Having the right resources and support network in place can mean the difference between a patient’s cancer treatment out-comes being optimal or subpar. Oncology nurse navigation is widely used in the United States to direct the treatment of cancer patients and increase the probability of adherence to the prescribed regimen (Gentry, 2021). The benefits of navigation in avoiding treatment delays, improving patient adherence to treatment, enabling early diagnosis and early stage of the disease, and enhancing clinical outcomes after cancer diagnosis have been documented and proven beneficial in the literature (Rodrigues et al., 2021).
Oncology Nurse Navigators (ONN) communicate across specialty lines and act as patient advocates and educators, educating patients and their families while providing guidance through the care journey (Peckham & Mott-Coles, 2018). Nurse navigators make early connections with cancer patients, enabling them to be trusted sources of support and advice. Their ongoing presence helps move patients quickly through the healthcare continuum and ensures guidelines are followed (Gentry, 2021). Nurse navigation is based on a relationship of trust between the patient, their family, and the nurse and involves the identification of obstacles hindering care. Nurse navigation aims to provide a patient-centered process (i.e., addressing patient concerns, wishes, comorbidities, social and financial constraints) to overcome obstacles and move the patient through the healthcare continuum (Peckham & Mott-Coles, 2018).
Dr. Harold Freeman established the first patient navigation program in New York in 1990. The main objective of the program was to eliminate barriers to patient care throughout the entire health continuum process, which included early detection, prevention, diagnosis, treatment, and end-of-life care. Factors such as socioeconomic status, culture, psychology, communication, and bureaucracy were also taken into account (Freeman & Rodrigues, 2011). Results demonstrated that once the program was implemented, patients with a diagnosis of breast cancer had a greater survival rate because of advancements in education and accessibility to vital community resources facilitated by the navigators. The development of navigation programs, which use nurse navigators more frequently in oncology settings, was sparked by this initiative.
Keeping in mind this historical context, many healthcare facilities modified and implemented patient support programs, particularly in the oncology sectors, where nurse navigators functioned as the primary bridge to support and assist patients in navigating the challenges experienced within the healthcare system setting (Rowett & Christensen, 2020). To help patients overcome any barriers to accessing high-quality care, navigators must ascertain each patient’s specific needs and collaborate with the patient and various multidisciplinary providers to develop a plan of care (Gentry, 2021).
Communication between professionals and administrators is necessary for the implementation of navigation programs. Community and institutional needs assessments can assist in identifying the navigation program that best suits the patient population, given the specific nature of each healthcare setting. Healthcare professionals or those with little to no professional healthcare expertise can serve as navigators. However, the patient’s and the organization’s needs should guide that decision (Rodrigues et al., 2021). Furthermore, it is imperative to assess if navigators deliver care that aligns with their educational background and experience level (Lubejko et al., 2019). Nurse navigators, social workers, and lay navigators are examples of navigators.
The Doctor of Nursing Practice (DNP) registered nurse operating in the ONN role possesses advanced knowledge and skills to identify and address a wide range of physical and psychosocial issues that patients encounter throughout the cancer care continuum. DNP-prepared nurses function as nurses with clinical expertise, communication skills, and knowledge of healthcare systems, which allows for identifying gaps in practice outcomes that will reveal a need for practice change or implementation. Nurses with a DNP are well-positioned to apply evidence-based research to clinical practice, participate in clinical innovation to advance practice scholarship, and enhance the quality of healthcare outcomes (Kesten et al., 2022).
Nurses who are DNP-prepared have the skills and knowledge to impact health systems and deliver care that results in safe, effective practice through practice scholarship, translating science to change health care delivery and clinical research to improve practice (Kersten et al., 2022). Today’s health systems are highly complex and are constantly challenged to provide quality care that results in improved health outcomes, especially within the specialty of oncology, which faces many barriers and challenges to ensure optimal patient care. The contribution and expertise the DNP-prepared ONN brings to the organization cannot be minimized.
The Oncology Nursing Society’s ONN Core Competencies outline the essential knowledge and abilities that a professional nurse must possess to fulfill the function of an ONN (Baileys et al., 2018). The core competencies focus on four functional area categories of practice: coordination of expert oncological care, communication, education, and professional role (ONS, 2018). Each of these tenets is embedded and aligned with the educational foundation of DNP nurses, which makes them perfectly suited to provide the necessary advocacy, support, and effective communication required to ensure patients receive true holistic care.
Individuals diagnosed with any form of cancer or patients in specialized programs like palliative care or survival may all be managed by ONNs. Based on the requirements of a particular program or system, each ONN may operate differently. However, the basis of each program is to facilitate the removal of barriers to care (Temucin & Nahcivan, 2018). The development of training and educational models for navigation has to be grounded in core competencies, with the aim of augmenting role comprehension and guaranteeing the fulfillment of crucial patient objectives, which can lead to improved clinical outcomes. Furthermore, it is critical to ensure that the ONN possesses the expertise in oncology nursing needed to address the needs of this population (McMullen et al., 2018).
Having DNP-prepared ONNs in place can greatly improve cancer treatment outcomes by providing support, evidence-based education, and guidance to patients and their families. These navigators help patients overcome barriers to care and ensure adherence to treatment guidelines, ultimately enhancing clinical outcomes. The role of Nurse Navigators is based on trust and patient-centered care, and their presence throughout the healthcare continuum is crucial for optimal patient outcomes. Additionally, the development of navigation programs, inspired by Dr. Harold Freeman’s initiative, has led to the implementation of patient support programs in oncology settings, with nurse navigators playing a key role.
DNP-prepared nurses are seen as implementation specialists who possess the knowledge and skills to serve as change agents to improve the quality of care received by their patients and their families (Baileys et al., 2018). The core competencies outlined by the Oncology Nursing Society provide a frame-work for the necessary knowledge and abilities of an ONN, and training and educational models should be based on these competencies to ensure the fulfillment of patient objectives and improved clinical outcomes. The DNP-prepared nurse, with their advanced knowledge and skills, is well-suited to fulfill the role of an Oncology Nurse Navigator and contribute to improving healthcare outcomes.
References
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Kesten, K., Moran, K., Beebe, S. L., Conrad, D., Burson, R., Corrigan, C., Manderscheid, A., & Pohl, E. (2022). Practice scholarship satisfaction and impact as perceived by DNP-prepared nurses. Journal of the American Association of Nurse Practitioners, 34(5), 722–730. https://doi.org/10.1097/JXX.0000000000000707
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McMullen, L., Banman, T., DeGroot, J. M., Scott, S., Srdanovic, D., & Mackey, H. (2016). Providing novice navigators with a GPS for role development: Oncology Nurse Navigator competency project. Clinical Journal of Oncology Nursing, 20(1), 33–38.
Oncology Nursing Society. (2018). Role of the oncology nurse navigator throughout the cancer trajectory. Retrieved from https://www.ons.org/make-difference/advocacy-and-policy/ position-statements/ONN
Peckham, J., & Mott-Coles, S. (2018). Interprofessional lung cancer tumor board: The role of the Oncology Nurse Navigator in improving adherence to national guidelines and streamlining patient care. Clinical Journal of Oncology Nursing, 22(6). https://doi.org/10.1188/18.cjon.656-662
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