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Are Your Responsibilities as a Navigator Clearly Defined?

April 13, 2011 | AONN+ Blog | Role of the Navigator
Featuring:
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
Editor-in-Chief, JONS; Co-Founder, AONN+; University Distinguished Service Professor of Breast Cancer, Professor of Surgery, Johns Hopkins University School of Medicine; Co-Developer, Work Stride-Managing Cancer at Work, Johns Hopkins Healthcare Solutions

If not, then anticipate political problems with your oncology team members, overlap of responsibilities with others, and job dissatisfaction at some point in time. Why? Because without clear roles and responsibilities, others will not understand why you are on the team at all.

If you've heard the word "infrastructure" before and wondered exactly what that means, the case is the same for many when they hear the word "navigation." It's important to define the roles and responsibilities from the start of the position. If you, however, are already in a navigator role, it’s not too late to address this missing element, which is critical to your success. To get started, define what are the tasks that you've been told are to be your responsibility, and why. What is the current process of coordinating efficient delivery of care, and how are you to go about improving it? Remember too, without measurement prior to getting under way, there is no clear-cut way to measure your success by comparing results from before your job existed to how things are going for your patient population 6 months after you implemented changes.

Nearly every cancer center is implementing navigation at some level. However, not many are doing their homework up front in determining how they want to define this role. Navigation has become a requirement for some accreditation survey processes for cancer centers today. But even those organizations that are performing the survey process are not defining either what is expected to be the key components and measurable performance of a navigator.

In order to post a navigator position for hire, the manager overseeing this new position needs to define what tasks and functions are needed to be incorporated into the navigator job description. This also requires knowing the job functions and tasks of other team members, such as appointment schedulers, social workers, clinic nurses, physician extenders, and anyone else involved with diagnosis and treatment of your cancer patient population. Why? To avoid overlap, turf wars, assigning too high or low a level task to the new navigator, and ensuring that all team members embrace this new role with enthusiasm, respect, and a desire to help the individual succeed.

Let's look at some examples:

"Arranging for a post-op consultation with a medical oncologist" is not the same as "scheduling the appointment." A nurse navigator may electronically inform a scheduler that Ms. X needs a post-op appointment with Dr. Z between March 4 and March 12 (7-11 days post-op when the navigator knows that full pathology will be available by then for a medical oncologist to be able to make systemic treatment decisions). The task of actually scheduling the appointment, however, is a clerical task that doesn't require an RN degree to perform.

"Providing an overview of the surgical procedure the patient will have” (ie, wire localization lumpectomy, mastectomy, etc) is different from "preoperative teaching," too. An overview provided by a nurse navigator entails explaining how the type of surgery was determined to be the best option for her by the surgeon, what will happen on the day of surgery (ie, IV insertion, hospital gown, perhaps wire localization in breast imaging, that anesthesiology will meet with her in the precare area, when her family can and cannot be with her on the day of surgery, what to expect in the recovery room, length of hospitalization, etc). This is different from preoperative teaching performed by a nurse practitioner who works also with the surgeon and educates the patient and family members about drain management, wound care, post-operative pain control, signs and symptoms of infection, when to urgently call her (ie, spiking a high fever or JP drain stops functioning).

See the difference? Yet, if not clearly defined as it has been done above, someone on the team will assume you are taking over her role and that your job really isn't needed or necessary. Team members, whether it is the surgeon, medical oncologist, radiation oncologist, scheduler, surgeon's secretary, or clinical nurse, all need to have an understanding of the navigator's role, how it should dovetail with their own, and recognize its value to the team and most specifically to the patient.

The point in time when your responsibility with the patient begins and ends also needs to be defined; otherwise, assumptions will be made. There is also a tendency when a new position is created to have lots of folks assume that this new person can do many things to "help out," which can quickly dilute the time available to do what the person was hired to do. This needs to be brought up politely and at the same time assertively, otherwise the navigator's time will be swallowed up doing functions that probably belong to someone else, or should be someone else's responsibility. This means that the navigator needs a champion to protect her time, and support her when changes in job functions for her or anyone on the team are being made.

Also work with your manager to discuss how your performance will be measured. Simply recording how many patients you navigated isn't enough. Did you navigate them "well," and how is "well" being defined? Did you reduce waiting times from one appointment to another? What was the average wait time before you started the position, and what is the average wait time now? Were any other changes made that need to be credited to someone else and for which you shouldn't be taking credit (like the installation of scheduling software that has built-in “reminder” notifications)?

This all may sound frustrating and time-consuming, but without this type of structure and processes in place, you will find that you lack clarity about your role and others are avoiding your professional company.

I heard a surgeon say, "I have no idea what our nurse navigator does, but when she isn't here, things go to hell." It's great to be appreciated. It's also important for people, including the doctors, to understand your role. In doing so, they too will value you more and perhaps even know when to solicit your help with a patient.

There are no two institutions that function exactly the same. Thus there is no job description that ideally describes what your roles and responsibilities are to be. Such a job description needs to be institution specific. Consider, however, contacting other cancer centers and requesting copies of their job descriptions to give you an idea of what the potential content and wording might be. Toss those that are unclear. Be sure to have an understanding of what is needed, when, how, where, and why. The outcome can and should be job satisfaction for you, the navigator, your manager, and the other oncology professionals and support staff you will be working with. Most importantly, your patients will value your navigation role and greatly benefit from it.

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