Unique Roles in Oncology Nursing: Oncology Nurse Navigation
By Darcy Burbage, DNP, RN, AOCN®, CBCN®
As early detection, treatment modalities, and symptom management advance in oncology care, we are seeing an increase in the number of adult and childhood cancer survivors. Added to the unique challenges of comorbid conditions in an aging population, oncology nurses have a lot to juggle in the spectrum of patient care. The relatively new role of the oncology nurse navigator (ONN) was developed to enhance care coordination in patients with cancer.
Filling Unmet Needs
Traditionally, oncology nurses practice in certain subspecialty areas such as inpatient care, home care and hospice, ambulatory infusion centers, or radiation oncology. For the most part, they only see their patients episodically: when they are admitted or when they come in for treatment or a follow-up visit. They didn’t have any one nurse who knew them—really knew them—that they could consistently call to answer questions throughout their treatment journey. They simply had to tell and retell their story to each nurse or clinician that they met, which led to patient fears of being lost in the system or the perception that their team didn’t communicate with each other. It increased anxiety for patients and their families during an already stressful time.
The need for ONNs emerged as treatment modalities became increasingly complex, requiring expert coordination between patients and their physicians. ONNs also help patients overcome barriers to care, such concerns surrounding transportation, finances, and lack of social support, that could lead to delays in care, reduced adherence to treatment plans, and decreased patient satisfaction.
ONNs’ Day-to-Day Work
Patient experience is often influenced by the cancer care team’s ability to work together effectively. In some cases, patients meet with five or more physicians in addition to support staff and are overwhelmed by the amount of information to process. ONNs meet with newly diagnosed patients or, in some cases, are present when patients are receiving their diagnosis and serve as a consistent, trusted resource for patients, families, and caregivers to call for questions or to discuss concerns throughout treatment, survivorship, and end-of-life care. Patients describe (https://www.ons.org/books/oncology-nurse-navigation-delivering-patient-centered-care-across-continuum-second-edition) the role of the ONN as “one of the most significant” on their team. ONNs guide patients and families to resources, provide psychosocial support, help them make sense of all the information, and assist them in the decision-making process.
Beyond diagnosis, ONNs’ role extends (https://doi.org/10.1188/16.ONF.278-280) across the entire spectrum of oncology care from early detection, survivorship and palliative care. ONNs assist patients who are at increased risk of developing cancer by ensuring that they receive recommended screening. ONNs who work specifically in survivorship and palliative care serve as an added layer of support by collaborating with (https://www.oncologynurseadvisor.com/home/headlines/conference-coverage/ona-navigation-summit-2019/from-prevention-to-palliative-care-optimizing-the-breast-cancer-patient-experience-with-nurse-navigation/2) patients to manage the intricacies of complex symptom management.
In some clinical practices and institutions (https://www.nap.edu/catalog/25073/establishing-effective-patient-navigation-programs-in-oncology-proceedings-of-a), experienced ONNs oversee a staff of ONNs or lead quality improvement initiatives documenting ONNs’ effectiveness in reducing inpatient length of stay and 30-day readmission rates and improving access to and participation in cancer clinical trials. In larger practice settings (https://www.nap.edu/catalog/25073/establishing-effective-patient-navigation-programs-in-oncology-proceedings-of-a), experienced ONNs may be involved in program development or in educator roles. Nonclinical or lay navigators are used in community settings to improve access to care in high-risk areas.
Is Navigation Right for You?
ONS’s 2017 Oncology Nurse Navigator Core Competencies (https://www.ons.org/oncology-nurse-navigator-competencies) describes the ONN as a “professional RN with oncology specific knowledge who offers individualized assistance to patients, families and caregivers to help overcome healthcare system barriers.” The ONN serves is the core of the patient care team that connects and coordinates services on patients’ behalf. ONNs combine clinical expertise with patient advocacy, education, and support, leading to the best outcomes for our patients.
Oncology nursing provides many opportunities for professional growth and development and the ONN role is another example of how oncology nursing continues to evolve to meet the needs of the patients we are privileged to care for.