Emerson Hospital ONCOLOGY NURSE NAVIGATOR in Concord, Massachusetts
The Oncology Nurse Navigator (ONN) is an experienced oncology nurse responsible for the individualized needs assessment of cancer patients, family members and their care givers across all phases of the cancer care continuum. The Navigator readily identifies personal and systemic barriers and through problem solving and referrals, helps to improve access to treatment and thereby achieving better patient outcomes. The ONN reports to the Director of Oncology and Infusion Services and works collaboratively with all members of the oncology team.
Coordination of Care
Identifies patient’s potential and realized barriers to care at the initial encounter and periodically throughout navigation, matching unmet needs with appropriate services and referrals both hospital and community based (e.g. nutrition, social work, pre/rehabilitation, transportation, support groups, legal and financial services, palliative care, etc.)
Develops or uses appropriate screening and assessment tools and methods.
Develops knowledge of available resources within the hospital and establishes relationships with the providers of these resources
Develops knowledge of available local, community, or national resources and the quality of services provided; also establishes relationships with the providers of these services.
Assesses and promotes healthy lifestyle choices and self-care strategies through education and referrals to ancillary services.
Applies knowledge of clinical guidelines throughout the oncology continuum (diagnosis, surgery, medical and radiation oncology, and survivorship or end of life).
Supports a smooth transition of patients from active treatment into survivorship, chronic cancer management, or end-of-life care.
Documents relevant patient information and individualized care plans in the patient’s electronic record
Provides individualized care and education within the context of functional status, cultural consideration, health literacy, psychosocial, reproductive/fertility, and spiritual needs for patients, families, and caregivers.
Collaborates with treating physicians and support staff to provide appropriate and timely education to patients to prevent unnecessary hospitalizations or clinic visits and improve adherence to treatment.
Obtains or develops patient educational materials for patients, families and caregivers.
Provides anticipatory guidance and manages expectations to assist patients in coping with a chronic or terminal diagnosis, and its potential and expected outcomes.
Advocates for patients and empowers patients to self-advocate and communicate their needs promoting patient-centered care.
Acts as a liaison between patients, families and caregivers and the care providers within their multidisciplinary oncology team.
Builds therapeutic and trusting relationships with patients, families and caregivers through effective communication and listening skills.
Works collaboratively with Medical Oncology, Radiation Oncology, Surgical Services, Naka Infusion and other subspecialties (e.g. nutrition, social work, rehabilitation, support groups, etc.)
Facilitates communication among members of the multidisciplinary cancer care team to prevent fragmented or delayed care.
Attends and participates in meetings and cancer conferences to ensure timely follow-up on treatment and supportive care recommendations
Participates in the tracking and monitoring of metrics and outcomes, in collaboration with administration, to document and evaluate outcomes of the navigation program and report findings to the oversight committee.
Maintains and supports patient’s rights to care, privacy and respect.
Supports the development and maintenance of a survivorship program in collaboration with MGH Medical Oncology.
Supports workgroup initiatives to achieve and maintain national accreditation status.
Works to promote and advance the oncology nurse navigator role and takes responsibility to pursue personal professional growth and development.
Contributes to the oncology nurse navigator program, role development, implementation, and evaluation within the healthcare system and community.
Develops and promotes pathways for oncology patient recruitment by collaborating with internal and external stakeholders.
Demonstrates the importance of patient satisfaction by addressing feedback data and working to develop patient satisfaction improvement processes for patients.
Contributes to the knowledge base of the healthcare community and in support of the oncology nurse navigator role through activities such as involvement in professional organizations, presentations, publications, and research.
Ensures all proper documentation is readily available for all members of the multidisciplinary team across all EMRs (i.e. Mosaic, Epic, Meditech & Centricity).