When the National Breast Cancer Foundation awarded a grant to Brattleboro Memorial Hospital in 2011, one of their major considerations was the fact that we have a Nurse Navigator Program. The role played by the nurse navigator is critical in an area like Windham County, where people can have difficulty accessing and affording mammograms and other breast care services.
The sub-specialty of nurse navigation has its origins in the early 1990s when the American Cancer Society published a report showing that men and women from low-income families were being diagnosed in the later stages of cancer and therefore dying in greater numbers. Dr. Harold Freeman, the society’s president, developed a program at Harlem Hospital that made breast care education, screening, and detection accessible to the uninsured and underserved.
The National Cancer Institute expanded on Freeman’s program in 2005 with the establishment of nine patient navigator research centers across the U.S. Initially, the position was a non-nurse role typically called patient navigator or care coordinator. Now a navigator is expected to have an RN or even a master’s degree in order to assist patients with both medical and administrative needs.
It’s the nurse navigator that keeps patients in the system, and guides them and their families through the whole process–from an abnormal finding to diagnostic testing to surgery (if needed) and, hopefully, out to survivorship. We also follow patients throughout survivorship to make sure they get their screenings. That’s because survivors have a higher risk of developing cancer again.
At BMH’s Comprehensive Breast Care Program we have about 300-400 people receiving care and attention in any given year. About 50 of those are patients diagnosed with cancer, most of them in the breast. Then you have another 100 that have been treated but are still engaged with follow-ups. Then another couple of hundred who are coming for their screenings.
Once you become one of our patients you will always be on our radar. Even if you see different specialists at different stages of your treatment, you will always be on our email list and you can always check in with us for different needs. Some people, for example, need a ride to the hospital for their screening, or a gas card to get to their radiation treatment. Some may need a referral to social services or want to speak one-on-one with a survivor instead of coming to a support group.
One of the improvements we’ve made in oncology nursing is giving people lots of choices to keep them well. Patients want to be human-doings, not human beings. A nurse navigator is someone who organizes yoga classes and kayaking trips. Sometimes just going for a walk with a group of three or four women can facilitate a conversation about surgery.
We also have a group for the partners. Some spouses or significant others of people with breast cancer are in a place where they want to provide support, but they need direction. Even just making a meal can be incredibly helpful. Chores and meal preparation are areas where partners can make a big difference.
One of the keys to the Nurse Navigator Program is keeping these services and activities free of charge. We are very fortunate to be living in a caring and generous community like Brattleboro. It’s allowed patients to find affordable dentistry, eyeglasses, and other needed services.
Upon meeting a patient, we like to say: “The answer is yes. What’s your question?” No matter what it is, we’ll figure it out.
It’s the oldest cliché in the book, but early detection does save lives. Whether it’s awareness, access, or affordability, we work with patients to make sure money doesn’t stand in the way of getting a mammogram or any of the other breast cancer support services our Nurse Navigator Program can provide.