A Complementary Partnership: The Case for Nurse Navigators and Patient Navigators Working Together in a Clinical Setting

Contact Name: 
Diana Garcia and Sugi Pauldurai
Name of Institution, Organization or Community Where the Project Was Implemented: 
The GW Cancer Center
Description of Project Setting: 

A clinical breast care division of a cancer center

Patient Navigation
Barriers to Care Access
Care Coordination
Target Population: 
Cancer Site: 
Project Description: 

Breast cancer patient navigation in Breast Imaging at the GW Cancer Center is accomplished through partnership between Ms. Pauldurai, a nurse navigator, and Ms. Garcia, a patient navigator. Ms. Pauldurai handles clinical tasks such as setting up for procedures, providing assistance with MRIs, drawing blood for genetic testing, performing pregnancy tests, and conducting biopsy follow-up, including phone calls and appointments to go over the results. Ms. Garcia, who is bilingual and familiar with many community resources available to serve Spanish-speaking and/or uninsured populations, primarily focuses on patient needs such as ensuring patients have correct paperwork, setting up appointments and referrals, and overcoming insurance issues and other barriers breast imaging and intervention patients may encounter. She accompanies Spanish monolingual patients to appointments to translate, when necessary. [Note: Ms. Garcia is a licensed medical translator. Only licensed medical translators should provide translation services.] Ms. Garcia works with the call center to navigate the approximately one-fifth of their patients come without referrals or a doctor’s orders or have incorrect referrals.

Problem or Issue the Project Was Designed to Address or Improve: 

How to maximize support for patients and adhere to role boundaries.

Project Successes: 
Working in partnership allows Ms. Pauldurai and Ms. Garcia to address both clinical nursing issues, like explaining a procedure, and logistical ones, like ensuring patients have necessary referrals and that patients and families understand the health information they have received. The nurse navigator and patient navigator work together to make sure clinical and practical issues are simultaneously addressed. Ms. Pauldurai and Ms. Garcia have gotten to know “every single person that works in [their department] as well as what each of them does so that they can effectively access services for patients and coordinate care across the cancer continuum.
Helpful Information Before the Project Started: 
Ms. Garcia wishes that she had known that patient expectations might exceed role boundaries of a patient navigator and become unrealistic. She addresses this challenge by taking time to reflect and consider the appropriateness of requests before responding to them, and by clarifying her role to patients and team members. Ms. Garcia cited the importance of and knowing the appropriate referrals to make when navigators feel like they are stepping into the realms of social work, psychology, or other areas.
Project Significance: 
This partnership demonstrates the importance patient and nurse navigators in providing quality patient care. Patient navigators and nurse navigators are experts on different patient support needs and can work well together by tapping each other’s strengths. Ms. Garcia, the patient navigator, has worked at the GW Cancer Center longer than Ms. Pauldurai, the nurse navigator, including with Ms. Pauldurai’s predecessor. Ms. Garcia explained that, at times, she has to resist thinking “I can do (tasks) on my own because I’ve been here longer.” Ms. Garcia reminds herself that Ms. Pauldurai might know the answer or be able to explain this better than she can. Similarly, Ms. Pauldurai offered the example of seeking Ms. Garcia’s help to determine a patient’s eligibility for food assistance, which also led to determining that patient’s eligibility for transportation assistance.
Lessons Learned for Patients, Caregivers and/or Communities: 
Patients need to be introduced to the idea of navigation; they may not know that they can ask for navigators. Ms. Garcia said, “Once you tell them who we are and what we can do for them, we are their best friends.” Ms. Pauldurai observed that many cancer centers now have navigators. “Patients can ask for them. If they need help from the nurse’s side they can always get help from the clinician as well.”
Lessons Learned for Clinicians or Health Care Professionals: 
Patients can feel overwhelmed by the volume of hospital contacts and clinical services they need. For example, patients may not know who to contact when they are in pain or if they have special instructions for a drain or other procedure. By providing a navigator point of contact to liaise between the patient and the health care system, health systems can reduce patient’s feelings of being overwhelmed. Navigators are in a unique position to facilitate care coordination across the cancer continuum by supporting communication across all health care team members, especially transitional team members such as fellows.
Lessons Learned for Researchers or Additional Research Needed: