Why Cardiology Needs More Nurse Navigators: A Checklist for Improving Outcomes

Friday, October 11, 2024 | Jenny Kennedy, MSN, RN, CHFN, NEA-BC

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Illustration: Lee Sauer

Introduction: A Checklist for Cardiology

Nurse navigators have long been a cornerstone in oncology care, guiding patients through complex treatment pathways and ensuring seamless care coordination. In this specialty area, nurse navigators are invaluable in improving patient outcomes, ensuring satisfaction, and coordinating care. They provide individualized support, help manage numerous appointments and procedures, ensure patients understand their treatment plans, and more.Given their success in other specialty areas, it's time to explore how we translate this model to cardiology, where patients often face complicated care journeys. The question is, how do we adapt this model to cardiology? With over 20 years of nursing experience, I have seen the profound difference that heart failure (HF) nurse navigators can make in patient care and outcomes. When I first implemented a nurse navigator program at our hospital, I was truly amazed by its transformative effects on our HF patients. 

This blog provides checklists for considering whether a nurse navigator is right for your programming, hiring the right individual for your team, and integrating the nurse navigator into your team to ensure success.

Why Aren't There More Nurse Navigators in Cardiology?

Despite the clear benefits, nurse navigators remain underutilized in cardiology. Several factors contribute to this, including:

  • Lack of Understanding: Many healthcare organizations are unsure how to integrate nurse navigators into their cardiology programs effectively.
  • Financial Justification: It is challenging to directly link the role of the nurse navigators to economic outcomes, making it difficult to justify the role.
  • Resistance to Non-Traditional Roles: There is often hesitation in embracing roles that deviate from traditional functions, especially in light of direct care nursing shortages.
  • Uncertainty About Implementation: Organizations may not know where to start even when leaders recognize the value of nurse navigators.

Building the Case: Key Benefits of Using Nurse Navigators in Cardiology

When facing the above mentioned challenges, it’s important for cardiovascular leaders to build a case for utilizing a nurse navigator on your care team. Some key tactics for building your case include:

  • Garnering Support: Engage physician champions and administrative leaders by showing the potential financial and clinical impacts on the organization.
  • Outlining the Economic Benefits: Consider readmission reduction, decreased length of stay, downstream revenue, and opportunities for quality initiative payments. Get creative and seek guidance from your financial team.
  • Considering the Impacts to the Team: Outline how a nurse navigator would help streamline care delivery by creating a visual map of your team’s roles and how those roles will be supported by the nurse navigator.
  • Planning Your Metrics for Success: Prepare a list of key performance indicators that may be affected by the addition to your team.

There are numerous benefits of having a nurse navigator on your care team, and it’s an important step to communicate these benefits as you begin to garner support. At the end of the day, the most important benefits of using nurse navigators in cardiology are for the patients and include:

  • Improved Patient Outcomes: Nurse navigators help reduce hospital readmissions and mortality rates by delivering timely follow-up care and promoting adherence to treatment plans.
  • Enhanced Patient Experience: They provide personalized support, answer questions, and help patients understand their diagnoses, treatment plans, procedures, and recovery processes. Frequent touch points through various methods of communication increase patient trust and satisfaction.
  • Better Care Coordination: Nurse navigators facilitate seamless transitions from hospital to outpatient care, ensuring that patients keep their follow-up appointments and receive necessary education and resources.
  • Increased Adherence to Guidelines: Nurse navigators promote adherence to clinical guidelines and increase referrals to appropriate services. For example, increasing referrals to cardiac rehabilitation promotes improved patient recovery and long-term health.
  • Support for Self-Management: Nurse navigators enhance patients' self-management skills by providing education on managing their conditions, leading to better health outcomes and reduced need for hospital, emergency department and office visits.
  • Holistic, Multidisciplinary Care: Nurse navigators are an integral part of a multidisciplinary team that provides comprehensive care and addresses patients' medical and psychosocial needs.

The nurse navigator in my program collaborated closely with patients who faced frequent readmissions, identifying critical barriers to effective self-management. Through education on HF, medication adherence, and lifestyle modifications, patients were empowered to take control of their health in partnership with their care teams.

The results were remarkable. Patients learned to play an active role in their care, leading to improved health outcomes, fewer exacerbations, and a significant reduction in unnecessary hospital admissions. This success underscores my strong advocacy for nurse navigator programs.

In addition to supporting patients, nurse navigators on cardiology care teams provide significant benefits to other team members, including:

  • Improved Efficiency: Nurse navigators handle many coordination and follow-up tasks, allowing physicians and other specialists to focus more on direct patient care and complex medical decision-making.
  • Enhanced Communication: They are a central point of contact, facilitating better communication between healthcare providers, departments and external services.
  • Optimized Workload Distribution: Nurse navigators manage patient education, care coordination, and routine follow-ups, allowing all team members to work at the top of their licensure and within their scope of practice. This redistribution of tasks ensures that each professional's unique skills and expertise are fully utilized, leading to more efficient and effective patient care. This optimization reduces overall workload and enhances the quality of care provided by the entire team.
  • Increased Job Satisfaction: With nurse navigators handling many of the logistical aspects of patient care, other team members can focus on their areas of expertise, potentially leading to increased job satisfaction for all members of the care tem.
  • Improved Team Collaboration: Nurse navigators often work across different departments and specialties, fostering a more collaborative and integrated approach to patient care.
  • Data Collection and Quality Improvement: Nurse navigators are well-positioned to collect patient outcomes and experience data, which are invaluable for ongoing quality improvement initiatives.

These advantages highlight nurse navigators' critical role in improving the quality of care and outcomes in cardiology patients. The next question is, how do you start?

How to Start: Introducing Nurse Navigators in Cardiology

To successfully introduce nurse navigators into your cardiology program, consider the following steps:

  • Data-Driven Needs Assessment: Use the existing data and knowledge from your cardiology program to identify needs and gaps. Engage care teams to pinpoint the areas where nurse navigators can be most impactful.
  • Specific Targeting: Clearly define your target population and metrics for improvement. Being intentional and focused before hiring a nurse navigator will help your team measure the program's success.
  • Hire the Right Nurse: Look for a nurse who is engaged and highly motivated, works well both independently and in a team, and is resourceful and trustworthy. This role requires an individual with a level of skill that comes from experience and who can think critically to solve problems.
  • Getting Started: The most common mistake is pointing a nurse navigator in one direction and saying "go." While this is a common approach and one that I’ve taken in my own career, it’s too broad of a role. While you don't have to know exactly what the role entails in the beginning, provide guardrails and guidance to get them started in the right direction.
  • Role Definition: Clearly outline the roles and responsibilities of nurse navigators. Ensure they are working to the top of their license, and be prepared to adapt these roles as needed. This will develop over time and likely evolve with the program.
  • Flexibility: Consider options that allow flexibility, including hybrid models, which allow for adequate time to manage patients and administrative responsibilities. The right fit will get the work done.

Integrating these specially trained nurses into our HF program improved many performance metrics and strengthened the connection between hospital and outpatient care. Our nurse navigators emerged as the HF experts and the glue that held our program together, earning respect and appreciation from both patients and healthcare providers. 

Supporting Nurse Navigators: What They Need

To ensure the success of nurse navigators, provide the following support:

  • Frequent Check-Ins: Nurse navigators are often self-starters who take on too much. Regular check-ins, especially early in their role, can help maintain balance and job satisfaction.
  • Protection and Focus: Ensure they remain focused on their primary responsibilities and are not pulled into multiple initiatives. They will be highly sought after because they are driven and efficient problem solvers. Empower them to set boundaries and escalate issues as needed.
  • Prioritize: Help them prioritize and look for opportunities to offload things that may be taking up time. For example, confirm they have support with meeting minutes, presentations and data collection? While crucial, these tasks are time consuming and can often be offloaded.
  • Role Communication: Regularly update the team and stakeholders on the nurse navigator's role and impact on patient care.
  • Advocacy: Support nurse navigators publicly and privately, as they can often feel alone in this role. Integrate them into teams and networks that will provide additional support.
  • Professional and Personal Growth: Support their goals by providing resources and tools to educate themselves through professional organizations, attending conferences, and obtaining specialty certifications.

Conclusion

As we expanded the nurse navigator role to five additional hospitals within the health system I worked in, the positive effects multiplied. These navigators have become mission-critical in enhancing care for the high-risk HF population.

Cardiology programs should adopt and embrace nurse navigators. The benefits to patients, families and the healthcare system are immense. By embracing the role of nurse navigators in cardiology, we can enhance patient care, improve outcomes, and streamline complex pathways that cardiology patients must navigate. Let's take the first step toward integrating this valuable resource into our cardiology programs.

If you are considering starting a program at your institution, I wholeheartedly recommend it. Please feel free to contact me if you have any questions—I’m always happy to share my experiences and lessons learned along the way.

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