Oncology Nurse Navigator: the professional figure to better navigate the care journey

The nurse navigator is a nurse with specific clinical expertise in their area of work (Disease Unit, Operational Unit, team) who provides personalized care to the oncology patient (and non-oncology patient in some cases) through a continued care, which develops from the first outpatient access until discharge and subsequent follow-up. 

There are 2 main goals of the nurse navigator:

• facilitate the diagnostic-therapeutic care pathway; 
• address any critical issues that may arise related to the condition. 

The nurse navigator is responsible for preparing and facilitating the care pathway, accompanying the patient from the very first moment. 

The nurse navigator contacts and meets the patient during one of the early stages of the diagnostic-therapeutic pathway, in consultation with the medical team, becoming the patient's primary point of reference throughout the course of care. 

Nurse navigators play a key role not only with the patient but also with family members and caregivers. Indeed, they are the figures who are responsible for making family members more aware of the patient's condition, making them understand the needs and support the patient needs to cope with the care pathway in the best possible way. The role of the nurse navigator can be divided into 3 stages:  

• preparation for therapeutic treatment; 
• hospitalization;
• follow-up.

At each of these stages, the nurse will address all aspects of care that can facilitate and accompany the person, identifying needs and developing an ad hoc pathway. 

This new figure in Italy is present in only a few centers. Within the Cancer Center of Ospedale San Raffaele there are 8 nurse navigators assigned to as many disease departments. Over time, other Disease Units will have a nurse navigator to ensure all the personalized care needed for patients in the Center. 

Treatment: preparing the patient for the treatment pathway 

During the first stage of meeting with the patient, the nurse navigator provides information/education to the therapeutic intervention, which the patient is to undergo, identifying and managing possible problems. 

At this stage, the patient is guided through the necessary psychophysical preparation to effectively manage and successfully undergo the chosen therapeutic treatment.

This stage can begin 2 to 6 months before the surgery itself, depending on the type of disease.  

During the preparatory phase, the main macro aspects of care that the patient may need are investigated, and a prehabilitation course is established, comprising:

• Nutritional assistance;
• Psychological support;
• Movement education;
• Patients' rights.

During hospitalization, the role of the nurse navigator transforms. At this point, they become responsible for supervising the patient's care and act as a bridge between the patient, their family, and the care team. They provide essential information and facilitate access to services and resources that the patient may not be aware of.

It is often the nurse navigator who assesses and manages the patient's secure discharge.  

The post-discharge pathway 

In the post-discharge pathway, the nurse navigator resumes an active role in supporting the patient, providing suggestions for strategies to improve the patient's quality of life. 

At this stage, the nurse's role is to check if clinical or urgent issues emerge, possibly activating post-discharge consultations accompanying in the follow-up. 

The great value of the nurse navigator lies in representing a true point of reference, a navigator who orients, guides, and recalculates the course of care when necessary.