Nurse Navigator

special interest group newsletter

Volume 4, Issue 2, September 2013
Coordinator’s Message:
Connecting With the Right People

Carol Bush, BS, RN
Wichita, KS

“Surround yourself with only people who are going to lift you higher.”—Oprah Winfrey

She’s right. Nothing is a faster, more effective way to fill the gap between where you are and where you aspire to be than having the right passionate and supportive people in your corner. Maybe you’re lucky and work with a big team of nurse navigators. More than likely, though, you’re not. Many of us work alone or with one or two others. It can be isolating.

We know how much could be possible if we surrounded ourselves with awesome people. We’ve heard stories of changes people have made, businesses they’ve built, weight they’ve lost, and things they’ve experienced just as a result of connecting with the right people. Yet so few of us know how to do it. We have all kinds of reasons why we don’t reach out and make the connections we could—we don’t live in a big city, we’re an introvert, we’re not experienced, we have nothing to offer, or we don’t know where to start.

We want oncology nurse navigators to have a different experience. Over the next two years, our SIG is on a quest to create a supportive community that can provide connections to peer support to enhance your practice as an oncology nurse navigator.

The following are a few connections available. For a complete picture of the SIG’s work plan, check it out on the Virtual Community (VC).


  • Newsletters—Articles by members highlighting new models of practice or quality initiatives. Make sure to check out the articles on oral adherence and lung cancer screening in this issue! If you would like to submit an article for publication, e-mail Dominique Srdanovic, RN, OCN®, MA, newsletter editor.
  • Communiques—Quarterly e-mail from the SIG coordinator, updating you on project highlights and leadership opportunities for SIG members
  • Discussion board—Have a question? Need a connection? Submit your request to the SIG’s discussion board.
  • LinkedIn project—In partnership with the Survivorship, Quality of Life & Rehabilitation SIG, we will be investigating ways to use social media to continue conversation throughout the year. We have room for one more member on the project team. E-mail me if you are interested in joining!

If you have been in your role for more than three years, please consider volunteering to be a mentor. We are updating our mentor list and will publish the updated list on the VC by January 2014.

Speaker’s Bureau
We get e-mails frequently from organizations looking for nurse navigators to speak at conferences. We would like to identify a SIG Speaker’s Bureau and publish a list of speakers and their expertise on the VC. E-mail Ellen Carr, RN, MSN, AOCN®, VC co-administrator, if you are interested.

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

Nurse Navigator

Special Interest Group Newsletter  September 2013

A Closer Look at the Oral Chemotherapy Nurse Navigator Role

Elizabeth Bettencourt, RN, BSN, OCN®
Sunnyvale, CA

The nurse navigator role is becoming an essential part of the cancer care continuum. Nurses have the opportunity to specialize in a specific cancer diagnosis or area of cancer care. These specialized nurses include breast cancer navigators, prostate cancer navigators, lung cancer navigators, and many more. Another important area in cancer care is the recent increase in the development and use of oral chemotherapy.

I work at Palo Alto Medical Foundation, a not-for-profit, non-hospital-based clinic comprised of several campuses in Sunnyvale, CA. The oncology department in which I practice has five, soon to be six, oncologists. I have been working in the oncology department with varying roles for 20 years. For the past two years, a large portion of my current position has been spent as an oral chemotherapy nurse navigator.

My role as an oral chemotherapy nurse navigator involves all aspects of care of patients receiving oral chemotherapy. I process the prescriptions based on the pharmacy’s insurance contracts. I help patients with financial assistance for the very high copayments and Medicare “donut hole” or coverage gap. I work with patients, pharmacies, drug companies, and charitable organizations to obtain access to drugs for patients who do not have insurance coverage or cannot afford their portion of the drug cost. I also coordinate drug refills as needed, as well as prescriptions for dose changes, with the pharmacy.

My most important role is providing diagnosis and drug regimen education at the start of treatment, as well as routine follow-up throughout the course of treatment. Education includes dosing, storage and handling, disposal, side effects, laboratory monitoring, and adherence issues. I contact patients within three to five days of starting treatment, weekly as needed for the first month, then monthly and as needed throughout the treatment course. My follow-up is usually a phone call and involves assessing the patient’s physical status, ensuring and encouraging drug adherence (including a pill count), ensuring timely access to refills, ensuring adherence to monitoring parameters, reviewing side effects, and offering any other teaching or emotional support needed. If a patient reports side effects, I coordinate with the doctor and arrange an office visit for evaluation. I currently monitor about 60 patients per month.

