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Society establishes criteria, research goals for oncology nurse navigators
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The Oncology Nursing Society issued a position statement intended to clearly define the roles of oncology nurse navigators.
The position statement also outlines the qualifications needed for oncology nurse navigator (ONN) distinction.
“Oftentimes, navigation is not done by a nurse,” Colleen O'Leary, MSN, RN, AOCNS, associate director for nursing education and evidence-based practice at The Ohio State University Wexner Medical Center and Richard J. Solove Research Institute and a director-at-large on the Oncology Nursing Society’s board of directors, told HemOnc Today. “When it is done by a nurse, that person might not be an oncology nurse. We felt that it was very important to set some standards for qualifications and role requirements.”
The position statement recommends oncology nurse navigators possess certification through one of the National Commission for Certifying Agencies-accredited certifications offered by the Oncology Nursing Certification Corporation. At a minimum, they should hold Oncology Certified Nurse certification.
The Oncology Nursing Society also recommends ONNs:
The position statement further suggests that ONN services begin with prevention and screening activities and continue through diagnosis, treatment, survivorship and end-of-life care. It also indicates more research is needed to help characterize and compare ONN activities across clinical programs.
“The Oncology Nursing Society has always been very supportive of the nurse’s role in cancer care,” Beth Faiman, PhD, APRN-BC, AOCN, certified nurse practitioner at Cleveland Clinic and a HemOnc Today Editorial Board member, said in an interview. “Because cancer treatment is so complex, there are many different pieces to the puzzle, and ONNs are a very critical piece. The ONN is a unique role, because these nurses really focus on evidence-based, cost-effective care and help to navigate patients throughout treatment. Affixing a title with baseline competencies is very important.”
Advances in cancer care have contributed to a greater need for ONNs, Faiman said.
“In most cancers, patients are living longer than ever now, and more patients are becoming survivors,” Faiman told HemOnc Today. “When they go through periods of remission and relapse, the ONN can follow them through treatment. A patient might go through different physicians, different nurse practitioners, different social workers — but the ONN is there from the beginning to the end for the patient and for the caregivers.”
ONNs can serve a particular purpose when they specialize in the treatment and care of a specific patient population, O’Leary said.
“My area of focus had been head and neck cancers, and this is a perfect example of a group that has a lot of treatment needs,” O’Leary said. “These patients go from surgery to radiation and chemotherapy, and many of them require psychosocial care. More and more, I think we will see ONNs getting terrific outcomes in specific areas, and more people will want to have them as part of their treatment teams and get that level of care coordination.”
Faiman, who primarily works with patients who have multiple myeloma, agreed.
“My experience perfectly reflects the importance of the role of ONNs,” Faiman said. “My patients meet their ONN at diagnosis, and those ONNs help the patients make treatment appointments, refill prescriptions and assist with day-to-day needs. This really helps with patient adherence, because these patients have so many things going on, and primary care physicians do not always have time to focus on every aspect of the everyday patient experience.”
Little research has been conducted into the role of ONNs in cancer care. That type of research may serve to make ONNs a more standard conduit in the treatment of patients with cancer, O’Leary said.
“Now that organizations like the Oncology Nursing Society are working to standardize navigation roles, we are trying to figure out what works and what doesn’t work in order to make evidence-based decisions,” O’Leary said. “ONNs can guide this research. We can ask questions like, ‘What are the patient outcomes, and how are they related to the role of ONN?’ We can start collecting data on areas of treatment like length of hospital stay, patient satisfaction and trajectory of care time. When we start to collect these data, we will likely begin to see better patient outcomes.”
Faiman said certification requirements, additional research and increased visibility will lead to an expansion in the role of ONNs, which will improve cancer treatment across the board.
“The field of ONN is rapidly evolving,” Faiman said. “Registered nurses have been providing expert care for many years. Now, we have a title and a certification to demonstrate our level of knowledge. Adding an expert ONN to a treatment team can make a difference in the lives of patients and the lives of caregivers. I believe the presence of ONNs will only continue to grow in the cancer treatment arena.” – by Cameron Kelsall
Reference:
Oncology Nursing Society. Oncology nurse navigation role and qualifications. Available at: www.ons.org/advocacy-policy/positions/education/onn. Accessed on Aug. 12, 2015.
For more information:
Beth Faiman, PhD, APRN-BC, AOCN, can be reached at Cleveland Clinic Main Campus, Mail Code R33, 9500 Euclid Ave., Cleveland, OH 44195; email: faimanb@ccf.org.
Colleen O’Leary, MSN, RN, AOCNS, can be reached at The Ohio State University Wexner Medical Center, 410 West 10th Ave., Columbus, OH 43210; email: blestrn@aol.com.
Disclosure: O’Leary reports a leadership role with the Oncology Nursing Society. Faiman reports no relevant financial disclosures.
