The Novant Health Oncology Specialists at the Novant Health Forsyth Medical Center provide world-class cancer care at the Derrick L. Davis Cancer Center in collaboration with the Maya Angelou Women’s Health & Wellness Center. Located in Winston-Salem, NC, the cancer center is accredited by the Commission on Cancer, offering comprehensive patient care along with the latest in diagnosis, treatment, research, support services, and genetics evaluation. The specialists associated with the cancer center treat common and complex cancers, and provide a wealth of resources and services for patients and their families.
The Oncology Nurse-APN/PA (TON) spoke with Sharon Gentry, RN, MSN, AOCN, CBCN, the first breast cancer nurse navigator at the Derrick L. Davis Cancer Center, and one of the first to be involved in the early days when nurse navigation became a standard of care in the United States. To this day, Sharon remains a committed and involved nurse navigator, serving on the leadership council of the Academy of Oncology Nurse & Patient Navigators.
TON: How did you become a nurse navigator?
Sharon Gentry: I became a nurse navigator in 2000, when our hospital had 2 visionary leaders from our breast imaging center and our cancer center who conducted focus groups with patients with breast cancer being treated at our facilities. Our imaging center has always been 1 mile down the road from the hospital where the cancer center is located, because women in the community do not want to get mammograms at a hospital.
The leaders talked with the patients about what they thought about their breast cancer experience, and how the care could be improved. The responses led the directors to see that patients needed better education and improved understanding of their care. Many patients voiced concern that some women had different treatments for their breast cancer than themselves, and did not realize that each had received standard of care for their diagnosis at the time. Because the idea of nurse navigation was just beginning to take hold around the country with the work of Lillie D. Shockney, RN, BS, MAS, and Harold P. Freeman, MD, this gave rise to the directors asking for the first nurse navigator at our center. With the support of a local Susan G. Komen grant, I was able to develop the first breast nurse navigation program in North Carolina.
TON: What was it like in the beginning?
Ms Gentry: The 2 visionaries gave me support and encouraged me to follow our patients with breast cancer to determine their point of entry into our system. My aim was to improve the “flow” of breast care for all our patients. I began by spending the first year observing how patients enter the system—where they come in, where they go next. Some come from the breast clinic, but others come from surgical offices and even emergency departments.
You start by gaining a perspective from the patient’s view on the whole system, understanding the process of care within the community and the healthcare system, as well as by identifying resources you can tap into within the larger community. If they were referred by the imaging center, the surgeon, or the primary care physician, for example, each patient would need different types of education on their disease and process of care.
Our program is community-based, and the nurse navigator links together the breast imaging clinic, cancer center, hospitals, surgical offices, and community resources. Sometimes I needed to redirect the patient on what she had heard or not heard. I have always followed patients through the breast care continuum and provided proactive education along the way. Originally, all patients were “navigated” until a year after surgery, but the navigation end point is more fluid now, with navigation ending after acute treatment and the patient being transitioned into a survivorship plan. My aim is to empower the patient and help her feel in control.
A key component of our breast navigation program development was the feedback patients and families returned via a mailed survey. We asked what they liked best, and also what we should do better. Within 6 months, we knew this was something patients and families appreciated.
We got responses such as the following:
- “The security knowing she could be reached anytime and her caring phone calls were reassuring to me.”
- “Whenever I had a question or concern, she was always available. Her physical presence of checking in with me during chemo [chemotherapy] and radiation was very reassuring.”
- “My experience with the Breast Nurse Navigator has been very positive. My fears were reduced with information. Putting me in contact with other services that I otherwise would not have known were available has also been very helpful.”
- “Being there immediately after surgery and the calls following my surgery were appreciated. This is the kind of support that is needed for breast cancer patients and their families.”
- “I feel very fortunate that the Breast Nurse Navigator was there for me during what has been one of the hardest times of my life.”
One common thread was that everyone wanted education based on their care.
TON: What else did the survey reveal?
Ms Gentry: The question on how we could improve brought multiple responses, but often themes emerged, like the need for surgical garment resources before surgery. The common concerns are presented to the cancer center breast advisory team.
In the beginning of the navigation process, patients were frustrated that on the day of their surgery, they had to make 2 stops before checking in for surgery. After discussing this with the advisory team, changes were made over time to eliminate one of the stops. This streamlined the flow and made patients happier. The beauty of this feedback from patients is that we develop a stronger breast cancer program. We identify barriers, ask physicians and administrators to recognize them, and solve them as a team.
These changes based on patient feedback required visionaries in leadership, the nurse navigator as the eyes and ears of the patients, and bringing patient responses back to the team to improve patient care.
TON: What did you do before you were a nurse navigator?
Ms Gentry: I had 18 years of experience as a nurse in inpatient oncology, working in clinical care, education, and case management. Interestingly, I participated in local community organizations by speaking on breast health before becoming a navigator.
TON: What is your role at the Academy of Oncology Nurse & Patient Navigators?
Ms Gentry: Because our program was one of the first established, and our leadership was willing to share our results, and I assisted in organizing the state navigation association (North Carolina Oncology Nurse Navigation Association), I was often asked to speak at national events about our program. I gave a talk at the first Academy of Oncology Nurse & Patient Navigators conference in Baltimore, MD, and have been a part of the Leadership Council since its inception. I speak at their annual conference on nurse navigation issues, and have chaired the annual conference since 2012. It has been exciting to see the profession develop, as we now have an organization and as well as a journal [Journal of Oncology Navigation & Survivorship] dedicated to the work of navigation. The patient and nurse certification exams were released this year, as well as evidence-based metrics supporting the difference navigation makes in the healthcare system and the life of a patient.
The goal of this independent, nonprofit organization is to advance the role of nurse and patient navigators in cancer care and survivorship. We provide a network where navigators meet and develop their practices at regional and national meetings. We give nurse navigators the tools to enlarge their roles. Once you have a navigation program, patients become better educated.
TON: How has navigation affected breast cancer care in the community?
Ms Gentry: We have witnessed an increase in the use of community resources, United Way agencies, and support groups. Women and men have been empowered to speak out to others about the importance of early detection and to volunteer as a peer contact for others starting the cancer journey. The camaraderie among this group of survivors has been strengthened. Most importantly, the journey path has had a few stones removed to make the traveling smoother.
It is a win-win situation, as more survivors are becoming involved in the community.
TON: What is the biggest challenge in your job?
Ms Gentry: Although I would not exactly refer to it as a challenge because it keeps the job interesting, I often think I have my day planned, and then a patient priority takes over and everything changes. For example, a newly diagnosed patient may need more “hand-holding,” requiring a bigger share of my attention than I had originally anticipated.
TON: What is the greatest reward associated with being a nurse navigator?
Ms Gentry: Hearing from patients and families in appreciation of the good care that they got and how this made a difference in their lives and their cancer journey. Providing optimal care to patients is a team effort—I want to emphasize that. I collaborate with radiology at diagnosis, surgeons, medical oncologists, radiation oncologists, geneticists, dietitians, physical therapists, volunteers, the chaplain, psychologists, and resources in the community. The key to successful navigation is to proactively prepare the patient for what is coming.