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November 10, 2011 | AONN+ Blog | Novice Navigators
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 you've recently become a nurse navigator specializing in an area of oncology, you are among a growing number of nurses who have zeroed in on a new specialty, helping your patient travel along a pathway that can be riddled with confusing information, a myriad of decisions to be made regarding treatment, and other significant decision making along the way. It's rewarding when it works well. It can be frustrating for everyone when it doesn't.

Something that I recommend to anyone just embarking on a nurse navigator role is this-you cannot navigate a patient if you haven't walked in her shoes. No, you don't have to have had the disease she has, but you do have to have a bird's eye view of what this journey looks like through the eyes of a patient. So step 1-follow a patient, preferably several different patients, along the care continuum beginning with the screening process (ie, getting scheduled for a screening mammogram, colonoscopy, Pap smear, etc) and document the entire process all the way through. By doing so, you will be able to identify the inefficiencies that exist along the way, the delays in treatment, barriers to decision making, access to care issues, patient compliance problems due to lack of understanding of the importance of following treatment recommendations and other issues that will become your responsibility to help address. Removing barriers to care is a key function in your new job as nurse navigator. Some barriers may seem unsurmountable; others may be an easy fix. As patient advocate (which you are), your charge will be to work around barriers or eliminate them, so that she can get the care she needs.

So get out your paper and pencil and begin to record the care delivery process from beginning to end. Don't leave out any steps. Record a time line along with the steps. How many days lag between the patient's having a screening mammogram to learning she has to return for a diagnostic mammogram? How long a wait does she then have before getting scheduled for these additional images? How soon does a biopsy get scheduled if the findings seem suspicious? Does it take 7 days to get biopsy results back before a patient gets a diagnosis of cancer? Each day that goes by is additional stress and anxiety for her and her family. (And we wonder why breast cancer is the disease women fear the most? We scare them to death before they even get the verdict of malignancy vs benign findings.)

Commit to your patients that you won't allow same old same old to be acceptable. Meet with faculty and staff, on behalf of the patients you navigate, and see what can be done about reducing these wait times. (Our turnaround time for biopsies used to be 5 days; now its 24 hours.)

Don't expect to solve every inefficient process you identify in the system either-at least not overnight. Make a list, identify the right people to recruit to help work on improving these processes of care, and take them on one by one.

These barriers become important in measuring your performance too. Demonstrate how you were able to eliminate a barrier; reduce a wait time; get the patient home with home health sooner.

So go ahead and get underway! Patients are, well, waiting!

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