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Beyond the Bedside: Nurses as Patient Navigators

Farling, Linda CRNP, OCN; Gingrich, Rebecca RN, MS, OCN

doi: 10.1097/01.COT.0000428662.59605.5a

After diagnosis, each cancer patient treated at Penn State Hershey Cancer Institute is assigned a nurse coordinator—a registered nurse who manages that patient's care, working under the direction of a physician and with the entire cancer care team. The authors of this editorial, who have both served as nurse coordinators there, discuss how and why the system works.

Nurse coordinators at Penn State Hershey Cancer Institute (PSHCI) are the glue that holds the multidisciplinary cancer teams together by coordinating all aspects of care for patients, from diagnosis through treatment and into survivorship. Nurse coordinators assure that patients have access to the most appropriate care, provide emotional support, and connect patients to the community resources they need.

The nurse coordinator is the single point of contact for the patient moving through the different stages of cancer care at PSHCI. Traditional patient navigators focus on providing and improving access to care. But, unique to the PSHCI nurse coordinator's role is how the coordinator manages care comprehensively—helping patients and their families access care, managing patients' symptoms, providing education for patients, offering emotional support where needed, and recommending appropriate supportive care services.

LINDA FARLING, CRNP, OCN (left), is a Thoracic Team Oncology Nurse Practitioner at Penn State Hershey Cancer Institute; and REBECCA GINGRICH, RN, MS, OCN, is the Bone Marrow Transplant Program Manager and Manager of Clinical Program Coordinators at PSHCI

LINDA FARLING, CRNP, OCN (left), is a Thoracic Team Oncology Nurse Practitioner at Penn State Hershey Cancer Institute; and REBECCA GINGRICH, RN, MS, OCN, is the Bone Marrow Transplant Program Manager and Manager of Clinical Program Coordinators at PSHCI



The nurse coordinators are part of a designated multidisciplinary disease team. They help the patient schedule all appointments, including those with surgeons, medical oncologists, and radiation oncologists, as well as appointments in the infusion room, blood tests in the lab, and any necessary imaging. Coordinators, by working with the same physicians every day, have become specialized in caring for specific types of cancer and have expertise in managing specific types of cancer.

As cancer patients face an uncertain future and a health care system both complex and difficult to navigate, nurse coordinators provide consistency. Patients often complain that they do not know who in the multidisciplinary care team to call when experiencing a problem, and have vented in great detail their level of frustration when passed from one discipline to another without having their needs addressed. As patients battle for their lives, the nurse coordinator is the one who helps ensure continuous, seamless care. Here's how it works.

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At Diagnosis

The surgical nurse coordinator joins the patient for his or her initial clinic visit after diagnosis to offer emotional support and to guide the patient through the next steps of his or her treatment. The nurse coordinator helps the patient understand the physician's explanation of the disease and future surgeries or treatments the physician has discussed. The nurse coordinator is there to listen to the patient and make sure all of his or her questions get answered.

After the patient undergoes surgery (if needed), the surgical nurse coordinator helps the patient transition into follow-up treatment, introducing the patient to the hematology/oncology nurse coordinator who follows the patient through that treatment, and into survivorship.

To ensure a smooth transition from surgical nurse coordinator to hematology/oncology nurse coordinator, all coordinators work in the same office, and deliver verbal reports as the patient transitions from one coordinator to the other. Teamwork and knowledge sharing are key components of the program.

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Through Treatment

The hematology/oncology nurse coordinator attends clinic visits with the patient when he or she sees the physician. As the patient continues treatment the hematology/oncology nurse coordinator is available via phone or in person to listen to any physical symptoms patients may feel and emotional struggles they might have.

The nurse helps foster communication between the physician and patient—making sure everyone understands the plan. The physician and the nurse coordinator meet on a daily basis to discuss patient issues and treatment plans. Physicians can also be reached by the nurse coordinator via pager to address any urgent patient issues.

The trust established between the patient and the nurse is priceless for the patient, for family members, and for the nurse. The nurse coordinator lets the patient know that he or she is the most important patient in that nurse's day for the time that they spend on the phone together, or the time they spend in clinic together.

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Transitioning to Clinical Trials

Nurse coordinators are familiar with the clinical trials available for their patient population and help screen patients for participation in those trials.

When patients are offered the opportunity to participate in a clinical trial at different points throughout their care, the nurse coordinator is there to work with the research nurse to plan and implement the patient's new treatment. Because of the close collaboration, patients feel no interruption of care. The nurses share information about the patient, so the patient feels comfortable with the change. They discuss how the patient tolerates treatment, side effects, what worked to relieve certain symptoms, the patient's response to treatment, and emotional state, support system, and any financial concerns.

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Into Survivorship

After treatment, the nurse coordinator then helps the patient transition into the survivorship phase of care and back to pre-cancer life. Nurses help recommend supportive services appropriate for individual patients and their families, such as social work, spiritual support, psychosocial support, and nutrition support.

The nurse coordinators usually continue to see their patients after treatment every three to six months in the clinic along with patients' physicians. And, nurse coordinators stay available via phone to assist patients with any issues or concerns they may have.

The nurse coordinators manage complex cases that require a high level of knowledge, skill, critical thinking, and compassion. They are a key component of the multidisciplinary cancer teams at PSHCI. They help provide top quality care and access through the health care system for all patients diagnosed with cancer.

© 2013 Lippincott Williams & Wilkins, Inc.
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