I remember when I first started our oncology navigation program in 1998; there were no national standards or core competencies for navigation. The only model I was aware of that followed the patient through different levels of care was the case management model. The goals of the case management model were to coordinate the patient’s care at the appropriate setting while keeping costs down. We discussed the plan of care with the physician and also spoke with the patient and their family to discuss their specific needs and whether their care could be handled at home or whether they needed an alternative care setting or level of care.
Fast forward to 2016. Today navigation has support from the Institute of Medicine, the Commission on Cancer has added a navigation standard to its Cancer Program Standards, the Oncology Nursing Society (ONS) has developed oncology nurse navigator core competencies, and there is a joint position statement on the role of oncology nursing and oncology social work in patient navigation from ONS, the Association of Oncology Social Work (AOSW), and the National Association of Social Workers (NASW). (Note: The George Washington University Cancer Center has developed core competencies for non-clinical patient navigators.) Today, our navigation programs follow the patient across the care continuum from the earliest point of entry though survivorship or end-of-life services.
Despite the fact that we now have navigation standards and core competencies in place, I still hear from navigators, “I was hired and told, ‘Go navigate.’ I had no idea what that meant.”
So, how do we teach our new navigators? Typically nurses come to the navigator role from varied backgrounds—the inpatient oncology unit, chemotherapy infusion suite, radiation oncology, and home care, just to name a few.
As with any new job, a robust orientation is key; a full navigation curriculum including an orientation checklist and annual competencies is essential for a solid foundation. Here is one example of the elements a navigator orientation checklist might include:
Navigator Orientation Checklist
- Hospital-specific policies/procedures and mandatory educational programs
- Navigation history, definition, and models of navigation
- Benefits and goals of navigation
- Job description, roles and responsibilities of navigator, and support staff
- Commission on Cancer Standards and Cancer Committee responsibilities
- Institute of Medicine; Delivering High-Quality Cancer Care
- NCCN, ASCO, and other national guidelines
- Referrals to the navigation program
- Internal resources, roles and responsibilities:
–Palliative Care team
- Community resources, list_____________________________________________
- Patient educational materials, i.e., disease–site-specific information, clinical trials, patient journal, etc.
- Caregiver toolkit and resources
- Assessment tools, documentation and reporting
- Communication and managing transitions with the patient, family and/or caregiver
- Communication among the healthcare team, internal and external resources
- Patient experience survey process
- Performance improvement models and initiatives:
- Support groups and educational programs
- Tumor conference responsibilities
- Multidisciplinary participation and responsibilities
- Professional organizations and certification
–AONN, Academy of Oncology Nurse Navigators
–Association of Oncology Social Work
- Other, list ______________________________________________________________
This orientation checklist is just a foundation for your new oncology navigator; adjust to your specific needs and navigation model. Remember: a good orientation is key for your new navigator’s success.
By Tricia Strusowski, MS, RN
Guest blogger ACCC member Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.