Volume 4, Issue 2, June 2013
Coordinator’s Message
Nurse Navigators Need to Take the Lead

Carol Bush, BS, RN
Wichita, KS

As the most trusted professionals in the United States, we nurses should claim the platform to tell the stories that can change health care.

In a recent study published by Health Leaders Media on collaborating to improve care and cut costs, 69% of healthcare organizations surveyed indicated that adopting care coordination across the continuum was the top intervention that could be implemented to reduce the costsof health care (Cantlupe, 2012). This is an initiative in which nurse navigators can be instrumental in taking the lead.

Yes, it’s a complex problem. Every organization has unique challenges, given its surrounding community, availability of resources, and patient case mix. No one-size-fits-all solution exists, but some are best practice or evidence-based.

Skills key to the practice of every nurse navigator are getting much needed attention in today’s world of accountable care organizations. This includes assessing system and individual gaps in care, coordination, and continuity of care and managing chronic illness, preventive care, wellness care, and patient education.

Why not share the evidence base and claim your platform through SIG involvement? The following are just a few ways to get started.

Check out a marvelous new program development resource on the SIG’s Virtual Community (VC)! Huge shout out to Britta Newcomer, RN, BSN, OCN®, clinical quality specialist at Catholic Health Initiatives (CHI) in Englewood, CO, for sharing CHI’s Navigation Program Resources Guide.

Mentor an international member! Be sure to read “Oncology Nurse Navigation Introduced in Romania” by Lori McMullen, MSN, RN, OCN®, in this issue. We have another opportunity available for international mentoring. Interested? Shoot me an e-mail.

ONS’s project team for oncology nurse navigator core competencies gave an update at Congress in April. The competencies were sent out to SIG members for field review and currently are going through an expert field review process. Stay tuned for the final product!

Share your quality project outcomes in a short article for the newsletter or on the VC. Better yet—pair up with a Clinical Journal of Oncology Nursing mentor to publish your work!

Is there a social media geek or two out there? Send me a direct message on Twitter (@KUCancerRN) for some easy and fun leadership opportunities! Or, connect with me on LinkedIn for a possible project with another marvelous SIG!

Join the discussion, and check out the resources on the VC!

Cantlupe, J. (2012). Collaborating to improve care and cut costs. Retrieved from http://content.hcpro.com/pdf/content/280838.pdf

The Nurse Navigator SIG Newsletter is produced by members of the
Nurse Navigator SIG and ONS staff and is not a peer-reviewed publication.

Special Interest Group Newsletter  June 2013

Oncology Nurse Navigators
The Measurable Link to Patient Advocacy

Lea Ann Biafora, MS, RN, OCN®, CCM, CPHQ
St. Petersburg, FL

Patient advocacy, or healthcare advocacy, is a term that usually refers to supporting patients and their interests within a healthcare system. Many efforts have been made to improve or strengthen the patients’ voices by developing new roles within the hospital setting; however, the effectiveness of these roles remains challenging to define, measure, and evaluate. Despite historical efforts to develop patient advocacy roles within the hospital setting, the lack of true patient support within the healthcare delivery system remains the area with most room for improvement within our fragmented and fragile healthcare delivery system. The oncology nurse navigator role quickly is becoming a prized solution to the lack of patient advocacy within healthcare settings; however, as the role is further defined and evolves, it is important to reflect on the limitations of past roles in order to be most effective in measuring the value of the role.

The emergence of the oncology nurse navigator role partly is due to a culmination of previous efforts to assist in advocating for patient care. The first organized effort to provide patient advocacy services in the hospital setting occurred in the 70s when the new role of patient representative emerged. During the 80s and 90s, an increase in nurse case management and social worker roles arose within hospitals to contain costs while advocating for patients’ needs. In the late 90s, Dr. Harold Freeman and others formed a new kind of patient advocacy focused on providing increased access to cancer care for the underserved population.

As our healthcare delivery system experiences tectonic shifts driven by policy and economics, the role of oncology nurse navigator will continue to be a valuable link for patients with cancer receiving high-quality care—a link that focuses on patient advocacy to support patients and their interests. We need to play a proactive role, not a reactive one, as part of the solution. It is imperative that we demonstrate our effectiveness through the power of measured successes. Of utmost importance is that we define and evaluate our patient advocacy efforts by measuring the need combined with the level of effort (intervention type and amount) we provide patients and the causal effects of the response or reaction.

