The St. Elizabeth Cancer Center offers cancer detection, diagnosis, and care—all under one roof. With an emphasis on precision medicine and genomic health, screening education and prevention, clinical research, and advanced, innovative technology, the center provides a seamless experience for patients with cancer undergoing treatment. In addition, as a member of the University of Kentucky Markey Cancer Center Affiliate and Research Networks, patients have access to additional clinical programs.
The Oncology Nurse-APN/PA (TON) recently interviewed Jennifer Mulholland, BSN, RN, OCN, Oncology Nurse Navigator, St. Elizabeth Cancer Center, Edgewood, KY, who discussed what inspired her to become a nurse, her day-to-day responsibilities at the center, some of the rewards and challenges of the job, and the research she conducted with a fellow oncology nurse navigator that is reducing time to treatment initiation for patients with cancer.
Ms Mulholland: When I was 15 years old, I traveled to Germany to visit some of my relatives and had the opportunity to shadow my aunt for a day who was an emergency room physician. I had little to no experience in hospital settings and was amazed by the complexity of it all. I vividly remember a young woman who came into the emergency room with a collapsed lung. Although she was being well taken care of by the team, I felt helpless and unsure of what to do, especially since there was also a language barrier. I could only understand pieces of what was being said but was able to understand that the situation was dire. At one point, her scared eyes locked with mine. I couldn’t give her any words of comfort so not being sure what else to do, I just held her hand. Looking back, I know this was a form of language we both understood. After that experience, I knew that someday I would be a nurse.
Ms Mulholland: As my passion for oncology nursing grew, I knew that I wanted to be involved in more than one aspect of my patients’ care. As an inpatient nurse, after meeting patients’ acute needs and discharging them home, I was often left wondering how they were doing and what their next steps would be.
As an oncology nurse navigator, I am involved in all aspects of my patients’ care regardless of which offices they are seen in or if they are inpatient or outpatient. Being a nurse navigator allows me the unique opportunity to have a bird’s-eye view of what is going on with my patients so that I can quickly address any potential needs and be there for them at any point.
Ms Mulholland: A typical workday is focused on improving my patients’ experiences and outcomes. My goal is to be my patients’ “Friend in the Business” and make their journey with a cancer diagnosis as smooth as possible. A portion of my day is spent on direct patient care, where I address barriers to care by connecting them to valuable resources while also providing emotional support. The other portion is spent on indirect care, such as following up on care coordination needs to ensure patients are getting where they need to be at the right time and working on quality improvement projects, such as decreasing time to treatment. I often meet patients at their appointments, but also communicate through telephone calls and the electronic medical record as I guide them along the way.
Ms Mulholland: Fortunately, our cancer center has a wide range of services available to patients, including but not limited to site-specific social workers, dietitians, pastoral care, financial counselors, onsite counseling services, and an integrative oncology department. However, I fear that without navigation, many of these services may be overlooked. Being able to offer a patient a nurse navigator helps connect them to these services in a manner that is proactive instead of reactive. In addition, patients that are assigned to a nurse navigator have a direct contact person to reach out to when several different care teams may be involved.
Although oncology patient navigation programs tend to be a nonrevenue–generating resource, like many other facets of supportive oncology care, our patients are very fortunate that the leadership at St. Elizabeth believes in offering navigation services anyway, to provide personalized care in a way that improves patient experiences and outcomes.
Ms Mulholland: This is the simplest of all the questions to answer. The most rewarding aspect of my job is knowing that I have a positive impact on my patients and have provided comfort to them along their journey. I am often rewarded by patients who tell me that what I did made them feel better, whether that was emotionally, spiritually, or physically.
Ms Mulholland: I have found that having the luxury of guiding my patients throughout the care continuum comes with a deeper level of connection with them. I am often with patients when they hear or see the terrible news of their diagnosis and am usually the first to reach out to console them. In addition, I am there when they are told there are no other options left to treat their cancer.
It is difficult to see my patients not respond to treatment as we had hoped, and it is challenging to know what to say to patients when it is time to reframe the definition of hope.
It has taken a great deal of effort to maintain my own sense of well-being by ensuring a healthy work/life balance.
Ms Mulholland: As nurse navigators, one of our goals is to improve patient outcomes. The length of time between a cancer diagnosis and the initiation of treatment can affect these outcomes. According to research that my fellow oncology nurse navigator, Katie Barrett, BSN, RN, OCN, and I found, when patients have a time to treatment initiation of 20 days or less, they have improved survival rates of 10.5 months. We discovered that our time to treatment initiation was above that 20-day mark, so we set out to determine how to change that, which would give our patients the optimal amount of quality time with their loved ones. Collaboratively with our multidisciplinary team, we created a clinical pathway that standardized the care coordination process prior to the patient seeing a medical oncologist. After implementation of our clinical pathway, we found that we decreased the time to treatment initiation by 30%, revealing that the navigated road is a little less bumpy.
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