Delivering on Patient Centered Care: Implementing an Evidence Based Nurse Navigation Model Impacting Patient Outcomes

Purpose:
Purpose of the work was to evaluate and identify how to improve the performance and outcomes for the Nurse Navigation program. Prior to the design and development of the evidence based model, there was variation in all aspects of the role, with inconsistent measurement of success across the system.

Significance:
The standardization of the nursing role, job description, standards, competencies and measurements positions our program to pursue level one evidence to validate the impact of a Cancer Nurse Navigation program on patient outcomes, quality of life, satisfaction and return on investment

Strategy and Implementation:
The process was rigorous and disciplined. The model for transformation was a shared governance structure, with system wide representation for the various entities as well as representation of the Cancer Nurse Navigator (CNN) incumbents. A gap analysis was completed by the CNN's to identify practice variations and opportunities for best practice, based on an exhaustive literature review. The review led to the development of an evidence based nursing clincal pathway beginning at time of cancer diagnosis through EOL care. The clincial pathway has six components, focused on addressing the needs of patients. The pathway also defines the intended outcome and measurement of the intervention. Also standardized was the job description, standards, educational comptencies, preparation and certifications as well as new hire orientation. Tools to track and measure success include an internal web based data base, a system patient satisfaction survey

Evaluation:
The nursing clinical pathway is fully implmented across the system. 24 CNN's practice and document interventions consistently. Patient satisfaction scores are in top decile. The data base runs reports per CNN, on patient encounters, follow ups and referrals to services (ROI), & distress management.

Implications for Practice:
Standardization of the CNN role allows the ability to objectively measure the impact of the navigator on patient outcomes. This model of care, given the rigor of the evidence & design could be applied to other chronic disease states and has far reaching possibilites in the era of accountable care.