The Role of Nurse Navigator in Single Facility vs Role of Nurse Navigator in an Integrated Multifacility Model

Background: There is limited literature available that compares nurse navigator (NN) roles in a single-facility model (SFM) and the role after transitioning to a multifacility model (MFM). In MFMs, navigation begins at patient diagnosis and ceases at end of active treatment. SFMs were used prior to 2018, and MFMs were implemented January 1, 2018.

Objectives: To define the role of NN prior to and after MFM implementation. Analyze the MFM’s effect on breast patients navigated.

Method: Web-based survey completed over 2-week period. Questions regarding role, setting, patient type, tumor types covered, and timeliness to care in the SFM and MFM were posed.

Results: 100% response rate; 7 NNs from 6 facilities in north and central Florida. There were no universal standards/policies for NN in SFM. Examples of duties included program development, hospital accreditation, data collection, CoC/NAPBC compliance, community outreach, administrative tasks, and tumor board coordination. Fifty percent worked with surgical inpatients, 80% worked with distress screenings. Cancer patients varied from newly diagnosed to those who completed treatment within 10 years. MFM revealed opportunity for growth in leadership roles within the MFM.

NN within facilities was: 2 in Inpatient Oncology Unit, 1 in Education Department, 1 in Cancer Center, 1 in Radiology Department, and 2 in a hospital ancillary setting. MFM NN reported facility centralized office space with reports of increased privacy and fewer work time distractions. SFM tumor type showed 4 generalists, 3 breast-specific. MFM shows 6 are breast-specific with allowances for additional tumor sites when needed. Timeliness to care, diagnosis to first treatment median days in SFM was 26 days and MFM was 24 days.

Conclusion: NN went from generalist to tumor site–specific, giving the NN a more manageable patient load and more expertise in that particular tumor type. In November 2017, a total of 332 breast patients were navigated. Through November 26, 2018, a total of 632 breast patients were served, and timeliness to care decreased by 2 days. The MFM model set definitive roles for the NN through metrics, leadership, peer support, and access to resources, which nearly doubled breast cancer patients captured though breast-specific tumor site NN.

Note: This abstract was accepted without revisions to the National Consortium of Breast Centers for poster presentation during the 2019 conference.