, retention, and subsequent professional momentum, including staff participation in research, evidence-based practice, and Shared Governance. To date, 22 department staff members have been promoted along the BHSF Navigation professional career ladder, while 95 ONNs and 13 OPNs across the system benefit from this shared opportunity for professional advancement.


  1. Bernard N, Oster CA. An evidence-based nursing career framework. Nurse Leader. 2018;16(2):127-133.
  2. Filani M, Novieastari E, Nuraini T. Nurses’ understanding and perception of career ladder system are related to work motivation: a multicenter cross-sectional study in Aceh, Indonesia. Enfermería Clínica. 2019;29:434-438.
  3. Mazer S, Farley K. A roadmap for professional growth: a Sarah Cannon initiative. Journal of Oncology Navigation & Survivorship. 2021;12(9):312-315.

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E3 Developing an Operational Playbook to Address Financial Advocacy Onboarding and Training Needs

Rifeta Kajdic-Hodzic1; Christina Mangir, MS1; Lori Schneider2; Wendi Waugh, RT(R)(T), CMD, CTR3; Angie Santiago, CRCS-I4; Anette Ehry5; Jennifer Paquet, RN, BSN6; Amy Copeland, MPH7; Elana Plotkin1; Lorna Lucas, MS1

1Association of Community Cancer Centers; 2Green Bay Oncology; 3Southern Ohio Medical Center; 4Sidney Kimmel Cancer Center; 5Intermountain Healthcare; 6Bassett Cancer Institute; 7Small Spark Consulting, LLC

Background: Financial advocates play an important role in helping patients with cancer navigate and address financial burden experienced throughout the cancer journey. The Association of Community Cancer Centers (ACCC) Financial Advocacy Network supports financial advocates in their role by developing and updating training resources such as the Financial Advocacy Boot Camp.1 In a survey of ACCC members, 36% of respondents expressed a lack of sufficient financial advocacy staff to support patient needs, and 50% of advocates stated that a lack of resources is their main concern.2

Objectives: To identify resource gaps and create a training tool to support adoption of effective practices in reducing financial hardship for patients with cancer.

Methods: ACCC convened a task force of multidisciplinary specialists, professional associations, and advocacy representatives to guide the compilation of effective practices. Focus groups and interviews were conducted to identify onboarding needs and training priorities. Respondents were asked about challenges and effective practices regarding onboarding and continuous learning for financial advocates, as well as ideal training formats and methods. Based on these findings, the task force compiled financial navigation training tools, evidence-based practices, and insights that aligned with each identified priority area of financial advocacy: benefits verification, financial distress screening, prior authorization, insurance education and optimization, and financial assistance.

Results: Challenges identified in the qualitative analysis included financial advocate burnout and high turnover, growing role complexity, and lack of standard training and resources. The task force developed the “Ready, Set, Go: Financial Advocacy Playbook,” which provides a collection of expert insights and methods necessary to effectively provide cancer patients with resources to reduce financial barriers to care. The Playbook is split into 3 domains of onboarding based on the priority areas. In a pilot phase from September 2021 to May 2022, the Playbook was downloaded by 341 members, of whom 81% stated they will use it for onboarding new hires. Qualitative analysis of the pilot outcomes is being conducted between June and August 2022.

Conclusions: Financial advocacy in oncology is growing more complex, and the need for financial intervention with patients is increasing. However, the staffing and training resources have not kept pace with the need, creating staff burnout and high turnover. The “Ready, Set, Go: Financial Advocacy Playbook” provides expert-developed and field-tested training tools and strategies to assist financial advocates in their roles. This resource will help sustain financial advocacy roles as needs evolve. The advocacy landscape needs to be periodically assessed and evaluated to incorporate timely updates on evidence-based and field-tested methods of addressing financial barriers to care.

Funding for this project was provided by Pfizer, AstraZeneca, and Sanofi.


