In the Chaos of Diagnosis, Nurse Navigators Clear a Path for Care

Michael Yeaw walked out of his first appointment at Wilmot Cancer Institute.

He’d just learned that he had tonsil cancer. He was going to need a feeding tube and a grueling regimen of chemotherapy and radiation. He was facing 135 appointments at Wilmot over the next 56 days.

And he wasn’t going to do it.

All he could think about were the treatments for Hodgkin lymphoma that he’d had more than 30 years before. He’d been in prison at the time, with no support and no way to manage the pain.

“It was so brutal I don’t know how I did it,” he says.

When Yeaw, now 56, walked out of his appointment, his nurse navigator Carolyn Ruffing, R.N., B.S.N., OCN, got up and followed him out.

“I was 230 pounds at the time,” Yeaw says. “She grabbed me by the earlobe and walked me back into the hospital like I was a schoolboy. She got my attention.”

Ruffing, who smiles at Yeaw’s recollection, doesn’t remember it quite that way. But she remembers bringing him back inside, looking him in the eye and explaining what the coming months would entail. Part of her role as a navigator is to assess her patients’ communication style, and Ruffing quickly saw that Yeaw needed her to be a straight-shooter.

“The words that came out of her mouth, they were serious,” Yeaw says. “She didn’t sugar-coat any of it. She told me the truth.”

She also made sure his 135 appointments had the least impact on his schedule as possible.

“I never missed an appointment, and I never missed a day of work,” says Yeaw, who finished treatment last fall, got married in December and is back out on his Harley.

Wilmot began its nurse navigator program in 2017 with Ruffing in the Comprehensive Head &Neck Cancers Clinic. Her goal was to reduce the time-to-treatment interval and thereby improve patient outcomes. Within nine months, she helped cut the time from diagnosis to treatment by 16 days, a statistically significant improvement that has also led to improvements in patient and provider satisfaction.

“It’s very rewarding to be there when patients get diagnosed, and to be able to assure them that they're not alone,” Ruffing says. “I help them understand that whatever they encounter here can be managed, that this is a place they should feel safe.”

Wilmot’s navigator program was designed to be led by nurses because of the clinical expertise they bring to interactions with patients and with treatment teams.

“Nurses have the ability to understand the diagnosis and referral information such as scans, and we can assess acuity to see who needs the most support,” says Ruffing, who participates in the multidisciplinary tumor board meetings.

Nurse navigators also play a key role in building trust with new patients.

“Having a nurse who knows the specific disease can help expedite the patient’s care, and patients feel more secure and confident when they’re talking with someone who has that expertise,” says Cheryl Turner, B.S.N., R.N., OCN, the navigator for patients with multiple myeloma and benign hematologic conditions.

While nurse navigator roles are customized to the needs of their patients, their goal is the same — to identify and address barriers to care. They are an added resource for the treatment teams, and they often serve as the first contact patients and families have with Wilmot. The nurse navigators coordinate appointments before treatment begins, ensure consistent communication between service lines and treatment teams during active treatment, advocate for referrals for support services, and act as a central contact for patients.

“I am their primary contact initially, being their stability in such an unstable situation,” explains Sue Fowler, R.N., B.S.N.

Fowler meets her patients at their initial appointment when they learn their pancreatic cancer diagnosis from their surgeon. As part of that appointment, whether with Surgical Oncology or Medical Oncology, Fowler will take notes for the patient and family, so they can focus on the discussion. She is there to help them better understand their diagnosis and treatment options, as well as to provide emotional support. She also provides patients and families with a wide range of education related to chemotherapy and managing side effects, and she provides tours throughout the cancer center.

“I get them through the unknowns to the knowns,” she says.

By contrast, Turner does not often meet her patients in person. She will connect with them by phone before their first appointment to answer any questions and to help schedule any required pre-testing. She also obtains medical records and creates a summary to prepare the treatment team for that first appointment.

“I get a story about the patient and see what they’ve been through already to help the team anticipate what the patient will need,” Turner says. “It makes for a more efficient visit. The providers have more information going in, and more questions can be answered.”

Navigation is a growing role. Joe DeMarco, M.S., R.N., recently began serving as a navigator in Thoracic Surgery, helping patients with lung or esophageal cancers. The rapidly evolving nature of cancer care makes navigation essential, he says.

“It’s not just radiation, surgery and chemo anymore,” DeMarco says. “It’s immunotherapy and targeted therapy, and as the number of older people is growing, the need is really going to explode. It’s complex, and you need to be knowledgeable.”

That knowledge is at the core of establishing trust and connection, and for Yeaw, that meant Ruffing looked him in the eye and didn’t sugar-coat anything.

“She’s not going to lie to you. If you put your mind to it, she’ll get you through it,” Yeaw says. “She’ll find a way to make it work for you and get you out the other side.”