This role provides me with an opportunity to support, encourage, and educate patients on a long-term basis. Some patients remain on oral therapy for months to years. Patients need to have a thorough understanding of the importance of adherence to the drug regimen. I am the eyes and ears between the patient at home and the physician. This role is important in ensuring the safe administration of chemotherapy in the home environment.

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Low-Dose Chest CT Screening for Early Detection

Karen Overmeyer, MS, RN, ANP
Richmond, VA

Lung cancer is the leading cause of cancer deaths—more people die from lung cancer in the United States than breast, prostate, and colon cancer combined (Centers for Disease Control and Prevention, 2013). The leading cause of lung cancer is the inhalation of cigarette smoke (firsthand and secondhand). Unfortunately, more than 50% of patients will have distant spread at diagnosis and only 20%–25% of patients will have masses that are localized and able to be removed (National Cancer Institute, 2013).

Since the conclusion of the National Lung Screening Trial (NLST) in October 2010, which showed a 20% reduction in lung cancer mortality, major groups have stepped forward to define guidelines for recommended screening of patients at high risk (National Lung Screening Trial Research Team et al., 2011). The National Comprehensive Cancer Network (NCCN) has established a set of guidelines for lung cancer screening (NCCN, 2013), and the American Association of Thoracic Surgery also has published a set (Jaklitsch et al., 2012). The two sets of guidelines vary, and the debate continues about what ultimately will be included in a final version.

Many hospitals are in the process of developing a screening program. Our particular program at Henrico Doctors Hospital Cancer Center Specialty Clinics in Richmond, VA, began in 2005 when our physicians became interested in a National Institutes of Health early research study indicating a significant reduction in deaths related to screening smokers (Kramer, Berg, Aberle, & Prorok, 2011). By 2010, when the evidence was verified, our program’s infrastructure was ready to roll out in a more formal manner.

To participate in the program, an interested person calls our central line and is screened by one of our nurse navigators, utilizing a series of questions that comply with NLST criteria. The screening also includes a brief health review and tobacco usage history. After one has met the criteria, a low-dose computed tomography (CT) scan is scheduled at one of our outpatient imaging centers. This is an out-of-pocket expense, and the individual is made aware that payment will be expected on the day of the scan.

The intake process includes a brief 5–10-minute smoking cessation assessment, counseling, and referral to our tobacco treatment specialist. The goal is to offer help with cessation and reaffirm that the purpose of the exam is not to obtain “clearance” to continue smoking.

On the day of the scan, the nurse navigator meets with the patient and provides counseling about potential results (e.g., false positives) and information about the follow-up course and addresses any anxiety. The nurse navigator reviews a consent form—to be signed prior to the exam—that explains the nature of the scan, the fact that insurance does not cover the screening exam, and other particulars including the follow-up plan.

What sets our program apart from others is the follow-up. The patient has the opportunity to meet with the thoracic oncology nurse navigator and a pulmonologist or thoracic surgeon if a nodule is discovered. The primary care physician is notified, and we collaborate on the follow-up care. Patients who have no nodules on exam are offered a one-year scan during follow-up.

On July 30, the U.S. Preventive Services Task Force (PSTF) released a set of guidelines (U.S. PSTF, 2013) that includes current and former smokers aged 55–80 years with a history of smoking the equivalent of a pack a day for 30 years or two packs a day for 15 years. Also included are former smokers who have quit within the past 15 years. This is yet one more step in paving the way for reimbursement. Out-of-pocket costs are thought to have been prohibitive for smokers.

Nurse navigators screening patients for lung cancer need to be well-versed on the risks and benefits and be able to speak to patients who are concerned about issues such as radiation exposure that may be cumulative over an undetermined time of serial CT scanning. Currently, screening CTs are at a lower dosage—an estimated average of 1.2 mSv or 120 mrem, compared to standard CTs at approximately 8 mSv or 800 mrem (Worker Health Protection Program [WHPP], 2013). As further comparison, average annual exposure in the natural environment is 3.1 mSv or 310 mrem per year (WHPP, 2013). A paucity of studies regards actual risks, so the NCCN and PSTF guidelines stress that screening only should be used in the high-risk groups specified.

