By Kelly McCue, RN, MSN, CNS, OCN, CHPN
When the National Breast Cancer Foundation awarded a grant to Brattleboro Memorial Hospital earlier this summer, 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 have had difficulty accessing and affording a mammography 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 the patients in the system, guiding them and their families through the whole process, from the abnormal finding to diagnostic testing to surgery if needed and, hopefully, out to survivorship. Then we also follow the patients throughout survivorship to make sure they get their screenings because survivors have a higher risk to develop cancer again.
In the four years I’ve been at BMH there have been about 300-400 people on my radar 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 are coming for their screenings.
So once a patient is my patient, they are always my patient. Even as they see different specialists at different stages of their treatment, they are always on my email service and they can always check in with me for different needs. Some people 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 my 30 years as an oncology nurse is giving people lots of choices to keep them well. Patients want to be human-doings, not human beings. As a navigator I’ve organized 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.
I also have a group for the partners. Some spouses or boyfriends of women with breast cancer are in a place where they want to support a loved one but need direction. Even just making a meal could be what they need. Chores and meal preparation are areas where partners feel like they can help.
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. I’ve helped patients find affordable dentistry, eyeglasses and other services they need. The Enright Hair Salon recently gave $2,600 in wigs. It was a tremendous donation that has benefited a number of women already.
I borrowed a phrase from a friend in Connecticut. I always say to patients upon meeting them: “The answer is yes. What’s your question?” No matter what it is. I’ll figure it out. I can’t think of anything I’ve said no to.
The NBCF grant will allow us to continue saying yes, and hopefully saying yes to more people. It’s the oldest cliché in the book, but early detection does save lives. Windham County has the lowest screening rate for breast cancer in the state. Whether it’s awareness, access or affordability, the NCBF grant will help us make sure money doesn’t stand in the way of getting a mammogram or any of the other breast cancer support services a nurse navigator program can provide.
Kelly McCue, RN, MSN, CNS, OCN, CHPN is the Nurse Navigator for Brattleboro Memorial Hospital’s Comprehensive Breast Care Program.