Nurses and healthcare workers are essential to building trust and understanding the needs of patients both inside and outside the clinical setting, said Susan Sabo-Wagner MSN, RN, OCN, Executive Director of Clinical Strategy at Houston, Texas-based Oncology Consultants.
Can you describe the role of nurse navigators and what they do for oncology consultants?
We have 2 types of collaborators working in our HOPE Initiative project. There are the nurse navigators and then the community health workers. They are certified community health workers, and for practice we call them patient advocates. We bring them in and they work under the Nurse Navigators to provide our patients with holistic care from the start.
Our oncology patients receive a call when they are referred to the practice. We try to call her the day before her first appointment; If that doesn’t work, we’ll talk to you on the day of your first appointment. Bur Community Health Workers reach out to patients and conduct a survey on the social determinants of health for each patient. It is the screening tool used by CMS that addresses housing, food, safety, childcare – all the key social needs patients are potentially dealing with. Then they adjust the resources that our patients may need. If it is transport they will work to get the transport together or whatever the case may be.
You remain in contact with the patient throughout the treatment here in the practice. So they call back after the first appointment; You will report again before and after the treatment. There are certain cadences built into the programs to help them step up and relate to the patient as a true advocate.
In Houston, we are one of the largest and most diverse cities in the United States. Part of that comes with different cultures and different languages. The 3 main languages spoken by our patients in our practice are Spanish, Vietnamese and English. Our first 3 languages that we wanted to make sure our advocates spoke were these 3 languages. One of our advocates speaks Vietnamese; 3 of them speak Spanish; and of course everyone speaks English. That way we have some cultural competency, reach out to the patients and make sure they are not only able to do a survey and speak to them in a language they understand, but really build trust.
There is a lot of distrust in different cultures, different populations, for very different reasons, depending on the population. We find this to be one of the best ways to fill a small gap and build trust and comfort for the patient walking in.
We have often found, and our community health workers have reported, that in many ways patients are less concerned about the cancer itself and the diagnosis and more concerned about the financial issues. “How am I supposed to pay for this?” Or “how am I supposed to leave work to even be there?” Or “Who’s taking care of my kids?” Or “I don’t have enough gas money to take my car to this office.” Many of these interviews and the message “we’ll provide something” or “we’ll get in touch with some resources for you” gave us a great relief right from the start.
Not to mention that the Vietnamese population, especially the older Vietnamese population, has a lot of trust issues to come into the office and feel comfortable. Although we have doctors and staff at the practice who speak Vietnamese who are Vietnamese, coming here can be scary enough at times. Reaching out to someone was a really good program for her.
The community health workers or patient advocates are in touch. They are hands-on, patient-focused, and take care of all socio-economic needs. The Nurse Navigators who report to them take care of all clinical needs. They also cater to socio-economic needs, but if there’s something like home care or hospice or something more clinically integrated, then they work together and work together so that clinical needs are addressed as well. They also take care of other things that are happening with patients who are also currently in the practice and that they need referrals to different lymphedema clinics and things like that. They also oversee the counseling that takes place, the various programs that we have set up within the practice.