This is a critical time for oncology nurses, as we have the capability and opportunity to champion efforts toward a more patient-centered healthcare delivery system. However, first it is crucial to address the wide variation of how the role is utilized and structured within various settings. Benchmarks need to be developed to compare to the variations. It is not until then that oncology nurse navigators will be able to validate the power of patient advocacy inherent in the role of nurse navigator.

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Special Interest Group Newsletter  June 2013

Oncology Nurse Navigation Introduced in Romania

Lori McMullen, MSN, RN, OCN®
Ewing, NJ

In October, I had the opportunity to travel to Romania to work on a project funded by a grant from Bristol-Myers Squibb. The project brings together two professional institutions—one specialized in public health, health promotion, medical management, research, and training (National School of Public Health, Health Management and Professional Development) and the other in nursing (Romanian Nurse Association)—to use their expertise and produce an innovative care model for persons at risk for cancer and patients with cancer.

The two institutions involved in this project are working to develop a curriculum and training manual for oncology clinical nurse navigators and a model of integrated quality services for patients with cancer from economically undeveloped areas. This approach to prevention and integrated cancer treatment will adopt the role of oncology nurse navigator from the United States into the Romanian healthcare system. The project goal is to improve the chances of patients with cancer accessing quality medical care in hospital and ambulatory services and to ensure continuity of care in the home community.

During my time in Romania, I traveled daily to downtown Bucharest, to the Department of Health Management and Professional Development, to meet with a team of 12 nurses, medical doctors, and educators from across the country. The team members went into this project with no preconceived ideas of the role and function of oncology nurse navigators. They were eager for information on the history of the role, how navigators work in the United States, how we are funded, and how to best integrate the U.S. model into the Romanian healthcare system and culture.

The first step in the week-long process was to understand how the healthcare system in Romania was organized by tracing the path through the system of a patient who was suspected of having cancer. The current healthcare system is based on a socialized medical model. The primary care physicians in the towns and villages are the gatekeepers of all care. If a patient is suspected of having cancer, testing is done locally if it is available. I learned that a person may need a computed tomography scan, but the scanner may not be working. If a positron emission tomography scan is needed, the referral goes into an approval process that often takes a minimum of several months.

Nurses are trained on the oncology wards to specialize in oncology. However, they don’t have a formal training course, chemotherapy safety standards, or an OCN® certification exam. Nurses typically work 12-hour shifts, and the average salary for a nurse in Romania is $400 per month. These factors have led to a great deal of emigration of trained nurses to Europe and the United Kingdom. The nurses who stay are dedicated and eager for oncology education.

A medical oncologist met with the group to share his experiences. It is not uncommon for him to treat patients without definitive pathology or complete workup due to lack of services. As he explained, “I may call a radiation oncologist to refer a patient, and he may not have an opening to see the patient for three or more months.”

Sickness is perceived as a weakness, and patients often are diagnosed with late-stage cancers. No reliable data exist on new cases of cancer and cancer-specific mortality; the national cancer registry is not operational. Health promotion is a newer concept that has not been fully adopted by the general population or fully supported by the government. For example, women are not given routine Pap smears; therefore, Romania has the highest incidence and mortality of cervical cancer within the European countries. Services and resources like the American Cancer Society and LIVESTRONG Foundation, which we take for granted in the United States, are not part of the Romanian system.

With a clearer understanding of how patients traveled through the system once they were diagnosed and the barriers they faced along the way, the team and I were able to establish a framework and role definition for the proposed navigators. The oncology nurse navigator role is going to be added to the current job duties of the Romanian nurses working with patients with cancer. Nurses who work with primary care physicians also are going to be part of the navigation process to help promote continuity of care and communication. Throughout the week, the team discussed and debated in Romanian, asked questions or for advice in English, and returned to speaking Romanian. Despite the language barrier, the ultimate goal of putting together a teaching curriculum outline for a Romanian oncology nurse navigator program was achieved.

