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Whether at a hospital bedside, home, medical office or clinic, one of every nurse’s most important responsibilities is to be an advocate. As the health care system has become increasingly complex, some nurses are taking on more focused roles as navigators, with a mission to help patients better deal with a system that can be scary and overwhelming.
On May 6, the nation’s 4 million nurses start to celebrate National Nurses Week with the theme: “Nurses: Inspire, Innovate, Influence.” AARP and the AARP Foundation have been working with the Robert Wood Johnson Foundation to strengthen the nursing profession through the Center to Champion Nursing in America.
Some navigators, or patient coaches, work for major medical centers or community hospitals; others are hired directly by patients. Their goal is the same: to help patients and their families cope with a serious illness — from considering treatment options to making sense of the medical system’s often-treacherous terrain. In some cases, a single advocate will support a patient through an entire course of treatment.
“One major job of nurse advocates is to identify barriers to a patient’s treatment,” says Lillie D. Shockney, R.N., an oncology nurse navigator who is also a two-time breast cancer survivor. Shockney directs the Cancer Survivorship Programs at the Sidney Kimmel Cancer Center at Johns Hopkins University in Baltimore. She says one of her key roles is to ensure the patient’s voice is not lost in what can be very complex treatment regimens that require multiple tests, evaluations and specialists.
A patient who receives an unexpected and difficult diagnosis, such as cancer, may be simultaneously confronted with lots of paperwork and multiple, quick decisions regarding treatment and payment options. That patient may or may not have a reliable support system and family members may be too emotional to be able to dispassionately consider medical and economic choices.
“We should get to know each patient early on and understand who they are,” says Shockney. Hopkins has had a nurse navigator program in its oncology department for more than a decade.
Shockney says the best navigators zero in on what may seem to be unrelated issues to a patient’s treatment and detect red flags others may miss. She describes a young woman diagnosed with breast cancer. While talking to the woman, Shockney discovered that she was an aspiring concert pianist. Because of Shockney’s oncology training, she knew that one side effect of the chemo the woman was about to receive was recurrent finger pain. So Shockney talked to the woman’s oncologist and they decided on another drug that did not have that complication. “It would have been terrible if we would just have given her the first drug without talking to her about side effects, and then later be asked by her why she could no longer play the piano.”
The American Nurses Association designated 2018 as the "Year of Advocacy" in order to celebrate “the many examples of nurses’ efforts to affect change and improve the lives of others while promoting and protecting the profession,” says Janet Haebler, the ANA’s senior associate director of state government affairs. The advocacy efforts of nurses range from work with patients to influencing the profession and health care issues at the local, state and national level.
Becoming a nurse navigator is a relatively new career path for nurses. Other than being a registered nurse, there is no specific certification or standard curriculum, although there is an increasing availability of courses that prepare nurses for this added role, including training in clinical research, social work, insurance and patient education.