Perspective
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Janice M. Shipe-Spotloe, PA-C, MS
As I reviewed the oncology nurse navigator (ONN) paper, I reflected on the vast number of changes in patient management and available therapies that have evolved throughout my 28 years practicing in hematology/oncology as a physician assistant “advance practice professional” (APP) in a busy research-oriented academic setting. Many of the new hem/onc models have stemmed from quickly evolving data, which have driven a better understanding of pathophysiology, molecular profiling and staging, thus leading to the surge of emerging novel drugs based on these advancements.The development of the Oncology Nursing Society, and later description of an ONN, may have ultimately stemmed from a history of utilizing lay women, but the clinical and financial expertise required to guide patients through their journey requires the patient-centered expertise of ONN specialists on our team. This has never been more important because the focus of oncology care is now grounded in a patient-centered model based on outcome … as it should be.
It is not just the challenge to assist our patients with bloodwork, specialized medications and treatment support, but also to maintain complex schedules for therapy and diagnostic/surveillance/lab studies. Happily, our patients are living longer, but their survival often comes with the cost of long-term manifestations of toxicities leading to risks that impact their overall well-being. An ONN is the partner to ground us with our patients’ ongoing needs — based on the specifics of their past treatment, comorbid conditions and social considerations. So too is the increasing challenge to keep up with prior authorizations and financial support programs necessary to offset the out-of-pocket expenses of our patients. Much of the supportive data needed require nursing expertise only an ONN trained nurse would have.
Many practices have infusion centers with staff treating a huge variety of patients and treatments of many drug classes. We cannot expect the specific expertise we need from infusion nurses — their expertise is centered on the parameters, and safe acute infusion of drugs, not the longitudinal impact of them.
Along with advancements in hem/onc practices, the dissemination of ever-more complex information to the patient and ongoing teaching to maturate the necessary understanding for patients about their diagnosis, therapy, potential adverse events/toxicities of their therapy and follow-up requirements are best accommodated by an ONN in our practices. Much research has centered on the limited comprehension by patients of the information received at the time of an initial consult (often as little as 20%). Thus, the ongoing reinforcement of this information by the entire team is necessary. Fielding phone calls and supportive medication requests now utilizes ONN expertise, as well. For other clinical providers on our treating teams to function efficiently, to the top of our scopes, the expertise of our ONN colleagues remains paramount for our patients.
Validation with certification and ongoing core competency established by ONS for the ONN assures the oncologists, APPs and other clinical and supportive hem/onc team members that our patients’ needs are being met with excellence.
Perspective
Back to TopJoan B. Zampieri, MPAS, PA-C
The nurse navigator is an instrumental part of the oncologic care team. In an age of ever-increasing scrutiny and cost constraints, demonstrating competency of all staff is required to maintain a National Cancer Institute certification. The goal is to provide excellent care while preventing gaps in treatment. These tend to occur at time of diagnosis, end of active treatment/transition to survivorship or end of curative care/transition to palliative care. In more rural or community centers, lay people trained by oncology navigators may assist in supporting the patient through the process. Providing continuity of care has been shown to decrease patient anxiety, facilitate improved communication with the health care team and enhance adherence to the prescribed treatments.A nurse navigator has to be familiar and experienced in all aspects of cancer care. There are no current guidelines that address qualifications necessary for the role or any standardized national certification. The navigator is often the first professional to contact the newly diagnosed patient. A nurse navigator needs to have familiarity with the stages, treatments, clinical research, ethics and the legalities in order to assist patients in decision-making. Patients encounter work-related problems, family care, transportation, fertility preservation, and legal issues related to health care power of attorney and palliative care/hospice care. A navigator can assist the patient in connecting to the proper resources to assist them. They interact with various members of the multidisciplinary care team to assess needs and provide the patient the necessary supportive services.
With the cost of cancer care projected to reach at least $158 billion in 2020 (calculated in 2010 dollars), it is increasingly important to innovate methods to streamline care. The costs associated with various cancers related to incidence, survival and overall care are highest for breast cancer, followed by colorectal cancer, lymphoma, lung cancer and prostate cancer. With the use of targeted agents; improvements in screening, surgical and radiotherapy techniques; and better supportive care, the number of survivors is on the increase, as well. We continue to see the trend of higher mortality among non-Caucasian patients. It is critical to reduce the interval between diagnosis and treatment. A nurse navigator can be instrumental in referring the patient appropriately, expediting the screening process, and facilitating the transfer of records and imaging. As the patient leaves active treatment and transitions into survivorship, the navigator continues to be a resource to ensure that close follow-up is maintained. As patients achieve longer remissions, the incidence of relapse and/or secondary malignancies may become a problem. The reported rate of secondary malignancies may approach as much as 15% 20 years post-diagnosis. OS rates from cancer are approximately 66%. The continuity of care provided by a navigator can be beneficial to find these new malignancies while they are still treatable/curable.
References:
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Markossian TW, et al. Cancer Epidemiol Biomarkers Prev. 2012;doi:10.1158/1055-9965.EPI-12-0535.
McMullen L. Semin Oncol Nurs. 2013;doi:10.1016/j.soncn.2013.02.005.
NCI. SEER Cancer Statistics Review 1975-2012. Available at: seer.cancer.gov/csr/1975_2012/. Accessed Aug. 31, 2015.
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