Care coordination is an integral component of every oncology nurse’s job, but the specific role of oncology nurse navigator (ONN) was developed to help address certain barriers to care, including difficulty navigating the healthcare system, poor communication, and lack of resources. Additionally, many institutions have included ONN staff to address quality and timely care, as well as to help them meet the American College of Surgeons Commission on Cancer’s patient navigation standard.

ONS conducted an ONN role delineation study in 2011, but much has changed since then regarding the understanding of the role’s functions and its necessary knowledge, tasks, and skills. In 2016, ONS partnered with the Oncology Nursing Certification Corporation (ONCC) to conduct a new role delineation study to better define the ONN role and determine whether the data would support development of an ONN certification examination. They reported their findings in the February 2017 issue of the Clinical Journal of Oncology Nursing (Lubejko et al., 2017).

Conducting an ONN Role Delineation Study

            A total of 118 ONNs responded to a call for volunteers for the role delineation study task force or pilot test. Additionally, ONS and ONCC recruited 10 subject matter experts from the respondents based on their experience with this kind of work.

The group agreed on a definition for ONNs, developed the survey, and pilot tested the questions. After refinements were made based on the pilot test, the survey was sent to 5,397 ONNs in the ONS database and members of the ONS Nurse Navigator Special Interest Group. In total, 498 surveys were completed and contained sufficient information to be included in the analysis.

ONN Role Delineation Study Findings

            All of the respondents were RNs working in the United States, most commonly in suburban (60%), ambulatory (75%) settings. Most worked in site-specific navigation roles, with breast and lung cancers most common.

Nurse navigator helping patient

Respondents identified 62 task statements that fell into four key concepts: access, barriers, care coordination, and communication. The tasks identified ONNs as an essential point of contact for patients and caregivers regarding facilitation and access to care throughout the cancer continuum. They also recognized ONNs’ responsibility for identifying and addressing patient-, organization-, or healthcare system-specific barriers that can inhibit optimal care. See Figure 1 for a list of the top ONN tasks identified in the 2016 study.

Additionally, respondents ranked 36 knowledge statements, the highest among areas involving pathophysiology of cancer, multimodality treatment, planning, goals of care, symptom management, quality of life, and evidence-based practice guidelines. They also rated 23 skills statements, the highest of which focused on communication, collaboration, critical thinking, problem solving, advocacy, multitasking, time management, and patient and family education.

Finally, the respondents provided more than 500 responses to questions about current and anticipated professional development needs. They were centered around the following themes: patients’ needs related to survivorship issues, management of psychosocial issues, new treatments, technologies and systems, disease-specific updates, financial aspects of care, metrics and outcome data collection and analysis, and improving communication with patients, caregivers, and healthcare providers.

How the ONN Role Is Evolving

            The 2016 study found new areas of importance in the ONN role, including tasks focused on psychosocial care (e.g., distress screening, survivorship care planning and communication, support during difficult conversations, advanced care planning) and processes of care (e.g., identifying patients appropriate for genetic counseling, designing educational plans and programs, monitoring patient adherence).

Additionally, the 2016 study showed greater differentiation between ONNs and clinical staff oncology nurses, most notably in the focus of daily practice. Clinical or staff oncology nurses focus on meeting patients’ clinical needs in one setting, whereas ONNs most often provide care coordination, guidance, education, and advocacy across multiple care settings.

Of particular interest to certification, however, both roles require similar knowledge and skills. ONCC compared the knowledge requirements that the 2016 study identified to the 2016 OCN® Test content outline and found that 74% were an exact match or aligned very similarly. “At this time, the results do not support the need for a separate and unique ONN certification and reinforce the [2015] ONS position statement on Oncology Nurse Navigation Role and Qualifications,” Lubejko et al. (2017) noted.

Clinical or staff oncology nurses focus on meeting patients’ clinical needs in one setting, whereas ONNs most often provide care coordination, guidance, education, and advocacy across multiple care settings.

Future Implications

            ONS is currently updating its ONN Core Competencies to reflect the tasks, knowledge, and skills identified in the study. Additionally, ONS and ONCC are exploring strategies to further support the role of oncology nurses and ONNs in care coordination.

For more information about the study and its findings, refer to the full article by Lubejko et al. (2017).

Lubejko, B.G., Bellfield, S., Kahn, E., Lee, C., Peterson, N., Rose, T., . . . McCorkle, M. (2017). Oncology nurse navigation: Results of the 2016 role delineation study. Clinical Journal of Oncology Nursing, 21, A1–A8.

comments

Posted by kelly Zukswert (not verified) 1 month 2 weeks ago

As a navigator it is very difficult to fulfill every aspect of navigation required for patients. The delineation between the clinical RN nurse and ONN is fairly clear. There needs to be a Navigation at the time of diagnosis through adjuvant treatment into survivorship. Then there should be another role for those who have progressed and or have persistant disease. This role falls short at times. More research should be looked at the role of navigation along the continuum. As much as I try to address all of the needs I find that my focus need to be with those in the adjuvant setting. Maybe that is where follow up appts. and or clinics whereby an NP might be better suited role.

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