June 2017 VOL 8, NO 6
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Evidence into Practice
Seasoned Navigator: Case Scenario on Professional Roles and Responsibilities
Tricia Strusowski, RN, MS
Susan is a new navigator at her cancer center; she is assigned to patients with head and neck cancer. Her preceptor is Mary, a navigator with 10 years’ experience. Susan was a bedside nurse before being hired as the head and neck cancer navigator.
During the first week of orientation Mary shared with Susan the navigation department orientation checklist, and she reviewed the roles/responsibilities and job description of the navigator. She discussed the role of the Commission on Cancer (CoC) and the specific standards in Chapter 3, Continuum of Care, related to navigation. Mary also shared that it is important for Susan to review all the CoC standards. The findings and recommendations from the Institute of Medicine report were also reviewed and discussed in detail. Mary shared the National Comprehensive Cancer Network guidelines for patients with head and neck cancer and emphasized that the updates need to be reviewed on a yearly basis to stay up to date.
Susan was not exactly sure how to coordinate care for the patient across the entire continuum; who, what, where, when, and how were important factors when managing transitions with the patient and family. Mary reviewed how to transition the patient and their family through warm handoffs between the different episodes of care. Mary explained how it is essential to share all the details of the patient’s journey with the appropriate disciplines, ensuring that she was introducing services as needed as a result of the patient’s psychosocial distress screening results. Mary shared the resources available for referrals for patients with head and neck cancer, as follows:
- Social worker
- Registered dietitian
- Rehabilitation department
- Speech and swallowing department
- Financial counselor
- Pastoral care
- Genetic counseling
- Palliative care team
- Hospice team
- Other as indicated for the patient/family
Patient and family educational resources were also discussed; the cancer program multidisciplinary team utilizes the National Cancer Institute (NCI) patient educational booklets to ensure standardization across the continuum. The patient’s family and caregiver are also provided educational materials from NCI on caregiver support. Cancer program resources and community resources are also provided to the patient and family as outlined by Mary.
Mary reviewed the monthly reports and navigation metrics that the department is collecting in regard to patient experience, clinical outcomes, and return on investment.
The orientation and annual navigation competency checklists utilized by Mary to orient Susan can be found here, respectively. Mary will be assigned to Susan for the next 6 months to provide support and guidance.
Metrics for Domain of Professional Roles and Responsibilities
As with any program, evidence-based metrics are essential to measuring success and sustainability. The AONN+ metrics below were created for the domain of Professional Roles and Responsibilities
Navigators possess insight of a patient’s comprehensive care needs, provide education and advocacy for the patient, link the patient to networks of professional and community resources, and act as a contact to enhance psychosocial care. By taking the time to observe the care process of patients, performing community needs assessments, and utilizing critical thinking and problem-solving skills, navigators are able to identify barriers to care, ineffective processes, and communication gaps. Navigation is integral to facilitate effective interprofessional collaboration and promote patient satisfaction and quality of care, as well as the efficient use of healthcare resources to decrease costs across oncology patient populations and healthcare settings. Functioning as members of the multidisciplinary team and being knowledgeable in the cancer care continuum, navigators provide patient-centered education; assist with communication among the patient, family, and healthcare team; reinforce to patients and their families the significance of adherence to treatment and follow-up; as well as promote healthy lifestyle choices and empower patients with self-care strategies.
Navigators may also have additional responsibilities, including performance improvement projects, program development and planning within the healthcare system and community, quality improvement and program evaluation, and reporting to their cancer committee and administration. Thus, an understanding of navigation metrics and their implementation is an important competency for the navigator to possess to measure structure, process, and outcomes, as well as to demonstrate their value through the roles and responsibilities they perform.
As navigators perform the role of educator for their patients and families, it is essential for navigators to commit to lifelong learning and evidence-based practice, and to pursue ongoing continuing education. Navigators must remain knowledgeable about practice changes and current advances in treatments and symptom management.
The author reminds all members of AONN+ to review the modules for the Professional Roles and Responsibilities domain on the website. The author also encourages members of AONN+ to post items regarding the competencies and best practices for Professional Roles and Responsibilities on the AONN+ website discussion board.
The author can be contacted as follows:
Tricia Strusowski, RN, MS
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