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A trusted guide through cancer treatment: the nurse navigator


Cancer patients can feel overwhelmed as they face not just their disease, but a bewildering array of appointments, treatments and insurance forms.

Many are looking for one person who can explain the next procedure, remind them of an appointment and help them deal with an insurance company.

That person is the nurse navigator.

One of the Upstate Cancer Center‘s nurse navigators, Holly Briere of Baldwinsville, explains the role as “the central point of contact for the patient. We‘re the person they can come to if they have any questions or concerns. We kind of put it all together for the patient.”

Briere works with liver, gallbladder and pancreas patients. The center also has nurse navigators devoted to other cancer teams: thoracic/lung, bone marrow transplant and head and neck, plus plans to fill a vacant breast cancer and survivorship position soon.

“We‘re kind of the face of the program we represent, that person the patient can always come to and rely on us and know that we are making sure that things are getting done on their behalf,” Briere says.

“Navigation brings together all the best parts of nursing. It‘s that personal interaction, but it‘s also quality, making sure that our program is as efficient as it can be.”

The need to improve access and guide patients through the complexities of the medical system became apparent to a surgical oncologist in Harlem by the late 1980s. Harold Freeman, MD, founded a navigation program in 1990 that evolved into the nonprofit Harold P. Freeman Patient Navigation Institute. Other groups have also formed to support the concept of navigation.

Navigator roles are still evolving and take different forms depending on the institution and the diseases involved, but “their primary role is to identify and remove barriers to care,” says Rose Valentino, the nursing director at the Upstate Cancer Center. This might involve problems with transportation, family or insurance, for example, and the navigator keeps busy behind the scenes -- monitoring patients as they move from, say, surgery to radiation treatments.

"In addition to smoothing the patient's experience, navigators have been shown to improve outcomes and efficiency for health care providers," Valentino adds.

Experience counts in a job like this. Briere, for example, draws on her 17 years as an oncology nurse to help educate and support her patients.

One of those patients, Mark Vamvakias, 50, of North Syracuse, refers to Briere as a godsend.

“I cannot stress enough the help and assistance that Holly provides to me and my family as we cope with my condition and all the endless paperwork and scheduling demands required to monitor, treat and recover from my condition,” says Vamvakias, who met Briere a month before his April 2015 surgery for neuroendocrine tumors. He has kept in touch during subsequent chemotherapy.

“Holly is only a phone call away to answer any question we have, no matter how insignificant we may think it is, or to just talk and give us some sense of reassurance. … To be honest, I really don't think we could have done any of this without her.”

What is a nurse navigator?

“Patient navigator” is the general term for people who work to identify and overcome barriers to patients‘ medical treatment and move them through the health care system efficiently.

Some institutions use lay people as navigators, particularly for nonmedical issues, such as scheduling or transportation.

The Upstate Cancer Center requires its navigators to be registered nurses, so they are not just patient navigators but “nurse navigators.” The center also recommends at least three years of nursing experience, at least a bachelor‘s degree in nursing or a related field and oncology or case management experience.

Currently, no state or national certification is required for nurse navigators, but efforts are underway to develop certification through the Academy of Oncology Nurse and Patient Navigators, says Rose Valentino, the nursing director at the Upstate Cancer Center.

spring 16 cancer magThis article appears in the spring 2016 issue of Cancer Care magazine