Patients also need education regarding false positives, which are well addressed in U.S. PSTF guidelines (U.S. PSTF, 2013). Serving as a point person to address questions and anxiety is yet another way nurse navigators can effectively collaborate with primary care physicians and bridge services between pulmonary specialists and other members of a multidisciplinary program to manage lung nodules or early lesion detection.

Stay tuned—insurance reimbursement may be closer than we expected.

Centers for Disease Control and Prevention. (2013). Lung cancer. Retrieved from

Jaklitsch, M.T., Jacobson, F.L., Austin, J.H.M., Field, J.K., Jett, J.R., Keshavjee, S., . . . Sugarbaker, D.J. (2012). The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. Journal of Thoracic and Cardiovascular Surgery, 144(1), 33-38.

Kramer, B.S., Berg, C.D., Aberle, D.R., & Prorok, P.C. (2011). Lung cancer screening with low-dose helical CT: Results from the National Lung Screening Trial (NLST). Journal of Medical Screening, 18(3), 109-111.

National Cancer Institute. (2013). SEER stat fact sheets: Lung and bronchus. Retrieved from

National Comprehensive Cancer Network. (2013). Lung cancer screening (version 1.2014). Retrieved from

National Lung Screening Trial Research Team, Aberle, D.R., Adams, A.M., Berg, C.D., Black, W.C., Clapp, J.D., . . . Sicks, J.D. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine, 365(5), 395-409.

U.S. Preventive Services Task Force. (2013). Benefits and harms of computed tomography lung cancer screening programs for high-risk populations. Retrieved from

Worker Health Protection Program. (2013). Lung cancer screening using low-dose CT. Retrieved from

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Spotlight on Symposia:
Access Supplemental Content Anywhere!

The Spotlight on Symposia, the annual ONS Connect supplement, is now available for free online. This valuable resource features summaries from 12 symposia presented at the Oncology Nursing Society’s 38th Annual Congress in April 2013. Contents cover hematologic malignancies, safety, site-specific cancers, and supportive care. The supplement is easier to access than ever on your tablet, smartphone, or other portable device. Available for free to ONS members and nonmembers alike, check out the Spotlight on Symposia today. Happy reading!

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Exclusive Articles Available Before Print

The Oncology Nursing Forum (ONF) and the Clinical Journal of Oncology Nursing (CJON) now provide advanced print exclusive articles to give our readers access to important, cutting-edge content ahead of print. For a period of time (at least a month) before a new issue of ONF or CJON is released, one article or more from the upcoming issue is made 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 “Multidimensional Needs of Caregivers for Patients With Cancer” by Karen A. Skalla, Ellen M. Lavoi Smith, Zhongze Li, and Charlene Gates. In this CJON article, the multidimensional needs of caregivers of cancer survivors are described.

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Journals Available in Digital Format

Did you know that the Clinical Journal of Oncology Nursing (CJON) and Oncology Nursing Forum (ONF) are available in digital format? To access the digital editions, click on the journal you wish to view at 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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Nurse Navigator

Special Interest Group Newsletter  September 2013

We Would Love to Hear Your Voice

We would love to welcome new bloggers to write about any or all of a variety of topics including oncology nursing, patient care, treatment updates, networking and professional development, nursing education and careers, what’s it like as a new oncology nurse or student nurse, and information for patients and caregivers. Writing for the ONS blog is great experience and will distinguish you as an expert in your field. Get your feet wet in the publishing and digital world at the same time.

If you have an interest in writing for the ONS blog or you’d like to know more about taking on this volunteer role, please email for more information.

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Check out the New ONS Connect Blog

The official blog of ONS is written by oncology nurses for oncology nurses on a variety of topics of interest, 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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Nurse Navigator

Special Interest Group Newsletter  September 2013

Five-Minute In-Service

In the latest issue of ONS Connect, the Five-Minute In-Service explains how Clinical Nurse Leaders Integrate Quality and Breast Cancer Care.

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Ask a Team Member

In the latest issue of ONS Connect, the Ask a Team Member column answers the question When Should a Patient With Cancer Begin an Exercise Program?

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Membership Information

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Nurse Navigator

Special Interest Group Newsletter  September 2013

Nurse Navigator SIG Officers

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

Ex-Officio (2013-2014)
Loir 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
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 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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