Sarah Cannon, the Cancer Institute of HCA Healthcare, offers a wide range of services for patients with cancer. One of these services is individualized patient navigation, designed to promote and ensure continuity of care during the cancer journey.
The Oncology Nurse-APN/PA (TON) spoke with Kristina Rua, MSN, RN, OCN, ONN-CG, Director of Oncology Navigation for Sarah Cannon’s East Florida Division, about her roles and responsibilities, some of the rewards and challenges of her job, and what she is currently excited about in the field of oncology.
Ms Rua: I have always worked in healthcare. Years ago, I was an optician and planned to go to medical school. However, these plans changed after I gave birth to my son. He needed to be hospitalized soon after he was born and it was through that experience that I learned more about the nursing profession. It seemed like a very rewarding career, so I switched my major from pre-med to nursing. Shortly before I received my degree, I gave birth to twin girls.
Ms Rua: I had my heart set on pediatrics, but during the last clinical leadership rotation before graduation, I was placed in the oncology unit. Once that happened, I realized that oncology had chosen me.
Ms Rua: I am Director of Oncology Navigation for the East Florida Division. I started the Oncology Nurse Navigation program here. When the program began, we had 2 nurse navigators—now we have 10 navigators who cover 7 different hospitals and 6 different tumor types. All of these individuals are oncology navigators who are tumor-site specific.
My role involves strategic planning based on physician engagement and oncology data. When I began my current job, I had to identify the available opportunities for navigators and then hire people to fill those positions. Now that we have 10 navigators, one of my responsibilities is to determine opportunities for expansion. This involves studying metrics (eg, patient retention numbers and patient survey results) and discovering ways to improve processes to expand the program.
I work with different service lines, such as orthopedics, surgical oncology, and neurosurgery. I meet with the physician specialists being hired to explore how navigation might be of benefit to the patients they care for. I also provide support, education, and growth opportunities to our oncology navigators. I am like their “momma bear.”
Ms Rua: I would say there are 2 big rewards. The first is that I have long enjoyed providing patient care and seeing the positive effect that nurses have on a patient’s course of treatment and outcomes. Since I am no longer providing direct patient care, my rewards now come from the accomplishments of my team. I not only see the impact they have on their patients, but I am also part of their career development and growth. I am able to help nurse navigators set goals and achieve them.
Ms Rua: We put patients first in everything that we do, which can often present challenges when juggling the complexities of the healthcare system. It is important for me to have honest conversations with all of the stakeholders, including providers, hospital leadership, and even the navigators or "cubs" themselves about how we can navigate these challenges for our patients.
Ms Rua: I am excited about studies demonstrating the efficacy of new treatments, including immunotherapies and targeted therapies, which are less toxic than conventional chemotherapy. I am also happy that there is more focus on financial toxicity and how to help patients deal with the costs of treatment. I am pleased that oncology navigation is at the forefront of caring for patients. People are seeing the value of nurse navigation and are implementing it into their systems. This will benefit both providers and patients.
Ms Rua: The real focus of oncology nurse navigation is breaking down barriers to care. These barriers can be related to education, transportation, funding, and coordination of care. Navigators guide patients through the healthcare system and help them to overcome barriers so they can have a timely transition from one treatment modality to another. They also work with patients who are uninsured or underinsured to help them obtain coverage for their cancer care.
One of our patients was a young woman with breast cancer who worked as a waitress. During the COVID-19 pandemic, she lost her job, and was in danger of losing her car, being evicted from her home, and having her cell phone service disconnected. We found resources and funding to help her, so that she was able to keep her home, her car, and her cell phone service. It was awe-inspiring to see our navigators be so creative and find so many helpful resources for this patient. We have created a resource guide for funding opportunities to help other individuals who may need this type of help in the future.
Ms Rua: I would tell them to make sure that they are taking care of themselves first. I have learned over the years that if you are not strong and happy in your life, you will not have anything to give back to your patients. I was a gynecology/oncology nurse for much of my career. Although it was rewarding, it was also taxing. It was emotionally difficult when I would care for a patient for many years and then see that patient die from cancer. There were times when I had trouble separating my personal life from my professional life. I would take my sadness home and it was breaking my heart. I realized that I was going to burn out.
Now, I focus on my home when I am home and on my work when I am at work. I have become better at disconnecting. I have a work phone and a personal phone, and when I leave work, I turn off the work phone and do not answer texts. This is possible because I am not doing direct patient care.
I would advise nurses to find activities that help them disconnect from their professional responsibilities when they are not at work, such as exercising, traveling, caring for a pet, or doing their favorite hobby.
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