Expert Commentary From Sean T. Walsh — Administrative Director, Academy of Oncology Nurse Navigators, and Christine Evans, RN, BS — President, National Coalition of Oncology Nurse Navigators

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Expert Commentary From Sean T. Walsh — Administrative Director, Academy of Oncology Nurse Navigators, and Christine Evans, RN, BS — President, National Coalition of Oncology Nurse Navigators
12/01/2009

Patient Navigation Associations: Uniting Navigators and Sharing Knowledge

Patient navigation is becoming an important part of cancer care as demonstrated by two newly formed professional associations. These associations provide support and address issues that navigators face, promote knowledge/resource sharing, and increase overall awareness of patient navigation. We recently had the opportunity to speak with leaders from two different oncology nurse navigation associations: Sean T. Walsh, Academy of Oncology Nurse Navigators (AONN) Administrative Director, and Christine Evans, RN, BS, National Coalition of Oncology Nurse Navigators (NCONN) President. Here, they profile their associations—how and why they began, their objectives, successes, and plans for the future. Click here to read about the interview with Sean T. Walsh of AONN. Click here to read about the interview with Christine Evans of NCONN.

Interview With Sean T. Walsh, AONN Administrative Director

How Did the Association Begin?

AONN was launched May 2009 at the Oncology Nursing Society (ONS) Congress by several nurse navigators who were looking for a forum to have their voice heard on a national level. AONN is a national specialty organization dedicated to improving patient care and quality of life by providing cancer patients with greater access to nurse navigators. We believe that nurse navigation is a crucial role and it is a growing profession that has the potential to help a large number of patients.

What Is the Mission?

AONN’s mission is to provide a network to help health care professionals better manage the complexities of the cancer care continuum. Our goals are to validate the role and value of oncology nurse navigators, increase patient access to nurse navigation programs, advance the profession through research, enhance the knowledge of nurse navigators, and establish partnerships and strategic alliances to grow the organization to a national level.

What Services and Resources Are Provided?

AONN provides its members with access to blogs, social networking, and continuing education. Discussion forums are available to discuss common issues and concerns.

In addition, we have partnered with the National Consortium of Breast Centers (NCBC) to promote its breast patient navigation certification program, the first navigation-specific certification that validates the skills of our members. Further, partnerships between AONN and such journals as The Oncology Nurse® and the Journal of Multidisciplinary Cancer Care® have advanced awareness about AONN and the role of patient navigators.

What Needs Are Being Addressed?

Being able to validate the value of patient navigation to senior-level administration within a cancer center is a critical need. When the economy contracts, some navigators become concerned about job security, and that should not be an issue. AONN provides information and networking support so that navigators can better measure and report outcomes.

Can You Describe an Early Success?

An early success was the development of our partnership with the NCBC to help promote its breast patient navigation certification program. The first official certification examination will be held at the NCBC national conference in March 2010; however, in 2009 some beta exams were administered in order to help improve the program and examination. This certification helps to validate the skill level of the breast cancer patient navigator.

What Does Your Membership Look Like?

AONN functions through a leadership council of nurse navigation experts1 and has 1,500 members who represent a variety of professions, including nurses, social workers, lay navigators, administrators, and physicians. Our members are in a mix of community and academic settings throughout the United States, and are located in urban, suburban, and rural areas. In addition, some manage only one tumor type, while others are multi-site.

What Do You See as Unmet Needs for Patient Navigators?

Patient navigators have several key needs including validating the benefit of patient navigation programs to administrators through rigorous outcomes reporting; defining the role and responsibilities of the patient navigator; addressing reimbursement issues and, in most cases, navigation not being a reimbursable expense; and understanding the optimal patient-to-navigator ratio and research.

Because administration requirements for outcomes reporting are vastly different among centers, AONN believes that it would be of great benefit to provide guidelines to help structure outcomes reporting. This may yield a greater understanding of the value of patient navigation programs.

What Future and Long-Term Trends Do You Foresee in the Patient Navigation Movement?

We hope to increase the involvement of other health care professionals, including physicians, in the navigation process. Navigators are emerging as critical to survivorship care—they are going to track the patients from diagnosis to the end of treatment and help transfer them back to the primary care setting. This will provide an added value to navigation and it will help implement and maintain navigation programs.

What Does the Future Look Like for AONN?

In September 2010, AONN held its first annual Navigation and Survivorship Conference to raise awareness of the value of navigation and strategies for implementing and maintaining navigation/survivorship programs.

Another future goal for the association is to include patient outreach. Providing information directly to patients via brochures and online directories is a crucial way to broaden access to navigation services and help to support the movement.

AONN hopes to continue to increase its membership and activities, focusing on education, legal issues, outcomes, guidelines, and certification. AONN also expects to provide certification programs for other tumor types in addition to breast cancer in the near future.

