Sure, I Can Do That...

When navigation as a concept in cancer care began, it began through the efforts of a physician, Harold P. Freeman, who realized that African-American women in underserved areas were more likely to present with late-stage breast cancer. He believed that training laypeople within their own communities to provide education and improve access to care would help achieve earlier diagnosis and better outcomes, and he was right.

These days the concept of navigation has grown, and in many cancer centers, nurse navigators are a staple of quality cancer care. These nurses have varied roles depending on the needs of their patient population. Sometimes they help with financial concerns, scheduling appointments, finding physicians, transportation, education, or emotional support.

The role of nurse navigators will continue to evolve as the healthcare climate changes. It is a role that has been and should be dictated by patient needs.

As a nurse navigator, I find my job description is a vague one. It is not the kind of job that has a rigid schedule or fits into a clearly defined box. This is what keeps my job interesting, but it is also what makes it frustrating. The lack of a clearly defined role means navigation can easily drift into a catch-all -- an organization fixer rather than a patient-focused position. It is all too easy to make "The navigator can do that" the Band-Aid solution to any problem that crops up. This doesn't fix bigger institutional problems, but it does absorb the navigator's time and prevent her from fulfilling her role.

A navigator is by definition flexible -- a helper. That means nurses whose bedside duties are clearly defined can easily come to see a navigator as nothing more than the person they call when they have things they don't have time to do. And the navigator, ingrained to be a helper, says, "Sure, I can do that." Before you know it, the navigator is so absorbed in fixing things that she loses her own patient focus. Navigators can be helpful to a fault.

Navigators can make an enormous difference in patient compliance with care, access to care, and coping with cancer's physical and emotional effects. However, they can do that only if they are not becoming slowly and progressively absorbed into everything else. Navigators can and should help their institution provide better cancer care, but they should find ways to do so while achieving their primary goal of helping patients.

I have read that many institutions struggle with this problem. Some institutions identify what the navigator will do before they ever hire one. One institution has the navigators themselves rewrite their job description each year to meet the ever-changing needs of cancer patients.

Does your institution use cancer nurse navigators? If so, what is the navigator role, and is it subject to job creep?