Nurses have numerous options beyond caring for patients in a hospital setting. Communities need nurses throughout the continuum of care; from preventive health services to complex disease states. When patients and their families are facing a health crisis, nurses are the most obvious choice to guide them through the myriad of diagnoses, testing, review of results, next steps, etc. Enter the nurse navigator.

A relatively new role for nurses, the nurse navigator is assigned to assist and support patients and their families through the foreign maze of the healthcare world. As with any foreign travel, not understanding the language, landmarks, or unusual customs can be terrifying for those facing a life-altering diagnosis. The nurse navigator is both translator and guide to ease the journey of fear and uncertainty.

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Although the role is quickly expanding, most nurse navigators are working with oncology patients facing chemotherapy, surgery, and/or radiation. For example, nurse navigators at Genesis Health System's Cancer Care Institute employ a team of nurses to have one-on-one contact with patients to offer resources and education regarding the planned treatment. The nurse navigator acts as a liaison between the patient and all members of the care team.

Patients facing treatment for cancer can expect to interact with a large care team. Teams are typically comprised of a Primary Care Physician (PCP), oncologist, hematologist, palliative care physician, pharmacist, behavioral medicine provider, and nurse navigator. While this is ideal and in the best interest of the patient, the vast team can be overwhelming to patients. If a change or problem occurs, it can be confusing to the patient to figure out which care team member to contact. For example, if the patient has a port-a-cath inserted for chemotherapy and there is a problem, does the patient or family contact the PCP, the surgeon who placed the device, the surgery center where the device was placed, the oncologist who ordered the medication to be infused, or the pharmacy that delivered the medication? This is a small example of why a nurse navigator is needed for this fragile population.

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Organizations that choose to create roles for nurse navigators are putting the patient at the center of the care, and increased patient satisfaction scores reinforce this fact. Numerous articles are published each year touting not only the intangibles such as the patient's perceived improvement of care, but also decreased hospital readmission rates and ED visits in the departments where nurse navigators are utilized. Most complex disease states require a large commitment by patients and families, and noncompliance to treatment regimens is not uncommon. Departments where a nurse is navigating the care improves compliance and therefore outcomes and overall health of the patients. As medicine becomes more specialized, patients and caregivers need a healthcare expert to guide them through the complexities of care from diagnosis to survivorship. The role of the nurse navigator can provide this expertise with proven return on investment for forward-thinking organizations who put the patient at the center of the care model.

Mary Eliza Mahoney

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