What Makes an Effective Nurse Navigator?

Janelle Wagner, RN, OCN

Oncology nurse navigators, which are also referred to as “ONNs,” are professional registered nurses with oncology-specific clinical knowledge. Professionals in this role help patients navigate the various steps of their cancer care journey by offering education and resources to help promote informed decision making and access to quality health and psychosocial care. They assist patients, families, and caregivers circumvent barriers in the health care system. ¹

Janelle Wagner, RN, OCN, Senior Manager of Patient Navigation Program for Community Sites, Seattle Cancer Care Alliance, recently met with Oncology Nursing News® to discuss what skills help make an oncology nurse an effective navigator, some of the challenging elements related to nurse navigation, and how the implementation of a nurse navigation program has added value to the patient experience at her own institution.

Oncology Nursing News®: In your opinion, what skills make an individual a good nurse navigator?

Wagner: The biggest thing is confidence and oncology knowledge [and] being able to problem solve and work independently. Somebody who is able to de-escalate stressful situations and able to see a big picture makes the best nurse navigator.

Do you have any advice for prospective nurse navigators or anyone looking for a career shift?

Many health care institutions define nurse navigation differently so it is important for any nurse who is considering the field to make sure the scope of work is well defined.

Being a nurse navigator requires somebody who has a broad understanding of oncology care. So [someone] that has worked in many different aspects of oncology, from inpatient to infusion to the clinic, [experience with] radiation oncology is helpful, [as well as] surgical oncology. Someone who understands the bigger picture of how all aspects of care happen—rather than just one discipline.

In terms of implementation, it's really bringing a full team together. When looking at oncology care, you're looking at multiple disciplines: surgical oncology, medical oncology, radiation oncology, etc. It’s really [about] bringing that whole team together to see what the current state is, how do the patients currently flow through the system? Is it working? Where are the gaps; where does the patient get kind of lost in the system? How can the nurse navigator be that person to help? Again, it's working with the existing system to hold that patient's hand and get them in to the right places and the right timeframe.

What are some of the more difficult components of nurse navigation?

Setting boundaries [are]. Oncology nurse navigation is a newer field, and there are many different opinions on what the job entails. Being able to set those boundaries and kind of sticking with your standard work to be able to best serve the patient [is crucial]. The challenge is understanding [that] our health care system is so complex, and that you really need to be the point person for that patient to navigate through that system [rather than] trying to fix the system.

Is there anything that you wish you had known before you became a nurse navigator?

I had been an oncology nurse for almost 20 years, and I started this program almost 5 years ago. I have quite a bit of prior oncology experience.

If somebody is going to go into this field, they need [to] make sure that they have good leadership, and good pathways for the position. It is really questioning: what does standard work look like? Who is my team? When you are navigating a patient through the whole continuum of care, it could be across many different organizations. [You need to understand] who that team is and how to utilize [your] skills to help the patient go through the system.

I hear many navigators say [that] they're used to having a team that they work with and having collaboration with colleagues. The nurse navigation position is really an independent position. The patients who you're working with? They are your new team; it is your patients and the providers rather than a collaboration of nurses working together.

Is there anything else that we haven't touched upon that you would like to discuss or add?

Our program was really designed to make sure we retained our patients and kept them at the center where they were diagnosed. When we launched the program our main focus was to increase our retention rate.

And within that first year, by assigning a navigator, we saw our patient retention rate increase, just by placing a nurse to help navigate their care. We have also seen a decrease in time to first-line therapy as well as improve our referral rates.

We are not only helping build a strong program for the institution, but also helping the patients move through the system a lot easier.

Reference

Hamilton D. Measuring the impact of nurse navigation. Presented at: Oncology Nursing Society Bridge; Sept 9-16, 2021; virtual. https://ons.digitellinc.com/ons/live/player/1438