Updated Core Competencies Reflect Evolution of Nurse Navigator Role

August 07, 2018 by Elisa Becze BA, ELS, Editor

Although care coordination and interdisciplinary collaboration are essential components of every oncology nurse’s role, oncology nurse navigators (ONNs) take that work even farther by helping patients and caregivers navigate a complex healthcare system and access much-needed resources.

By ONS’s definition, ONNs are key in meeting patient and caregiver needs while providing evidence-based, cost-effective, and quality cancer care by eliminating barriers to timely care.

As a relatively newer oncology nursing subspecialty, ONNs’ role has changed and grown in recent years. In response, ONS saw a need to update its ONN Core Competencies to reflect the evolution in the work since the competencies were first released in 2013. The new 2017 ONN Core Competencies now include 52 functions, divided into 40 novice and 12 expert, which Baileys et al. shared in the June 2018 issue of the Clinical Journal of Oncology Nursing (https://doi.org/10.1188/18.CJON.272-281).

Core Competencies

Designed to define the role, support growth and standardization of the role, and describe the knowledge and skills a nurse should have in the first one to two years in the role, core competencies help guide oncology nurses to ensure they are practicing proficiently. ONS has core competencies (http://www.ons.org/practice-resources/competencies) for oncology nursing generalists as well as clinical nurse specialists, nurse practitioners, clinical trials nurses, and ONNs available.

Figure 1. Types of Navigators

Oncology Nurse Navigator (ONN): A professional RN with oncology-specific clinical knowledge who offers individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers. Using the nursing process, an ONN provides education and resources to facilitate informed decision making and timely access to quality health and psychosocial care throughout all phases of the cancer care continuum.
Lay Navigator: A trained nonprofessional or volunteer who provides individualized assistance to patients, families, and caregivers to help overcome healthcare system barriers and facilitate timely access to quality health and psychosocial care from prediagnosis through all phases of the cancer experience
Novice ONN: A nurse who has worked two years or fewer in the ONN role and is building on his or her academic preparation, nursing knowledge, and oncology navigation experience to develop in the ONN role
Expert ONN: An ONN who has worked at least three years, is proficient in the role, and has the education and experience to use critical thinking and decision-making skills pertaining to the evolution of navigation processes and the individual ONN

According to Baileys et al. (https://doi.org/10.1188/18.CJON.272-281), the ONN Core Competencies outline the fundamental and advanced knowledge, skills, and expertise that professional nurses need to effectively:

Coordinate care for patients with a past, current, or potential cancer diagnosis.
Assist patients with cancer, their families, and their caregivers to overcome healthcare system barriers.
Provide education and resources to facilitate informed decision making and timely access to quality health and psychosocial care throughout all phases of the cancer care continuum.

2017 Updates

To develop and update the ONN Core Competencies, Baileys et al. explained (https://doi.org/10.1188/18.CJON.272-281) that ONS conducted a role delineation study (RDS) in conjunction with the Oncology Nursing Certification Corporation in 2013 and again in 2016. The findings from the second RDS showed that the ONN role is progressing. Consistent was “the practice focus of ONNs [in] educating and coaching colleagues about the navigation role, collaborating to identify and learn best practices, marketing, and applying population and systems-level knowledge, skills, and tasks.” However, in 2016 the study showed that as ONNs gain experience in the role and build on extensive previous experience in oncology nursing, they progress toward more knowledge, skills, and tasks, indicating a need to update the core competencies to differentiate novice from experienced or expert ONNs. With this information, the 2017 ONN Core Competencies included new types of navigators (see Figure 1).

Additional data sources for the update included a field review survey from nurses in the former ONS Nurse Navigator Special Interest Group as well as all ONS members who identified their primary work function as nurse navigator. Based on these sources, the 2017 update also included a revised list of initial knowledge and skills requirements for ONNs (see Figure 2).

Figure 2. Initial Knowledge and Skills Requirements for ONNs

Strong oncology knowledge: certifications such as OCN^®, AOCN^®, AOCNS^®, AOCNP^®, and CHPON^® demonstrate specific knowledge of cancer care for a specific patient population (i.e., adult or pediatric). Additional certifications such as CBCN^® and BMTCN^® speak to the unique care needs and requirements of even more specific patient populations
Basic knowledge of insurance reimbursement systems
Working knowledge of financial hardships and payer coverage
Working knowledge of national, regional, and community resources
Knowledge of self-care strategies and resources
Critical thinking skills
Strong leadership skills
Strong interpersonal skills
Ability to develop collaborative relationships internally and externally
Ability to work in teams
Ability to work autonomously
Strong verbal and written communication skills
Strong organizational skills
Ability to prioritize and reprioritize quickly
Basic computer skills

How to Implement Into Practice

Baileys et al. emphasized (https://doi.org/10.1188/18.CJON.272-281) that “the process of updating and identifying new ONN core competencies was supported by evidence-based practice and validated by a consensus-driven peer-review process” (p. 280). ONNs can feel confident implementing the competencies in practice. Ways to do so include:

Provide a clear definition and expectations of the ONN role.
Guide ONN role development and promotion.
Provide guidance for managers to successfully screen applicants for ONN positions.
Guide development of ONN job descriptions, competency checklists, and orientation programs.
Provide direction for preceptorship and identification of resources for new ONNs.
Provide information for evaluation of an oncology service line navigation program and establish performance and development goals.
Promote the role and provide education about the role to the oncology care community and the community at large.

For more information on the 2017 ONN Core Competencies, refer to the full article by Baileys et al. (https://doi.org/10.1188/18.CJON.272-281)

This monthly feature offers readers a concise recap of full-length articles published in the Clinical Journal of Oncology Nursing (CJON) or Oncology Nursing Forum. This edition summarizes “Nurse Navigator Core Competencies: An Update to Reflect the Evolution of the Role,” by Kristen Baileys, MSN, CRNP, OCN^®, Lori McMullen, MSN, RN, OCN^®, Barbara Lubejko, MS, RN, Deborah Christensen, MSN, APRN-BC, AOCNS^®, HNB-BC, Pamela J. Haylock, PhD, RN, FAAN, Traudi Rose, BSN, RN, MBA, OCN^®, Jean Sellers, MSN, RN, and Dominique Srdanovic, MA, RN, OCN^®, which was published in the June 2018 issue of CJON. Questions regarding the information presented in this article should be directed to the CJON editor at CJONEditor@ons.org. Photocopying of this article for educational purposes and group discussion is permitted.

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