Nurse navigators play a pivotal role in caring for oncology patients at Montefiore Medical Center in Bronx, New York. The nurse navigators are funded through the medical center’s participation in CMS’ oncology care model, which is a payment arrangement that includes financial and performance accountability for episodes of care surrounding chemotherapy for cancer patients.
According to CMS, there are 184 providers and 13 payers involved in the oncology care model.
Managed Healthcare Executive (MHE) recently interviewed Annmarie Flannery, RN, administrative nurse manager for medical oncology, radiation oncology, and hematology at Montefiore Medical Center, to discover best practices for hiring nurse navigators, as well as the appropriate responsibilities to assign to these members of the oncology care team. Flannery helped develop the oncology care model at Montefiore Medical Center.
MHE: What qualities and skills do you look for in the nurse navigators you hire? What qualities/background/clinical or otherwise?
Flannery: We stick to the oncology nurse competencies, which were developed by the Oncology Nursing Society. What we’re looking for is a nurse with strong organizational skills, previous oncology nursing experience, and the ability to work autonomously.
Oncology nurses need to be able to change on a dime. One call from a patient who’s sick and dehydrated changes your whole day—even if your day is mapped out. You have to focus on that patient who’s in distress.
Then, once the dusts settles—and the critical patient is stable—oncology nurses have to go back to the day’s work they planned. Another critical skill is the ability to delegate. For example, a registered nurse needs to be able to delegate the appropriate work to a licensed practical nurse.
We’re also looking for some inherent capabilities in our oncology nurses, such as empathy, dedication, and compassion. They have to be unflappable and focus on what’s important in the moment—that can mean making sure a patient is OK, emotionally and physically.
MHE: What degrees and training do your oncology nurse navigators have?
Flannery: We have four oncology nurse navigators, two registered nurses and two licensed practical nurses; we pair the registered nurses with licensed practical nurses at two different sites of care. The nurses work at the top of their licenses, meaning the registered nurse makes the plan of care and can delegate this work to the licensed practical nurse. The licensed practical nurse can educate the patient about their medications and their potential side effects.
We find this reinforcing team work really helpful for patients. Once they hear the word “cancer,” patients experience fear; that makes it difficult to retain information. Thus, it’s helpful to have an extra level of support from our oncology nurse navigators about their disease.
MHE: Your care navigators are nurses, rather than social workers. What are some ways that your care navigators may serve in a social worker capacity?
Flannery: Many of our patients are worried that this support from our oncology nurse navigators is going to cost them extra money. Our oncology nurse navigators explain to patients that there’s no cost associated with this support. During the initial patient visit, our nurses explain their role and the ways they can help patients, which includes anything from assessing their pain level to checking on community resources for financial support to facilitating medication changes.
These conversations can take place during a “chair chat,” where the nurse just sits next to a patient before or after a treatment to ask how they’re feeling. Our nurses also provide a distress screening [which assesses the emotional, psychological, social, or spiritual difficulties of coping with a cancer diagnosis].
Another important responsibility of our nurse navigators is to discuss with patients their advanced directives and their healthcare proxy. It’s really important to normalize these conversations.
MHE: It sounds like there’s a team of care providers for your patients. How do you make sure that all of your care providers are communicating with each other?
Flannery: We use Epic as our EHR. That means, for example, that the triage nurse will document in the EHR in real time her conversations with a patient. And that keeps the nurse navigator plugged into the patient’s status. We also do warm “hand offs” between team members, such as the triage nurse to the nurse navigator regarding a patient’s pain level.