The primary role of the nurse navigator is to coordinate services and guide patients through the health care system by assisting with access issues, identifying resources, providing educational materials and developing relationships with service providers. Whereas these functions are imperative in any healthcare system, they gain exceptional importance in the environment for TTUHSC Breast Center of Excellence. This center operates via a “center without walls” concept that is a coalition of services from three different financial entities. Therefore, the nurse navigator in this system has a pivotal role to ensure that the flow of care is smooth and well-coordinated from a patient’s perspective. Moreover, not all physicians are in network for all the major insurance carriers; so the nurse navigator has to be knowledgeable regarding the best way to affect comprehensive care with all the required elements without increasing financial burden on the patient.
Currently, TTUHSC Breast Center of Excellence has one nurse navigator, who is an Oncology Certified nurse with experience in dealing with cancer patients. She has completed her nurse navigator training and certification through the National Consortium of Breast Centers .
The duties of a nurse navigator incorporate patient education and system navigation for both benign and malignant disease, in addition to participation in community outreach.
More specifically, these functions are:
- Education of patient on procedures such as: breast biopsy, breast specific gamma imaging (BSGI), needle localization, and surgical procedures.
- Coordination of subsequent care in case of benign diagnoses that need further management
- Arranging referral for high risk patients for enrollment in risk assessment and prevention program.
- Carrying out a counseling session with patients that have biopsy positive for cancer. This session focuses on the following with a pre-prepared folder that is given to the patient:
- What is cancer
- What is staging
- Why is staging important for treatment planning
- What will happen next
- Importance of multidisciplinary approach including assessment of coping skills
- What is a clinical trial
- What trials are available
- Scheduling of patients with cancer diagnosis in the multidisciplinary cancer clinic (surgeons, medical oncologist, and radiation oncologist).
- Ensuring prospective tumor board discussion on the multidisciplinary clinic day.
- Identification of need for and scheduling appointments with plastic surgeons.
- Being available at most patient appointments (occasionally this is difficult to achieve).
- Provision of emotional support and identify additional needs.
- Obtaining medical records from referring physicians and past medical history.
- Attending tumor board and provide personal information on patients to help plan of care.
- Coordination of physician appointments and preparation of records.
- Recognition of and appropriate paperwork for patients who need genetic testing.
- Coordination of metastatic work-up (i.e. diagnostic work-up).
- Recognition of and appropriate paperwork for financial assistance needs.
- Communication with families and coordination of “out of town” issues.
- Arrangement of appointments with the “Comprehensive Postoperative Rehabilitation Program CPRP which includes:
- Physical rehabilitation (prospective lymphedema and shoulder ROM management certified therapists).
- Occupational rehabilitation (focus on return to work / recreation related quality of life issues certified therapists).
- Psychological rehabilitation (focus on coping skills licensed counselor)
- Measurement patient’s arms and ROM pre-op and also educate on lymphedema.
- Coordination of breast support groups
- Involvement in community events and advocacy for breast health.
- Availability by cell phone to all patients.