A training program is planned for 60 oncology nurses from across Romania in June. The oncology nurse navigator program will be trialed in Southeast Romania, where mining towns have a high incidence of lung cancer. The Romanian oncology nurse navigator program will be promoted to all key parties in health care through a national conference, articles in specialty journals, and institutions’ Web sites. Public administrative authorities, public health authorities, professional associations of doctors and nurses, hospital managers, and other healthcare and social care providers will be enlisted to disseminate the model to all regions of Romania. The ultimate goal is for the Romanian oncology nurse navigators to contribute to the improvement of treatment outcomes, especially for patients from economically undeveloped areas.

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Special Interest Group Newsletter  June 2013

NPNC Supports Patient Navigation

Steven R. Patierno, PhD
Durham, NC

Chrissy Cianflone, JD
Durham, NC

The National Patient Navigation Consortium (NPNC) was established in 2011 with the mission of endorsing patient navigation as a strategy to improve health outcomes and promote health equality by eliminating barriers to timely access to care, diagnosis, and treatment for cancer and chronic diseases. To accomplish this mission, the Consortium will focus on three major areas: training and education; policy and research; and evaluation.

The membership includes more than 30 local and national organizations including ONS, which holds a leadership position on the Consortium’s steering committee. As the Consortium develops its growth strategy, plans exist for the creation of a free-standing organization. One of its first priorities will be helping to establish minimum core competencies for patient navigators to ensure quality care delivery and create a platform for certification to denote professional competency and dedication to professional development. Given the multidisciplinary nature of patient navigation, it is increasingly important to ensure the creation of minimum core competencies to be included in all levels of training. ONS will be a key partner with the Consortium in establishing core competencies for oncology nurse navigators.

Another priority of the Consortium is advancing patient navigation through local, state, and national policy initiatives. The Consortium has developed a policy consensus paper with five key recommendations for advancing the field of patient navigation. ONS has provided input on the recommendations, and as the policy platform grows, opportunities to advocate on behalf of the work of oncology nurse navigators will be created.

The third major priority of the NPNC is to advance the science of patient navigation through research and evaluation. It is essential to promote the use of common outcome measures to evaluate the effectiveness and efficacy of patient navigation as proposed by the Patient Navigation Leadership Summit. Given the history of collaboration in this area, oncology nurse navigators will play a critical role in helping to advance this goal.

The Consortium was created after leaders in patient navigation recognized gaps and the need for strong collaboration in order to advance the field. The membership has grown since the inaugural meeting in December 2011 in Washington, DC, and it continues to attract local and national organizations. The leadership structure consists of an executive and steering committee. ONS has played a key role in supporting the Patient Navigation Leadership Summit and, as mentioned previously, is a member of the Consortium’s steering committee. The intent of the Consortium is to collaborate with all stakeholders to create a nationwide cohesive forum to move the work of nurses, social workers, and lay navigators forward as a cohesive and multidisciplinary team.

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Special Interest Group Newsletter  June 2013

NCONN Enters Its Fifth Year

Sharon L. Francz, BHA
NCONN Executive Director, Co-Founder
Rockville, MD

The National Coalition for Oncology Nurse Navigators (NCONN) ended 2012 with its most successful conference to date and looks forward to continued growth in 2013. Feedback received during and after the annual conference was positive but indicated that navigators are struggling to attend live conferences due to budgetary cuts by facilities.

Entering its fifth year as an organization, NCONN continues to be committed to serving the essential needs of oncology nurse navigators. Networking and expanding resources for working navigators remains a top priority, as well as offering assistance to new navigators and facilities starting and expanding disease-specific programs.

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Special Interest Group Newsletter  June 2013

Exclusive Articles Available Before Print

The Oncology Nursing Forum (ONF) and the Clinical Journal of Oncology Nursing (CJON) have unveiled advanced print exclusive articles to give our readers access to important, cutting-edge content ahead of print. Articles from the journals are available on the main ONF and CJON pages. These articles are open access, meaning they are available to members and non-members alike, until they appear in print at a later date. At that time, the content will become password-protected like other articles that appear in print as online exclusives in the journals.