  1. Association of Community Cancer Centers. Financial Advocacy Network Boot Camp. Boot Camp (
  2. Association of Community Cancer Centers. 2019-2020 Financial Advocacy Network Census Survey. vocacy/2pg_standalone_fan_infographic_final.pdf?sfvrsn=9de32db4_4. March 2020.

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E4 Oncology Nurse Navigation Orientation: Use of an Orientation Manual to Optimize Role Preparedness

Debra J. Woo, BSN, RN, OCN; Laura Kabrich, BSN, RN, ACM; Joanna Bellefeuille, BSN, RN, OCN; Karen Hardin, MSN, RN; Elizabeth Hess, BSN, RN, OCN; Karen Goad, BSN, RN, OCN; Rhonda Davis, BSN, RN, OCN; Melissa Aguiar, MSN, RN; Megan Callon, BSN, RN, CBCN; Delois DeShazo, BSN, RN, CCRP; Omba Thomas, BS, MHA

Levine Cancer Institute, Charlotte, NC

Background: For successful orientation of the novice oncology nurse navigator (ONN), providing timely, relevant, and fundamental role information/resources is essential during the onboarding process. Training of the novice ONN varies widely, with little evaluation of the most effective way to prepare for the role.

At Atrium Health’s Levine Cancer Institute (LCI), experienced ONNs recognized the need for well-timed content delivery during orientation in a more organized and relevant manner. In March 2021, 50% of navigators who recently completed a 4-week orientation rated how prepared they felt for the role as a 5 or less on a scale of 0 to 10. Integration of a standardized, consolidated tool was identified by expert ONNs as an avenue to provide a streamlined and comprehensive approach to ONN training. This would facilitate a more significant onboarding experience resulting in a more well-prepared ONN.

Objectives: To design and put into practice a standardized orientation manual (OM) containing pertinent information and resources to enhance role readiness, as evidenced by improved preparedness scores, while simultaneously providing an inherent mechanism to progress from conceptualization to actualization of the role.

Methods: In 2021, process improvement needs for new ONN orientation were identified from informal survey results. As a result, an OM and onboarding process improvement ideas were proposed. The navigation Unit Based Council and a navigation intern met monthly to develop the General Information section and revise both the General and Clinic Orientation checklists. The team decided to include the institution’s established ONN role policies and procedures along with the Oncology Nursing Society’s ONN Core Competencies and 8 meaningful content sections reflecting our institution’s ONN scope of practice. Implementation of the OM occurred in September 2021 with the onboarding of new ONNs. After the completion of orientation, the new ONNs were asked how well-prepared they felt, how helpful the OM was in providing information about their role, and they also indicated which sections were the most or least helpful.

Results: An informal study surveying new ONNs indicated the orientation manual significantly enhanced the novice ONNs’ opinion regarding preparedness for the role; 100% of the ONNs felt the OM was very helpful in preparing them for their role, with a mean preparation score of 7.33. ONNs found the General Information section the most helpful, with the Supportive Oncology section cited as being the most used. Nurses rated the manual a 9.33 in providing information about their role, with 66% rating it a 10. Results from a survey of the original 6 ONNs who initially provided feedback to spark this project felt the manual would have been extremely helpful in preparing for the role, giving it an average score of 9.5.

Conclusions: Use of an ONN OM results in the novice ONN feeling more prepared for the role. It renders a more consistent approach to orientation and provides a solid foundational springboard for role operationalization. The potential for individualizing the manual by specific tumor type or LCI regional site could further enhance preparedness.


Centers N, LaPerriere L. Navigator orientation in a multifacility model. Journal of Oncology Navigation & Survivorship. 2019;10(4):144-146.

McMullen L, Christensen D, Haylock PJ, et al. 2017 Oncology Nurse Navigator Core Competencies. Oncology Nursing Society.

Reed L, Rua K. Defining the role of the oncology nurse navigator. Journal of Oncology Navigation & Survivorship. 2020;11(3):90-92.

Strusowski T. Creating a Navigator Orientation Checklist. Association of Community Cancer Centers. /2016/11/29/creating-a-navigator-orientation-checklist. 2016,

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Last modified: August 10, 2023

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