Patient navigation is a health delivery support strategy that addresses barriers to care and assists in explaining the maze of information by enhancing patient shared decision-making through culturally appropriate education. Patient navigation oncology models use distinct types of navigators. In this instance, nonclinical licensed navigators or patient navigators are those who have direct knowledge of the community and its resources and are trained under their system of employment. Meanwhile, clinically licensed navigators, such as nurses, work with the multidisciplinary healthcare team by using their clinical skills to improve efficiency and adherence to care by ensuring that individualized care is coordinated among members of the team and to be a strong advocate for their patients.
A visual description of the nurse navigator is like a thread in a garment. This professional makes the care process appear as a seamless thread as they work between the patient and among the many healthcare resources they may have to deal with, whether it is people, agencies, or education. The patient is carried by this tapestry through the care continuum to be supported and to make personalized informed decisions. This customized garment envelops any barriers—systemic or patient-related, caregivers who are traveling with the patient, and other disease nuances—to allow for timely and supportive care.
What Makes Nurse Navigators Different from Nurses?
The role of nurses in patient navigation has evolved through hospital nursing functions of utilization review and utilization management with a broad healthcare system view to those in case management who worked directly with healthcare teams caring for specific patient populations. As case managers stayed in-house, nurse navigators followed the shift of outpatient oncology care in the early 2000s. Given the complexity of cancer care and challenges to obtaining care, the nurse navigator is the crucial eyes on the patient from the access point of care through delivery of care and then discharged into follow-up and survivorship care.
The nurse navigator’s view through the eyes of the patient and the analysis of the patient flow from point of system entry, such as screening to survivorship or end-of-life care, sets this role apart from an oncology nurse. The nurse navigator has operational management knowledge that tracks patients along the continuum, records steps to reduce barriers, ensures that cancer care meets standards of care such as National Comprehensive Cancer Network guidelines, and documents overall improvements in efficiency for the patient as well as the healthcare system in which they are employed.
But an oncology nurse often works in a silo—chemotherapy infusion, oncology in-patient unit, radiation, or other select roles. The nurse navigator provides a holistic approach to care delivery and focuses on care coordination, education, and physical, social, and emotional aspects of care. This all-encompassing eye of the nurse navigator views the entire community, healthcare systems, and provider organizations from the patient’s perspective.
How Do Nurse Navigators Offer Value?
The value of nurse navigation is the flexibility to work in any geographic area based on the needs of the healthcare system and an assessment of the community’s needs. The nurse navigator may be:
- Disease-specific in breast, urology, thoracic, or any other form of cancer
- Service-specific by providing assistance in the areas of outreach and screening, diagnostic testing, treatment, or supportive care
- Longitudinal, where navigators take all oncology patients from outreach through survivorship
- Financially focused, in which the primary role of the navigator is to help with financial patient support
With this value comes the navigation precision that patients are more connected to their care by having a single focus of contact, evaluated for other referrals and other healthcare needs such as financial, dietary, transportation, or anything else that can be met with a minimum of effort on the patient’s part—true patient-centered care. Other values of patient navigation encompass increased clinical trial participation, decrease in oncology times (treatment or diagnostic), better educated and prepared patients, and increased patient satisfaction.
Nurse navigators are also recognized as a solution to health inequities in cancer care. A basic competency of all navigators is awareness and techniques to address language and cultural differences, barriers created by these differences, and an approach to foster trust and empowerment within the communities they serve. Misconceptions that start in the community can be addressed with correct information by a trusted nurse navigator. Many work along underserved populations that need improved healthcare access, advocacy, and care coordination, and they use their clinical skills and talents to address deep-rooted issues related to distrust in providers and the health system. This bridge of trust prevents the avoidance of health problems and noncompliance with treatment plans.
So why are nurse navigators important to patients? They are a key fit when it comes to communication, care coordination, person- and caregiver-centered experience and outcomes, clinical quality of care, and patient safety principles. They improve the patient and caregiver experience by providing culturally and educationally appropriate evidence-based information that helps patients understand their diagnosis and make educated treatment decisions. They address health inequities across racial and ethnic minority populations by making healthcare systems a more just and equitable place as they help patients identify personal strengths to empower their preferences and priorities. They offer hope, support, and concrete help as they navigate patients through their cancer journey.
