California Nurse Navigators Steer Patients Through Cancer Treatment
Friday May 22, 2009
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She came to Marin General Hospital’s Breast Diagnostic Center in Greenbrae, Calif., for a breast biopsy, and three days later she received the devastating news that she had invasive ductal carcinoma. At that moment, she faced not only the emotional blow of a cancer diagnosis, but also the overwhelming responsibility of finding her way through the maze of unfamiliar medical terminology, decisions, and healthcare providers that would now be part of her daily life.
Luckily for Dowling, the upsetting news was coupled with an unexpected sense of relief when she learned that nurse navigator Cindi Cantril, RN, MPH, OCN, of Marin General Hospital, would serve as her advocate, intermediary, planner, and emotional support from diagnosis through treatment and then survivorship.
Unknown to Dowling, the hospital had just instituted the new role of breast cancer nurse navigator to help women overcome the emotional and physical hurdles of cancer treatment. In fact, Cantril’s role reflects a national trend, as more hospitals are hiring nurse navigators to improve cancer patients’ satisfaction and outcomes.
“More and more hospitals are developing navigation programs,” says Tina Beerman, RN, BS, ONN, president and co-founder of the National Coalition of Oncology Nurse Navigators. “It’s become a huge hot button in the oncology community because navigation is making a difference in patient care. Oncology nurse navigators are changing the face of cancer care.”
Beerman and her colleagues were excited the institute was raising awareness about the need for patient navigation, but nurses such as Beerman noticed there was a difference between a patient navigator and a nurse navigator. Patient navigators could be laypeople who assisted with coordinating services such as transportation or financial support but didn’t have the training needed to offer clinical support.
“Nurse navigators could help patients in the clinical sense, such as educating them about treatment options or holding their hands as they moved through treatment,” Beerman says. “We decided to take steps to try and bring the role of the oncology nurse navigator into the public eye, so we formed the National Coalition of Oncology Nurse Navigators.”
The coalition focuses on supporting the role of the oncology nurse navigator by fostering collaboration among nurses who are in this position and by working with the healthcare community to develop the role. Due to the fact that nurse navigation is a somewhat new role in many hospitals or clinics, coalition members often contact one another with questions related to job descriptions, salaries, and standards of practice.
“The true explosion in nurse navigation for breast cancer care has just begun to take shape in the last five years, and because of the success of the model in breast cancer, there are many hospitals and cancer centers that are implementing that same concept in other cancer diagnoses,” Beerman says.
For Cantril, her clinical expertise helped Dowling at several key points during the process of cancer care. For example, when Dowling learned she had invasive ductal carcinoma, Cantril could offer knowledgeable encouragement in spite of the frightening diagnosis.
“I could tell she knew what she was talking about,” Dowling says. “She told me that although my pathology report showed I had cancer cells, we caught [the cancer] early, it’s small, and it’s completely curable. From that moment on, I had no fear.”
Cantril gave Dowling brochures to learn about breast cancer and helped arrange a consultation with a surgeon. Cantril gave Dowling her cell phone number and told her she could call anytime. Cantril also attends the tumor boards, where she can hear firsthand what physicians say about patients, and then calls her patients with new information from the meeting. After Dowling later learned she also had widespread ductal carcinoma in situ in her left breast and would most likely need a mastectomy, Cantril helped her navigate the complexities of making appointments with plastic surgeons and deciding which type of reconstruction to choose.
Although Cantril is now a vital part of the cancer care team, she acknowledges it took time and effort to establish the new role within the cancer center. When she first arrived, one of her first tasks was to send letters to primary care providers (PCPs). She explained the role of the nurse navigator and offered to give patients the results of their pathology reports. Ninety percent of the PCPs responded saying they wanted her to give the results. Surgeons have been equally eager to have her meet with patients.
“Most of the surgeons want me to see a patient prior to seeing them because patients who have had a chance to emotionally decompress with me can listen better to the surgeon,” Cantril says. “I sit down with them for an hour to help them prepare for a doctor’s appointment and write down their questions.”
Enter Pamela Matten, RN, BNS, OCN. Matten, a nurse navigator for the thoracic oncology program, was hired five years ago to establish a role that would solve this problem. Similar to Cantril, Matten had to spread the word to PCPs in the community. She joined with a pulmonologist and a surgeon, and the trio offered luncheon meetings in which they educated PCPs about the nurse navigator role.
“I am like a concierge of lung cancer so patients don’t have to decipher all the details,” she says. “I also enjoy the fact that I get to follow patients for many years, so it’s a long-term commitment.”
Kim Moses, RN, BSN, OCN, nurse navigator of the urologic oncology program at St. Joseph, spent time introducing herself to physicians in the hospital and the community when she started two years ago. In addition to helping patients understand their clinical diagnosis and treatment plan, she educates them about potential side effects and how to manage them.
Moses recommends that patients attend a prostate cancer support group, and she will call patients at different points in their treatment and recovery to check on their progress. She will meet with them one-on-one if they are struggling physically or emotionally.
“As a nurse navigator, I have the opportunity to sit down with people for a longer time than physicians usually have,” she says. “I love empowering patients to turn around something that initially seems like a bad thing and helping them to find the silver lining.”
For Dowling, her contact with a nurse navigator was so powerful that the experience was one reason she decided to launch into a new career related to cutting-edge breast cancer care.
“Cindi helped me by setting the tone of optimism and by showing me I was not alone,” Dowling says. “She was clearly a patient advocate for me, and I knew she would help me through it. I’m amazed that we went without nurse navigators in the past, and that some hospitals do without them now.”
Readers interested in learning about a breast cancer nurse navigator certification course offered by the National Consortium of Breast Centers can visit the following Web site: www.breastcare.org.
The coalition will hold its first conference Oct. 10 in Baltimore. To learn more about the coalition, visit www.nconn.org.
Heather Stringer is a freelance writer.
To comment, e-mail editorCA@nurseweek.com.
