Oncology Nurse Navigators: A Key Variable in the Value Equation

Conference Correspondent - AVBCC 2019 Summit

Patients with cancer who have benefited from the services of an oncology nurse navigator know firsthand the inherent value of the role in the care continuum. Although the return on investment for instituting oncology navigation programs may not be as readily apparent to cancer center administrators, through data collection and standardized metrics, navigators can successfully demonstrate their worth. At the AVBCC Summit, leaders in the oncology navigation field discussed best practices for proving that value to administrators to develop, implement, and sustain navigation programs.

“Everybody has a stake in this game,” asserted Monica Dean, Director of the American Cancer Society National Navigation Roundtable. “The patient is at the core, so how are we going to make this work?”

One major step forward in this mission was the development of 35 Standardized Evidence-Based Oncology Navigation Metrics by the Academy of Oncology Nurse & Patient Navigators (AONN+). These metrics provide concrete benchmarks by which programs can measure value and sustainability, according to Danelle Johnston, MSN, RN, HON-ONN-CG, OCN, AONN+ Chief Nursing Officer and Senior Director of Strategic Planning and Initiatives. She added that results from the National Evidence-Based Oncology Navigation Metrics: Multisite Exploratory Study to Demonstrate Value and Sustainability of Navigation Programs will be presented during the AONN+ Annual Conference in Nashville, TN, November 6-10, 2019.

“Identify the low-hanging fruit of what metrics your organization can collect,” Ms Johnston advised attendees. “See if you can integrate those data fields into your [electronic medical record].”

Overseeing more than 200 navigators across the United States, Kendra Barber, MHA, RN, OCN, Division Director of Navigation, Cancer Services, Sarah Cannon Cancer Institute/HCA, is familiar with the need to demonstrate value to garner buy-in for navigation programs.

“Initially, it wasn’t easy,” she said, adding that her organization developed a model over time that suited its needs.

Brenda Nevidjon, MSN, RN, FAAN, Chief Executive Officer of the Oncology Nursing Society (ONS)—an organization whose Oncology Nurse Navigator Core Competencies and other efforts have helped to further navigation—agreed that proving the value of navigation is not an easy task, and said unfortunately, the question of how navigation is helping an organization is often considered more important than how it improves the quality of care.

“The cost and the quality issue are not just about the front end. It’s about the whole continuum,” Ms Nevidjon added.

When navigation programs are in place, patients do not fall through the cracks the way they otherwise could, she said.

“There is a safety net that certain kinds of navigation programs are going to be able to show they provide,” she said, citing prevention of hospital readmission as just one example. “I think the metrics are going to be invaluable.”

Discussing her own experience of launching a grant-funded navigation program, JoAnn Lovins, MS, RN, Service Line Director of Oncology at University of Colorado Health, said she knew it was a success when an experienced navigator was retiring and the physician with whom she worked immediately requested a navigator to be hired in her place.

“The actual time the physician had spent in the room with the patient had shrunk down…because the navigators bookended it,” she explained, adding that, along with tangible results, it is helpful to find an executive in one’s organization who will champion the cause.

According to Ms Johnston, taking a “30,000-foot view” of an organization can help in identifying where gaps in care exist so that these can be highlighted to the cancer care team as areas a navigator could address. She added, however, that a navigator’s role should be delineated clearly from the start. Ms Barber agreed, saying it is important that the individual to whom a navigator reports is aware of the role and what it entails.

With a wealth of resources from AONN+, including a soon-to-be-released toolkit created through a collaboration with Pfizer, “Patient Navigation in Cancer Care 2.0: Guiding Patients to Quality Outcomes,” along with available tools from ONS and other organizations, navigators have help in determining how best to demonstrate the value of what they bring to healthcare organizations.

“The time is now,” Ms Dean asserted. “We have to do this.”