Navigator, defined

Patients receive help through medical mazes.

by Sally McMahon and Melanie Wolkoff Wachsman

Look in the dictionary and “navigator” is defined broadly as a person who navigates a ship or aircraft, or as a person who explores by sea. However, when viewed through a healthcare lens, the definition becomes more specific.

Patient navigators, in various forms, help patients and their families navigate the healthcare system. Patient navigation is gaining attention as an emerging profession, as many local hospitals are now providing nurse navigators as a resource for patients.

The names for this work may vary (patient advocate, navigator, healthcare advocate or consultant, medical advocate), but the basic idea is the same: to help healthcare consumers navigate the healthcare maze. Navigators may be nurses, social workers or other staff members. Often, they have access to patient medical records, physicians and even insurers. Navigator programs typically are no cost to the patient.

No Two Programs Alike
Navigator programs come in all shapes and sizes, and may range to helping patients coordinate transportation to following up on prescriptions. Whenever a hospital sees a need for enhancing the patient experience, a navigator program can be born.

Recently, Baptist Health Paducah introduced oncology-certified nurse Terri Walters, RN, as a breast nurse navigator. Walters has worked 18 of her 30 years at Baptist Health in the oncology department. In her new role she works with the medical team to guide the patient when plans for care and treatment are developed and initiated.

Walter’s goals are to help patients understand their diagnosis and available treatment options, while also providing a compassionate and supportive listening ear to the patients and their family. She’s available to discuss questions or symptoms that may arrive over the course of treatment and recovery and serves as a community resource for families over the course of treatment and recovery.

Jewish Hospital & St. Mary’s Healthcare, a part of KentuckyOne Health, has a community care navigator–intransition
program, which sends navigators to visit patients prior to discharge. These navigators follow-up with weekly phone calls and visits to patients with the hopes of reducing 30-day patient re-admissions.

Jewish Hospital also employs pharmacy navigators as part of the Pharmacy Plus program. Once patients receive their prescribed medications, pharmacy navigators serve as health coaches. They regularly check-in with patients to be sure all medications are being taken correctly and that there is no break in the patient’s medication therapy.

For example, for transplant patients a pharmacy navigator works with transplant coordinators to educate patients on the
medications that they will be prescribed, how they plan to get their medications, what insurance coverage they have and what out-of-pocket costs they may incur and how they will manage their medications. Following transplantation, the pharmacy navigator continues to follow up with the patient periodically to be sure all medications are being taken as prescribed.

KentuckyOne Health Inc. has a cancer prevention and navigation services team, composed of nurse navigators. Breast
cancer navigators help patients develop a treatment plan. This may include scheduling conferences for patients with
oncologists and surgeons to connecting patients to patient-support groups.

Helping People Stay Healthy
Louisville-based Norton Healthcare Centers for Prevention and Wellness has a senior bilingual lay health navigator. A primary function of this navigator is organizing health fairs around the metro Louisville area, as well as serving as an advocate for those who have limited proficiency with the English language.

Further, Norton Healthcare Centers for Prevention & Wellness senior lay health navigators coordinate all of Norton Healthcare’s screening, prevention and wellness services with the goal of helping people get healthy and stay healthy.

According to senior lay health navigator Jenita Lyons, her work day isanything but typical.

“Because we work out of the office so much and interact with community partners to schedule and host health screenings, there really is no typical day. Every day is unique, which is what I love about this job,” she said. “On a day when we are offering preventative cancer screenings [mammograms and pap smears] on our mobile unit at a community site, I am at the host site where I help patients register and educate them on the cancer screening process and answer any questions they may have. If a patient identifies as not having a primary care doctor, I make sure to link them with resources.”

Another part of Lyons’ job responsibility is assessing community needs and allocating resources to provide health screenings in underserved areas. “In 2012 we screened 2,537 individuals and approximately 50 percent of our screenings were in underserved areas of town,” she said.

The ultimate goal of her position, Lyons explained, is connecting people to wellness. “Lay health navigation helps to bridge the gap of being able to access healthcare services and overcoming barriers like transportation and cost.

“Our goal is to connect people to wellness – we do this by increasing awareness, advocacy, promotion of healthy lifestyles, provision and support of evidence based screenings and programs,” she continued.

And it’s working. The facts show the success of prevention and early detection of cancer (and other chronic diseases) helps save lives.

“Since the beginning of our mobile prevention center in 2007, we have identified 82 cancers, which may not have been detected were it not for our services. All patients are navigated to follow-up care,” Lyons said.

Providing Emotional Support, Education
Floyd Memorial Hospital in New Albany, Ind., has several types of navigators—for staff and patients. The associate nurse navigator provides personalized plans of information, education and resources to help employees and family members manage their health and wellness.

While the breast cancer nurse navigator at Floyd Memorial meets patients at the time of diagnosis with the surgeon to provide emotional support and education.

Due to an increased number of joint replacements and spine surgeries, Floyd created the orthopedic and spine nurse navigator to help streamline the process and allow patients to have one contact person.

Laura Crump, RN, an orthopedic and spine nurse navigator meets with patients prior to surgery and presents educational classes. “I visit patients daily after surgery and follow up after discharge to see how a patient is progressing through recovery,” she said. She also works closely with physical therapist and assists with discharge planning.

Crump has worked on the surgical inpatient unit for 14 years. She holds a bachelor of science in nursing and is currently studying to obtain her certification in orthopedic nursing, which is not a specific requirement to become a navigator.

“I truly feel I am helping people,” Crump said. “I get a lot of feedback from patients that it is a great comfort to see a familiar face after their procedure, and I can encourage them along through their recovery.

Bottom-line: nurse navigators advocate for the patient. Be it through helping patients overcoming their fears to understanding their diagnosis and treatment options, navigators offer a wealth of resources and support.

“They see so many different faces while they are here, that it is comforting for them to see a familiar face,” she continued.
“Patients have surgery because their health issue is keeping them from living their lives. We discuss goals for patients.

“I love to hear when people meet their goal, whether it is playing with grandchildren, walking around, even doing their own shopping, these are big accomplishments for patients.”

From beginning, middle, end and beyond navigators guide patients through the complicated healthcare system.