The latest article to receive the advanced print exclusive designation is “Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans,” by Brian L. Sprague, Kim L. Dittus, Claire M. Pace, Dorothy Dulko, Lori A. Pollack, Nikki A. Hawkins, and Berta M. Geller. In this CJON article, the authors evaluate patient satisfaction with personalized survivorship care plans.

Request more information about the advanced print exclusives from ONF and CJON.

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Special Interest Group Newsletter  June 2013

Journals Now Available in Digital Format

Did you know that the Clinical Journal of Oncology Nursing (CJON) and Oncology Nursing Forum (ONF) are now available in digital format? To access the digital editions, click on the journal you wish to view at www.ons.org/Publications and follow the instructions featured prominently in the top center of the page. The digital editions are a members-only benefit, so make sure you have your ONS username and password handy.

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Special Interest Group Newsletter  June 2013

Check out the New ONS Connect Blog

The blog is written by oncology nurses on a variety of topics of interest to other nurses in the specialty, including facing day-to-day challenges at work, juggling busy lives at home, and keeping up to date with the magnitude of information available for practicing nurses. This month, you’ll find the following new discussions.

As a reader, join in on the conversation and connect with other oncology nurse readers by posting your own stories, tips, ideas, and suggestions in the comments section at the end of each blog post.

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Special Interest Group Newsletter  June 2013

Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service explains how to Develop a Care Plan to Meet Specific Survivor Needs.

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Special Interest Group Newsletter  June 2013

ONF Podcasts Tell “The Rest of the Story”

What is it like to be an adult survivor of childhood cancer? What physical effects occur long-term? What information would be helpful for survivors? Lead author Wendy McClellan, RN, BSN, presents information about the physical late effects and educational needs of adult survivors of childhood cancer as she discusses her May 2013 ONF article “Understanding the Functional Late Effects and Informational Needs of Adult Survivors of Childhood Cancer.” With the projected increase in the number of adult survivors of childhood cancer, pediatric oncology long-term follow-up programs afford an opportunity to provide education and screen for late effects. The descriptive mixed-method study featured in the article explores functional late effects, experiences, and educational needs of adult survivors. Understanding the needs of this unique population can guide patient education and nursing interventions for patients experiencing long-term effects from therapy and identify potential areas for future research.

Listen to an ONF podcast today!

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Special Interest Group Newsletter  June 2013

Membership Information

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Join a Virtual Community

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Special Interest Group Newsletter   June 2013

Nurse Navigator SIG Officers

Coordinator (2013-2015)
Carol Bush, BS, RN
Wichita, KS

Ex-Officio (2013-2014)
Lori McMullen, MSN, RN, OCN®
Ewing, NJ

Dominique Srdanovic, RN, OCN®, MA
Stamford, CT

Co-Virtual Community Administrator
Marie Borsellino, RN, BSN, OCN®, CBPN-CMA
Sarasota, FL


Co-Virtual Community Administrator
Ellen Carr, RN, MSN, AOCN®
San Diego, CA

ONS Nurse Navigator SIG Liaison to AONN & NCONN
Jean B. Sellers, RN, MSN
Chapel Hill, NC

ONS Copy Editor
Jessica Moore, BA, BS
Pittsburgh, PA

Know someone who would like to receive a print copy of this newsletter?
To print a copy of this newsletter from your home or office computer, click here or on the printer icon located on the SIG Newsletter front page. Print copies of each online SIG newsletter also are available through the ONS National Office. To have a copy mailed to you or another SIG member, contact Membership/Leadership Specialist Carol DeMarco at cdemarco@ons.org or 866-257-4ONS, ext. 6230.

View past newsletters.

ONS Membership & Component Relations Department Contact Information

Brian K. Theil, CAE, Director of Membership and Component Relations Department

Diane Scheuring, MBA, CAE, CMP, Manager of Member Services

Carol DeMarco, Membership Specialist—SIGs

The Oncology Nursing Society (ONS) does not assume responsibility for the opinions expressed and information provided by authors or by Special Interest Groups (SIGs). Acceptance of advertising or corporate support does not indicate or imply endorsement of the company or its products by ONS or the SIG. Web sites listed in the SIG newsletters are provided for information only. Hosts are responsible for their own content and availability.

Oncology Nursing Society
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Pittsburgh, PA 15275-1214

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