April 3, 2017

The Nurse Navigator: A Patient’s Compass On The Healthcare Journey

The Nurse Navigator: A Patient’s Compass On The Healthcare Journey

By Anne Devine, RN, BSN, BA, CBC     

Healthcare is a complex business these days, and there’s probably no one who feels it more than the person diagnosed with a serious or complex illness. Nurse navigators are becoming ever more important in helping patients “navigate” their way to timely and quality care. They also provide assistance in overcoming any barriers to care. 

According to the Academy of Oncology Nurse & Patient Navigators, “The heart of navigation is personalized care,” which applies to patients, families, and caregivers.

Nurse navigators focus first and foremost on the clinical aspects of care. They are often involved from the point of a suspicious finding through diagnostic testing, treatment, and follow-up or end-of-life care.

The nurse navigator responds to questions in a timely manner, explains the rationale behind the planned treatment, and coordinates care across the healthcare continuum. All this can go a long way in reducing a patient’s anxiety and enhancing his or her ability to follow through with appointments and prescribed treatment. 

As an example, breast tumors differ in how they behave and respond to available therapies. There’s no one-size-fits-all approach.

Patients may compare their own situation to that of a friend, or to what they read on the Internet. Providing information specific to the patient’s diagnosis and plan of care not only informs the patient but also helps relieve uncertainty and resulting anxiety.

This allows patients to focus on achieving the best health outcome possible, and on living their lives.

What Does a Nurse Navigator Do?

Nurse navigator roles and responsibilities vary depending on the nurse’s level of preparation and the healthcare setting in which he or she works.

But all nurse navigators advocate for patients by helping translate complex medical information into language they can understand and apply, and making the overwhelming more manageable. In providing patient-centered care, nurse navigators may do any or all of the following: 

Educate patients about their disease, prescribed treatment, and side effects of treatment and how to manage them
Provide clinical resources -- where to seek a second opinion, treatment or testing that may not be available locally, and how to access reliable sources of information
Assess patients for psychosocial distress and referral to a medical social worker or counselor if more intensive support is needed
Answer questions as appropriate and serve as liaison to the physician for additional questions and concerns
Address tangible barriers to care such as finances, housing, transportation, childcare, prescription costs, and much more. They refer patients to the appropriate contact, such as a social worker
Ensure any health information provided is accessible: this may include securing documents printed in the patient’s own language or arranging for certified medical interpretation, either in-person or by phone/video conference
Function as a member of an interdisciplinary team to assess, secure, and coordinate appropriate services through the continuum of care
Empower patients, families, and caregivers to assume as much responsibility for their care as possible, within the constraints of age, illness, and other factors
In consultation with other members of the healthcare team, promote awareness of clinical trials as appropriate
Support the timely scheduling of appointments, diagnostic testing, and procedures
Educate/identify patients for genetic counseling or fertility preservation, and facilitate appropriate referrals

What Are Desired Qualities in a Nurse Navigator?

There is more to being a successful nurse navigator than having specialized clinical skills, although clinical competence is certainly essential. Nurses who have the following qualities, or are willing to develop them, will be likely to perform well in and be professionally satisfied in a nurse navigator role.

  • Strong communication skills: The nurse navigator cannot work in a silo – much of his or her effectiveness depends on teamwork with others. Their areas of practice are highly multidisciplinary and require reliable, open, responsive communication in order to meet patient needs.
  • Cultural openness: the nurse navigator will be open to learning from patients, about values, beliefs, and how they see the world – all which may be very different from the navigator’s personal culture and beliefs. The navigator is willing to listen and be a liaison between the patient/family/caregiver and the medical providers, in developing a plan that is medically sound and culturally acceptable.
  • Respect for others: this may seem like a given, but the nurse navigator role requires the nurse to be especially diligent in this area and to show patience and understanding while setting reasonable boundaries and expectations.  Consider, for example, the patient who brings her three children to appointments (she may not be able to afford childcare) or the patient who misses appointments because he misunderstands verbal and written directions.
  • Commitment to patient confidentiality: Most nurses are sensitized to patient confidentiality, from the HIPAA training they’ve received from employers. However, nurse navigation may require an additional layer of awareness. Consider, for example, a patient from a tightly-knit ethnic community, whose partner is physically abusive. The nurse navigator, working with the social worker, might need to reconsider avenues of referral (other than the culturally-specific agency typically serving that community) to ensure her safety and privacy. 

What are the Requirements to Be a Nurse Navigator?

Requirements to be a nurse navigator will vary by clinical setting and institution. Any nurse navigator must have solid clinical experience in a specific area of nursing care (usually several years). 

They may also hold certification in their specialty area of practice, such as oncology nursing (OCN – oncology certified nurse) or nurse navigation, available through the Academy of Oncology Nurse Navigators and the Oncology Nursing Society

Some nurse navigators may be nurse practitioners or clinical nurse specialists, depending on their work setting and disease focus (lung cancer, cardiology, or organ transplant).

What Work Settings are Available to Nurse Navigators?

Nurse navigators typically work in a clinic and hospital settings, with strong ties to clinicians in other organizations as well as many contacts in a variety of community agencies.

What Kind of Salary Does a Nurse Navigator Make?

Salaries for nurse navigators usually align with those of others in their level of practice, whether nursing with a specialty certification or an advanced level of nursing practice.

How Do I Find Out More About Nurse Navigation?

To learn more about nurse navigation, talk with other nurse navigators in your area, or network via nursing social media sites, and visit websites for the Oncology Nursing Society and the Academy of Oncology Nurse & Patient Navigators.


The History of Patient Navigation

The patient navigation concept originated with Dr. Harold P. Freeman, a noted cancer surgeon and former President of the American Cancer Society, who conducted a series of hearings throughout the country which led to the ACS publication, Report to the Nation on Cancer in the Poor (1989).

Through his medical practice, Dr. Freeman became aware that patients who were poor and minority presented with advanced stages of breast cancer, and were more likely to die from their disease. He also recognized the many barriers that people in poverty had to overcome – including lack of transportation, limited financial resources, language barriers, and many, many others.

By inventing the field of patient navigation, where lay providers working in the community assisted patients in obtaining early mammography screening, and then helped them get into and “navigate” the healthcare system, Freeman actually saw a remarkable increase over time in patients’ five-year survival rates, from 39% to 70%, which he discussed in Oncology Issues.

Since the early work of Dr. Freeman, others have seen the value of navigation as a field of work. As discussed in AONN online community navigators are lay persons who focus on health teaching and prevention/screening activities in the community setting; patient navigators (unlicensed individuals) and social work navigators focus on making sure practical, tangible resources are in place to assist patients in obtaining needed care (e.g., transportation, Medicaid, medical housing, and other community resources); and nurse navigators, who focus on the clinical aspects of care and making referrals as appropriate to others on the multi-disciplinary team and beyond. 

Regardless of the role, all navigators have one ultimate goal: to provide patient-centered care so individuals can have the best health outcomes possible.


Next Up: 15 Highest Paying Nursing Specialties 

Anne Devine, RN, BSN, BA, CBC is a freelance healthcare writer who lives in Seattle, Washington. She has more than 15 years of experience working with employers and clients in the academic, nonprofit, healthcare, and corporate worlds, including a medical device company, online pharmacy, and a variety of startup and software/in-the- cloud firms. With roots in public health nursing, she especially enjoys working with and writing for healthcare organizations and the professionals who keep them going. 

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