The nurse navigator looking at me was exasperated after days of trying to find a specific resource for an uninsured patient. Worry covered her face. She sighed, "I'm just not sure what else to do. I've tried everything. I've reached a dead end."
Patient navigation officially began in the late 1970s with Dr. Harold Freeman focusing on breast cancer screening rates among African-American women in Harlem. As a past national president of the American Cancer Society and the founder of the NCI's Center to Reduce Cancer Health Disparities (two items on a very long list of amazing work), Dr. Freeman knows a thing or two about disparities in cancer care. His program greatly impacted women's health and was the catalyst for national change.
His patient navigation model utilizes trained lay navigators, community health workers, or promoters. Though they do not call themselves navigators, nurses have been working in similar roles for just as long. However, nurse navigation did not come into mainstream cancer care until the last decade.
Navigators get to know their patients well, and navigation was created as a workaround that closes gaps and finds resources so the patient receives timely care. What happens when navigation reaches its limit, and there is no workaround for the patient to receive the required care or resources? What a burden we are placing on these nurses! I've witnessed the strain and burden myself. May I be so bold to say navigation is not the ultimate answer for quality patient care. No, navigation is a tourniquet for our hemorrhaging healthcare system.
All of us, especially managers, leaders, and policy makers, have an obligation to fix the systems that navigators are working around. That will save time and energy for hundreds or thousands more people than the single person navigated. Navigators see these broken processes and systems daily. We must listen to them and change our care to stop the bleeding. Otherwise, I am afraid we are setting navigation up for failure.
How are your networks and systems leveraging the knowledge of navigators to bring about systematic changes?