Alternately, a high-acuity/low-volume model is utilized for patients whose complex care has the greatest need for navigator services, such as those with head and neck cancer. These traditional navigation models have evolved into a broad range of hybrid programs specific to their individual cancer care site.8 Patients’ needs are variable depending on stage at diagnosis, type of treatment, and existing patient support systems, thereby altering the resources needed for any particular patient population and influencing the services provided by patient navigation programs.1,8
No one standard definition for patient navigation in cancer care applies universally.2,5 Subsequently, the definition of the role, title, responsibilities, and qualifications for patient navigators vary considerably from center to center. In the same manner, patient navigators’ backgrounds vary as well, and the role may be assumed by registered nurses (RNs), advanced practice nurses (APNs), nurse practitioners (NPs), case managers, social workers, laypersons, tumor registrars, and even patients.2,5,6,8
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EXTENDING NURSING CARE THROUGH NAVIGATION
In the past two decades, the number of nurses, both RNs and advanced practice NPs, practicing in the navigator role has significantly increased.6 Many programs prefer to use clinically trained navigators over laypersons due to their ability to play a larger, more comprehensive role in patient care.5,6 A clinical background expands navigators’ capabilities to identifying psychosocial needs of patients, and to providing more in-depth answers to diagnosis- and treatment-related clinical questions. Most nurse patient navigators have at least a bachelor’s degree.6 Most often, nurses come to this type of work through oncology or other advanced nursing experience.
There is no one nationally recognized license or credentialing body in patient navigation, nor is there any one generally accepted criteria for certification. However, as the validity of the role grows, various professional organizations offer some type of training, certification, or professional society membership (Table 1). Available training and certification options allow navigators to provide generalized cancer care navigation or specialize in a specific cancer type, such as breast cancer; or even work in disciplines outside the field of oncology, such as women’s health.
Table 1. Exploring the role of the nurse navigator
APNs’ expertise in clinical practice, patient education, consultation, research, and management, which provides a comprehensive integration of medical and nursing perspectives, are additional benefits to utilizing these clinicians as navigators.6 Further, most patient navigation services are nonbillable; however, as part of an office visit for ongoing care, they are billable when provided by a nurse practitioner but not when provided by a registered nurse.
This additional revenue stream can potentially substantiate the difference between the costs compared with using a layperson or registered nurse in this capacity.1 Many cancer programs are incorporating NPs as active coordinators in their patient navigator programs. Both the facility and the patient benefit from the advanced diagnostic education and clinical expertise of NPs.
