Nurse Navigator RN, Orthopedics

Baystate Health•Springfield, MA

About The Position

The Nurse Navigator RN provides individualized assistance to patients and their families or caregivers, helping them overcome healthcare system barriers and access timely, quality care. Using the nursing process and clinical knowledge, the nurse navigator assesses needs, provides education and resources, supports informed decision-making, and coordinates care throughout the patient’s care continuum. The role collaborates with organizational departments, staff, providers, and external entities to support evidence-based care and appropriate use of clinical protocols and guidelines. The nurse navigator serves as a point of contact for patients, families, and providers; coordinates and monitors appointments, testing, treatment, referrals, and follow-up; and develops interdisciplinary plans of care. The position also provides specified direct nursing care, supports survivorship needs, participates in quality improvement and outcome measurement, and contributes to staff orientation and training. The posting’s summary describes oncology navigation, while the title identifies the position as an orthopedics nurse navigator.

Requirements

Three years of oncology and/or surgical nursing experience.
Experience working on an interdisciplinary team.
Experience with performance improvement or quality assurance.
Strong interpersonal communication skills.
Patient- and family-centered focus.
Ability to work with minimal supervision.
Critical thinking skills.
Ability to prioritize and work in a fluid environment.
Ability to multitask.
Oncology Certified Nurse certification is required within two years of hire.

Responsibilities

Complete comprehensive patient and family assessments to identify physical, psychosocial, educational, and functional needs, including social determinants of health, and address barriers to timely care.
Educate and coach patients and families or support persons, support shared decision-making, and empower patients to partner with the healthcare team.
Facilitate and monitor timely scheduling of testing and treatment, support patient flow through the system, provide education and practical interventions, and track orders and follow-up.
Develop, coordinate, and implement goal-directed interdisciplinary plans of care that address barriers and patient and physician needs; advocate for patients, survivors, families, and caregivers.
Follow established protocols, processes, and workflows; complete assessments and interventions, triage clinical calls, messages, and patient care needs, and document accurately and promptly.
Adhere to evidence-based practice guidelines and pathways, and participate in collecting and analyzing patient outcome data.
Communicate care plans to support timely, continuous care and maintain open communication among patients, families, nurses, and physicians.
Participate in community outreach activities to increase screening and prevention awareness, as appropriate.
Provide specified direct nursing care, including wound care, dressing changes, drain education and removal under practice-specific guidelines and protocols, and supportive care.
Participate in quality measurement, performance improvement, and outcomes measurement to enhance patient and family care and experiences.
Collect and report data on barriers to care and help patients access outside resources and care coordination.
Prepare for, assess, and support cancer patient survivorship care needs.
Maintain contact with providers and serve as the first point of contact for patients and families.
Participate in orientation, training, and evaluation of new staff; coordinate and implement clinical validations for medical assistants; and help design or create health education materials.
Attend and refer patients to tumor board in collaboration with the physician.
Maintain core competencies in care coordination, communication, education, and professional practice.
Pursue professional development and integrate evidence and research into professional practice.
Triage clinical pool messages for surgeon and APP patient calls, address inquiries as able, and prepare information for provider review and input.