Penn Medicine’s Abramson Cancer Center (ACC) is comprised of 6 hospitals and many facilities located in the tristate area of Pennsylvania, New Jersey, and Delaware. As a national leader in cancer research, patient care, and education, ACC is one of a select group of cancer centers in the country awarded the prestigious designation of Comprehensive Cancer Center by the National Cancer Institute.
The Oncology Nurse-APN/PA (TON) recently spoke with Margaret Rummel, RN, MHA, OCN, NE-BC, HON-ONN-CG, Oncology Nurse Navigator, ACC’s Perelman Center, Philadelphia, PA. In this interview, Ms Rummel discusses her responsibilities at the center, how nursing professionals are working to overcome the challenges presented by the COVID-19 pandemic, and effective strategies for navigating oncology patients through the continuum of care.
TON: Tell us about your responsibilities as a nurse navigator.
Ms Rummel: I am one of 9 nurse navigators at ACC. We are a disease-specific center, and I work with patients who have been diagnosed with head and neck cancer, amyloidosis, or multiple myeloma. As a nurse navigator, I am responsible for prescreening patients and performing the necessary assessments to identify and address any barriers to care they may be experiencing. For example, some patients may be underinsured, have food insecurity, or may be facing other significant challenges that can hinder their quality of care. An important aspect of my job is to determine what supportive services they may need, such as a referral to a social worker, a nutritionist, or a financial counselor, and then help them gain access to these services.
TON: How has the COVID-19 pandemic affected the way you perform your duties?
Ms Rummel: Our team has been working remotely since the beginning of the pandemic, which has been a big adjustment. However, we have risen to the challenge. In terms of technology, we had to ramp up quickly so that we could perform our jobs effectively and provide the necessary care to our patients. We also needed to help many of our patients learn to navigate the technology required to communicate with us, which presented some challenges. They needed to learn how to use telemedicine platforms and patient portals. In addition, some of our patients are facing significant financial challenges because of the pandemic, which means they may not have access to the technology necessary to support these programs. It is critical that we effectively address these issues related to access to care.
Our team has needed to find new ways to communicate with each other since we are currently not working together in the same building. Our individual navigator group holds its own virtual meetings once a week so that we can stay connected and discuss any issues that may arise. Our group also participates in a larger department meeting that includes key members of the team, including social workers, nutritionists, counselors, and other healthcare professionals. This allows us to provide each other with important updates and discuss what the plan will be moving forward. We also meet virtually with our disease site teams to collaborate on the needs of our patients.
TON: What advice can you offer nursing professionals who may be experiencing burnout during these stressful times?
Ms Rummel: There are many challenges facing nurses and navigators who are now working from home. Many of my colleagues are trying to work full time while caring for very young children or older children who are attending school via Zoom. They are being pulled in a lot of directions, which can be extremely stressful. In addition, we are all susceptible to computer fatigue now that we are required to interact online with patients and colleagues.
You need to be aware of the signs and symptoms of burnout and have effective strategies in place for combatting it. I think it is essential to take some time away from the computer and do something that you enjoy, whether it is an exercise class, a hobby, or your favorite television show. It is also very important to eat properly and get enough rest. Social isolation can be a serious issue as well, so it is important to find safe ways to stay connected with friends and family. Some people may need to join an online support group or seek individual counseling if they start to feel overwhelmed.
The human resources department at Penn Medicine has put together a comprehensive list of resources for employees who may be experiencing burnout or other challenges, which has been very helpful. We also participate in regular virtual town hall meetings where we can learn about updates regarding the pandemic, vaccinations, and other relevant healthcare and policy issues.
TON: How do you assist patients who are hesitant to schedule screenings or follow-up appointments because of the pandemic?
Ms Rummel: A lot of what we do as nurse navigators is provide patient education. Since the pandemic began, many patients have expressed concerns about coming to the center for screenings or follow-up visits. A critical aspect of my job is explaining the importance of these appointments to our patients and alleviating their fears. I make sure they are aware of the prescreening, sanitizing, and social distancing protocols that we have in place to protect patients and staff, and I emphasize the importance of preventive care, such as getting their scheduled mammograms or colonoscopies in a timely manner.
There are follow-up visits that can be conducted via telemedicine, but screenings must be performed at the center. If patients are not comfortable coming to one of our facilities, we at least try to keep the conversation going and send them e-mail or text reminders or speak to them via a phone call. We always stress the importance of follow-up.
TON: Are there any new initiatives at the center that you are particularly excited about?
Ms Rummel: Yes. I am very excited about the creation of several new online groups for patients and caregivers, which have been very successful. One of the challenges of being a large cancer center located in a city is the fact that many patients do not take advantage of the extra services we have to offer. When they have to commute 2 hours to our center for their cancer treatments, they often do not want to come back for other services. However, since the start of the pandemic, we have been able to offer a variety of virtual meetings and services that have opened the door for many patients and their families. We have started caregiver support groups, nutrition and exercise programs, virtual pet therapy, etc, and the response has been very positive. People are excited to be able to participate in these programs without having to leave their homes. Many patients are struggling with social isolation, so they are eager to join groups so that they can interact with others. Given the success of these programs, it is likely that they will continue after the pandemic has ended.