Navigation 101

Oncology nurse navigation is a supportive service offered to cancer patients and their families. There are specific skills and knowledge new navigators and program leaders need to be aware of to develop, grow, and sustain a navigation program. After conducting a role delineation study, the Oncology Nursing Society (ONS) developed the Oncology Nurse Navigator Competencies in 2013. The core competencies were updated in 2017 to include both novice and expert categories of knowledge, skills, and tasks needed to successfully fill the role of the oncology nurse navigator (ONN). The competencies are divided into 4 main categories: coordination of care, communication, education, and professional role.

Coordinated care provides timely access to oncology care by addressing patient barriers and providing interventions. ONNs develop a keen awareness of the types of physical, emotional, and psychosocial barriers that patients may face (ie, financial concerns, lack of caregiver support, transportation needs) and work within their healthcare system as well as with local and national organizations to overcome such barriers. Effective communication skills aid ONNs in their ability to educate patients and families regarding the disease process and next steps. ONNs skilled in communication techniques can educate patients and families by translating medical knowledge into content patients can use to improve their understanding of their disease, manage side effects, and empower them to advocate for what they need throughout their cancer journey. Finally, professional role development can assist the ONN in moving through the stages from novice to expert.

In addition to identifying the entry points into navigation (ie, at diagnosis, tumor boards, referral to oncology), determining key touch points where the ONN proactively reaches out to the patient is paramount. Touch points help structure and define the ONN role. It is important for the roles of other clinical staff such as clinic nurses, medical assistants, and advanced practice providers (APPs) to be clearly defined thereby reducing duplicate work being done on behalf of the patient.

The knowledge, skills, and tasks common to ONNs can enhance any of the various models of navigation. Institutions choose models that can best fit the needs of their patient population and available resources. Examples of navigation models include the professional model where the navigator is a bachelor- or masters-prepared nurse or social worker and focus is on addressing clinical barriers. The nonlicensed model employs the services of community health workers and/or lay advisors who are trained to provide culturally tailored navigation for people within their community and to overcome nonclinical barriers to care. Other navigation models integrate services across service lines, settings, and may utilize risk/acuity tools. 

Navigation programs and ONNs themselves must measure their successes through the use of defined metrics specific to navigation. The Academy of Oncology Nurse and Patient Navigators (AONN) has defined 35 metrics. Additionally, patient reported outcomes (PROs), clinical pathway adherence, and measuring the return on investment generated through a navigation program are key indicators of the successes and gaps in navigation. Things to consider when selecting which metrics to measure include time and ease of data collection, program size and scope, input from or organizational leaders and stakeholders. Data can be collected manually, captured within the electronic medical record or with a stand-alone or integrated software platform. Overall, a successful ONN will build upon these principles of navigation while adding their unique talents to the role of the ONN.