The Exec: Nurse Navigators Guide Cancer Patients Through Their Entire Care Journey

Northwell Health Cancer Institute's new Cancer Care Direct program begins with diagnosis and continues until survivorship.

Patients at Northwell Health Cancer Institute who face a new cancer diagnosis now have the caring hand of an RN to expertly navigate them through the complex and sometimes bewildering course of treatment.

The cancer institute, in New Hyde Park, New York, recently launched Cancer Care Direct, a comprehensive program to connect patients at its 10 cancer centers with clinical registered nurse navigators who allow patients to focus on their health while providing expert guidance to them and their caregivers.

Nurse navigators provide such personalized services as: securing timely appointments for all specialties; attending doctor appointments or arranging telehealth visits; helping with paperwork, connecting patients to clinical trials, and assessment for pain management; palliative care; social work; physical therapy; behavioral health; and accessing support services such as nutrition counseling, financial resources, transportation, and survivorship programs.

Prior to creating Cancer Care Direct,  the cancer institute offered navigation to breast cancer patients beginning in January 2022, said Rita Mercieca, RN, senior vice president and chief administrator. That service illustrated the need to offer it to patients being treated in all cancer specialties and since early 2022 nurse navigators have helped more than 1,200 patients in various cancer specialties.

Mercieca spoke with HealthLeaders about the program’s origination and the extraordinarily positive feedback it is receiving.

This transcript has been lightly edited for brevity and clarity.

Rita Mercieca, RN, senior vice president and chief administrator, Northwell Health Cancer Institute

HealthLeaders: Prior to Cancer Care Direct, a nurse navigation program originated for breast cancer patients in January 2022. How did that develop?

Rita Mercieca: I was asked to come to the cancer institute in the middle of 2021 right after COVID, and it was in November when a nurse at Long Island Jewish Medical Center (LIJ) reached out about her husband, who was having abdominal pain and went to see his primary care provider. He needed a CAT scan and when it lit up [meaning the possible presence of cancer], they told them to go to his GI doctor for endoscopy. That was 30 days out and the pain got worse. The primary care referred him to surgery and the surgeon saw him within a couple of days and requested a PET CT, but the closest appointment they could get was 10 days out, so they sent them to another site.

They went home and waited for results. Four days later, no one had called them. This was before the Cures Act was in place, where you get your results to the portal immediately, so she reached out to me and said, “I don’t understand. I'm trying to get the results. Can you help me?”

The wife did not have a good experience and she switched her care to another health system. This is our employee. She wrote a two-page email to me that ended with, “Could you please create some navigation that could help us?” And that's where we began.

Having cancer is frightening enough; just picking up the phone to make that appointment is a journey for a lot of people, so we thought about how to make this better. How could we take best practice wherever we can find it and create something that our patients will benefit from, as well as our providers?

We're a major health system. We do a lot of screening and biopsies, and we get a lot of positive findings. How are we delivering that message and how can we support our providers in delivering the message and then help the patient with the next steps?

We first took a look at breast cancer because when we call the mammogram patient with a positive biopsy, we tell them to follow up with their doctor, and often they respond with, “Who should I call? Can you recommend someone?” We thought it would be great if we could tell them to reach out to our breast navigator and actually support that patient, and that’s where we started.

We make that next appointment for them, and what’s different about what we do is our navigators are at that appointment if the patient is OK with that. Sometimes the patient is so worried and stressed they're not hearing clearly what’s going on, so we take that person through their journey of further imaging or neoadjuvant therapy or surgery or medical oncology or oral medications or radiation oncology, or whatever it is that they need. If they need support, financial assistance, or transportation, we link them to the right people.

Our coordinators who support the navigators are the ones making the appointments and authorizations, which allows our navigators and nurses to practice to the top of their license.

Other health systems and cancer centers do this, but we pulled from different models and tweaked it to be patient-centric and physician-centric. We looked at some best practices, we looked at some of the research on navigation, and we said, “Okay, that's all good, but we want to have that real personal touch where the patient feels supported.” Cancer is so complex, and the navigator knows that complexity.

HL: This program reaches across so many departments. How did you manage to coordinate with all of them?

Mercieca: I have an amazing team of people that work on this, but we also have an amazing health system with a group of chairs and their administrators that are encompassing everything a patient needs.

When we bring on colorectal, we've got our primary care at the table, we’ve got our gastroenterologists, surgeons who are doing surgical oncology, administrators, imaging, medical oncology and pathology, so we, as a multidisciplinary team in a very multidisciplinary health system, are able to pull in everyone we need—everything that’s going to touch a patient—to make this work in a very comprehensive way.

HL: What are the requirements to be a nurse navigator?

Mercieca: I'm looking for compassion and empathy first. The second piece is certification in navigation, of course. If they have a background in medical or surgical oncology, any kind of oncology that's always a plus. But we can teach this skill; it’s hard to teach the compassion, so that is the most important piece.

HL: How long does a nurse navigator assist each patient?

Mercieca: Everyone’s different, and every patient has different needs. Our navigators are there to assist until they have reached survivorship and then we have a great handoff to our survivorship team. It could be months, it could be a year—however long a patient needs to be with us, and when they’re done, and we've handed them off, if they need something they're more than welcome to continue reaching out to us.

HL: How many patients does each nurse navigator assist?

Mercieca: Our research found that a navigator can assist, in cancer, up to 230 patients at any given time, so that's the number we try to stick with. As we get close to that, we then add on another navigator or we pull a navigator from a different disease that's not quite as busy.

HL: Which patients qualify to get a nurse navigator?

Mercieca: Anybody.

HL: How much are you projecting the program to grow in the future?

Mercieca: We've just fully launched everything early this year, so we're still in the growing phase. I can't tell you what that's going to look like in the future, but we will put the resources we need to make sure that patients who want to be navigated are able to be navigated.

HL: What kind of feedback are you getting from the patients who have been assisted by a nurse navigator?

Mercieca:  Feedback from patients has been absolutely phenomenal. They are grateful, but more so they feel like they've got the support they need if they have a question, if they need to change something, or if they didn't understand who they are supposed to call. They can always call that nurse navigator.

We have sent out surveys to understand, first off, if there is anything we need to improve because that's really the feedback I'm looking for. I'm glad that everything's good so far, but is there something that we need to improve on? I can tell you that with the surveys we sent out, they're rating us on a scale of zero to five, with five being the best, and we are at 4.9, so that’s tremendous.