Interview With Christine Evans, RN, BS, NCONN President

How Did the Association Begin?

For about five years, oncology nurse navigators in the Washington, DC/Maryland area had been meeting quarterly to share resources, discuss issues, and share best practices. The success of this ad hoc networking group led five members2 to come together to develop a national nonprofit organization dedicated to promoting excellence in oncology patient care by fostering collaborative relationships and professional development among oncology nurse navigators and other health care disciplines.

What Is the Mission?

NCONN’s mission is to promote excellence in oncology patient care by fostering collaborative relationships and professional development among oncology nurse navigators and all health care disciplines locally, regionally, and nationally.

Our vision is to be the national leader in establishing standards that define the oncology nurse navigator role by advocating for the oncology nurse navigator within the community and professional arenas.

What Services and Resources Are Provided?

NCONN provides its members with an interactive Web site that includes a members-only list serve, discussion forum, membership directory, resources page, and newsletter. Members also can access the newly published basic core competencies that define the skill, knowledge, and expertise that a nurse should be bringing to the role of oncology nurse navigator.

NCONN provides networking dinners and other opportunities around the country to bring navigators face-to-face to facilitate information and resource sharing. The First Annual NCONN Conference, held in October 2009, was dedicated to the education and networking of navigators. Attendees included lay as well as nurse navigators, administrators, doctors, and social workers.

What Needs Are Being Addressed?

NCONN is driving an effort to develop standards of practice, competencies, job descriptions, and practice models that can be applicable to various settings.

Hospitals, clinics, and cancer centers in some cases are hiring nurses as navigators without having clear job descriptions or role definitions. New nurse navigators are looking for resources to help them craft their job descriptions, organize their activities, implement tracking mechanisms, and coordinate a multidisciplinary team in the framework of navigation to provide the patient with the appropriate services, resources, education, and advocacy.

Can You Describe an Early Success?

An early success was the development of the basic core competencies created with feedback from NCONN members. Having these core competencies available to serve as a framework for navigators as they are being hired is a powerful step in the direction of adding definition and structure around the role of nurse navigator. The inaugural conference was very successful as it was the first time that an educational conference was dedicated solely to the evolving role of the navigator. The keynote speaker was Harold P. Freeman, MD.

What Does Your Membership Look Like?

Our membership is comprised of nurses, administrators, social workers, and physicians. NCONN does not yet have any lay navigators as members, but is open to anyone who is interested in oncology patient navigation. In the future, NCONN hopes to include lay navigators and others in the health care profession who care for oncology patients. The oncology patient needs a team approach to navigation.

What Do You See as Unmet Needs for Patient Navigators?

In addition to establishing the definition and job description of nurse navigator, NCONN believes that navigation needs to be considered as a reimbursable service. Further, navigators need to be educated on making appropriate referrals, building relationships, and developing the multidisciplinary care team. They also need tools, materials, and support mechanisms.

Long-term needs include the development of certification for patient navigation and bringing a recognition to and acceptance of the oncology nurse navigator as a new discipline and a critical member of the cancer care team.

What Future and Long-Term Trends Do You Foresee in the Patient Navigation Movement?

NCONN sees patient navigation becoming a critical part of cancer care. The Cancer Program Standards 2011 Project of the American College of Surgeons Commission on Cancer (CoC) has proposed including patient navigation in the CoC accreditation standards.3 The association leaders hope that both health care professionals and the general public will expect and require that there will be a nurse navigator for every cancer patient.

The cancer patient and the general public also need to be aware of the value that patient navigation brings; this value may include earlier diagnosis, improvement of outcomes, and cost-saving benefits.

What Does the Future Look Like for NCONN?

In the immediate future, NCONN hopes to see one professional title, “oncology nurse navigator.” The association also plans to continue to expand the network of oncology nurse navigators across the nation and globally.

The future of NCONN will be in working toward developing standards of practice, disease-specific competencies, and certification for oncology nurse navigators, and in continuing to network and establish synergies with other professionals and organizations to bring oncology nurse navigator and patient navigation concepts into the mainstream of cancer care.

References/Footnotes:

1 Members include Susan M. Gardner, RN, CBEC, CBCN; Sharon Gentry, RN, MSN, AOCN, CBCN; Carol Lewis, RN, BSN, OCN, CRNI; Pamela Matten, RN, BSN, OCN; Lillie Shockney, RN, BS, MAS; and Jay R. Swanson, RN, BSN, OCN.

2 Current Board of Directors and founding members include Minna Manalo Bacarra, MSN, CRNP; Deborah Cook, RN, BS; Christine M. Evans, RN, BS; Sharon L. Francz, LPN; Rebecca Saron Trupp, RN, OCN.

3 American College of Surgeons Commission on Cancer. Cancer Program Standards 2011 Project. 2009. At¨ http://www.facs.org/cancer/schedules/greene.pdf/. Accessed December 9. 2009.