Patient navigators offer unparalleled support that can improve patient experience & outcomes
It’s a story many people know all too well: A patient is diagnosed with a complex disease. He has myriad scans, treatments and follow-up appointments to schedule, he’s not sure how his health insurance coverage factors in, and he doesn’t fully understand the details of the diagnosis or the implications of the prognosis. It can feel like the doctors are speaking a foreign language—and it can be scary.
To help patients untangle the intricate web of a complicated health issue, healthcare facilities are employing patient navigators—nurses and healthcare professionals who accompany patients through their care journey to offer support and guidance. This resource can completely change the experience of the patient, says Christopher Ott, M.D., FACEP, Chief Medical Officer with HCA Healthcare’s Physician Services Group in Nashville, Tennessee.
“The basic tenet of patient navigation is: Healthcare with a known diagnosis that needs follow-up or treatment is hard to navigate yourself,” Dr. Ott says. “What navigation does is take out all of the unknowns, giving the patient assurance that they’ve been going through things in a timely manner and have taken all the appropriate steps to have the optimal outcome for their given diagnosis.”
Navigators work in multiple complex services lines and commonly assist patients in oncology, cardiovascular, spine, geriatric and perinatal care. In addition to easing the burden for patients and family caregivers, navigators can also help influence patient outcomes, especially in at-risk communities, says Crystal Dugger, MBA, RN, former Vice President of Clinical Services at HealthTrust.
“As value-based care models continue to grow, having patient navigators is one of the most effective ways to truly ensure patients are getting the right care at the right time and at the right place,” Dugger explains.
Patient navigators—also commonly referred to as nurse navigators—are often registered nurses. Their role has become so valuable, due in part to the complexities of our medical systems. Patients need help figuring out their course of action. “I would challenge even those who are medically literate to navigate the system on their own and not have something fall through the cracks,” Dr. Ott says.
For many patients, care is no longer limited to just one building or one provider. For example, Dugger describes a typical experience for cancer patients: They might be diagnosed in a hospital’s imaging center, have their surgery at the hospital’s ambulatory center, go back to the surgeon’s office for follow-up, see a medical oncologist for chemotherapy and then go to yet another facility for radiation.
Patient navigators help people maneuver this complex process. In addition to the logistics of managing various locations, navigators ensure all physicians and caregivers are aligned in a united care path.
“A nurse navigator can come in at the brink of a complicated diagnosis and pull the physicians together to lay out a coordinated path,” Dugger explains. “The navigator is the glue that holds all of the program components together while building trust with the patient.”
Breaking down barriers
Patients with difficult diagnoses often feel like they need a Ph.D. in a healthcare-related field to make sense of everything. “They suddenly need to be very educated about a condition they know nothing about,” Dugger says. “The patient has to be informed to make key decisions about their treatment, yet they are not physicians, so they are in a very vulnerable state.”
Patient navigators often break things down into understandable terms so a patient can make the best decisions about their care. In addition, their credentials mean they’re qualified to give valuable medical advice—a service that can save patients from wasting time in the ER, or more important, losing time when they should be seen by a doctor.
“Patients often state they worry about calling their doctors to bother them, but they feel very comfortable reaching out to their nurse navigator to say, ‘Hey, is this serious or is this just something where I need to take it easy today?’ ” Dugger adds.
Navigators can also help patients gain access to important resources. For example, they can help remove financial barriers by connecting patients with financial assistance or remove language barriers by providing access to translation services.
“The navigator’s job is to help that patient walk empowered through the care continuum,” says Dugger.
Caring for the whole patient
“Not only do patients have to figure out our entire healthcare system, but they also have to deal with the fact that they are often scared and completely vulnerable to that system,” says Dugger.
Dr. Ott points out that the most meaningful way navigators help is by reducing that anxiety and fear.
“Navigators are there to help patients through a lot of the unknowns during these difficult times in their lives,” he adds. “They make the unknown known.”
Supporting patients and their families emotionally is rewarding for both the patient and the caregiver. Dugger, who was one of the first nurse navigators in Tennessee in 1999, says she has loved all of her roles helping patients, but working as a navigator has been one of the most fulfilling. “I know navigators who are still close to family members of patients who have passed away,” Dugger says. “To see someone care for your family member that way is just unbelievably impactful.”
Determining the need for navigators
For administrators who are asking, “Do we need to hire a navigator?” Dr. Ott suggests they look at their own business—the complexity of it as well as the complexity of their patients’ conditions. While a small community hospital may not have the need for a navigator on staff, a larger facility could use several.
Dr. Ott and Dugger have no doubt about the potential value navigators add—not only to patients and their families but also to healthcare settings themselves.
“At first, it can be really difficult for hospitals to understand the value patient navigators are bringing,” Dugger notes. “But it’s easy to demonstrate value when standardized processes with accountability metrics are implemented. When a navigator is in place, pathway adherence and loyalty increase substantially, and that’s proven by metrics.”
Patient navigator FAQ
Q: Are patient navigators new to healthcare?
A: Navigators are still a fairly new job in the U.S., but they’re becoming more common each year. “While nursing is a career that predates the 19th century, patient navigation is one of the newer roles in the nursing world,” Dugger says.
Q: Is there a specific certification for patient navigators?
A: Training for patient navigators isn’t standardized, meaning most hospitals create their own training programs. However, there are some certification programs available. For example, the Academy of Oncology Nurse and Patient Navigators (AONN+) offers certification programs for cancer navigators. These certifications are making significant headway in standardizing the role and value metrics for a patient navigator.
Q: How many patients does a navigator typically work with?
A: It depends on the complexity of the patient’s diagnosis. For a condition that requires a lot of education (like certain perinatal and cancer diagnoses), a navigator may have 200 to 250 patients per year, Dugger notes. For something less complex, virtual programs are valuable, and these navigators could have anywhere from 500 to 1,000 patients a year.
To learn more about setting up a patient navigation program, contact HealthTrust’s Clinical Services AVP Kimberly Wright, RN.Share Email Patient Experience, Q1 2020