Nurse Navigators Drive Patients to Enhanced Referral Process

Purpose: Gain insights into how mapping and advocating every new patient’s cancer journey led this nurse navigation department to rich outcomes for both patients and nurses. Nurse navigators at a cancer center recognized an opportunity to improve new patient services and increase nursing value for patients at the beginning of their cancer journey. Goals of this initiative were to promote health and wellness for patients and nurses’ satisfaction with their practice.
Description: Nurse navigators aim to provide patient-centric education, early diagnosis/treatment options, improved patient adherence and engagement, prevention of delays in treatments, and enhanced clinical outcomes. The nurse navigation department sought to improve their workflow and deliver top-of-license nursing practice. Within a cancer center-wide access redesign project, nurse navigators took the opportunity to take a critical look at their contributions to new patients. The team formed a small committee comprised of tenured nurses and nurses new to the department to assess nurse navigators’ standard workflows. First, the committee reviewed the center’s community needs assessment and the goals of Healthy People 2030. The cancer center’s community needs assessment revealed that 83% of area residents rated the overall health of the community as “fair” or “poor,” with additional barriers to care that include difficulty navigating the health care system, literacy, housing, safety, transportation, limited financial resources, language, and cultural barriers. With this information in mind, the committee implemented an education series targeted to the whole department. Education was provided during regular in-services and staff meetings. The education included information about internal and community-based supportive services. The navigation team learned how to use EMR functionality to independently refer patients to internal cancer center services. Subsequently, the team shared community resources and websites amongst the group and stored the information in a shared electronic folder. Speakers from community non-profits were invited to present at staff meetings. The team standardized the patient interview and EMR documentation. A survey was sent to the nurse navigators pre- and post-implementation looking for perceptions of top of license.
Evaluation/outcome: Prior to the implementation of navigator education of supportive resources and learning how to independently place EMR referrals, a baseline of 2% of patients were referred to supportive services. Standardized questions asked during the navigator-new patient interview helped identify barriers and prompted the navigator to refer patients to resources. A 250% increase over baseline (7%) was achieved. The top-of-license survey demonstrated improvement in nurse satisfaction in emotionally supporting and educating patients, incorporating patient data into the plan of care, evaluating the plan of care with patients, coordinating care with clinical team members, and working at top of license. This patient-centric initiative improved the new patient’s experience with nurse navigators and increased support to patients through referrals to needed services. Additionally, this project improved nursing satisfaction with several top of license activities.