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Putting the Nurse Back into Nurse Navigation

More than 15 years ago, Fox Chase Cancer Center launched one of the first Nurse Navigation systems to expedite the journey through advanced cancer care with experienced oncologic nurses as a patient’s initial 'point-of-contact' via phone. However, by 2021, due, in part, to great breakthroughs in diagnostic and therapeutic options, the system needed an update to accommodate the timely coordination of appointments for new specialized tests and key physician referrals, enabling a patient to start treatment as soon as possible.

“Megan Metzgar, BSN, RN, OCN

Megan Metzgar, BSN, RN, OCN

To address the challenge, five nurse navigators across Fox Chase's oncologic specialties formed a committee to identify the issues. Immediately apparent was that nurse navigators were spending valuable time making appointments and chasing down test results – instead of on patient care, education, and advocacy—especially important for those with environmental, socioeconomic, and cultural barriers to early diagnosis, treatment options, and delays in starting therapy.

"Previously, instead of 'working up my license' to prepare a patient for the rigors of treatment and enhanced clinical outcomes, I was bogged down in paperwork," says Megan Metzgar, BSN, RN, OCN, CBCN, a Breast Nurse Navigator for seven-and-half years. Kimberly Cobb, BSN, RN, OCN, CBCN, an eight-year veteran of Breast Nurse Navigator, adds, "You need quality time on that first phone call to discuss things like genetics, fertility, even transportation issues; no question is off the table.”

Kimberly Cobb, BSN, RN, OCN

Kimberly Cobb, BSN, RN, OCN

Tackling these issues meant redesigning the Nurse Navigation system to serve patients and nurses better. The Committee started by standardizing documentation for each new patient interview using a detailed, templated questionnaire for each cancer diagnosis. A robust EMR implemented in late 2022 ensures that this information goes to every department with which the patient interacts. And now, instead of nurses juggling appointments, teams of scheduling agents manage the matrix of appointments and tests recommended by the nurse navigator, freeing up the navigator to tend to patients.

“Karen Marie Heron, BSN, RN

Karen Marie Heron, BSN, RN

“It's all about driving care coordination from that first phone call. We are the first ‘touch’ for a patient at Fox Chase. We want to put their mind at ease and on the path to recovery,” explains Karen Heron, MSN, BSN, RN, and a Nurse Navigator for lung, sarcoma, and head and neck cancers.

Patients who are satisfied and happy about the new process will transmit these sentiments to the Navigators. A survey distributed to the nurse navigation team about whether the process adjustments were affecting professional satisfaction, showed that the nurse navigators' satisfaction increased between October 2021 —before the changes were implemented — and April 2022 — after the changes were implemented.

To document and demonstrate these results, Fox Chase nurse navigators recently published a paper describing the patient access redesign at Fox Chase entitled, “Nurse Navigators as the Drivers to an Enhanced Patient Referral Process,” published in the Journal of Oncology Navigation and Survivorship (JONS).

At Fox Chase, the work to improve access services for patients is ongoing to ensure that every patient is well-prepared, both clinically and physiologically, to start treatment and into survivorship.