Patient Navigators Offer Support, Promote Care

November 11, 2019
By: NHRMC
CL upload blog

The most valuable tool at Neesha Allen’s disposal isn’t a blood pressure cuff or a prescription pad – it’s her ears. 

“Having a listening ear is often the best detective to determine what might be needed to assist with getting a patient on a road to better health,” said Allen, the Pediatric Patient Navigator at NHRMC’s Nunnelee Pediatric Specialty Clinics. “If you do not have food in your home, how will you be able to get healthy? It is the navigator’s job to determine ways the patient may benefit from added resources.”

Nunnelee sees patients and families from over a dozen counties across Southeastern North Carolina. Allen’s goal is to ensure each patient is empowered to have the best resources to succeed, thereby improving patient outcomes. Part of that is continuity of care in the medical setting, and part of it is creating a plan that helps the patient succeed at home.

The job requires flexibility, problem-solving and empathy. “Empathy fuels connections and is one of the most important parts of a Patient Navigator’s job description,” Allen said.

Allen’s role is especially important because she helps families who may feel overloaded by managing the care of a child with health problems along with their other responsibilities.

“Neesha assists and coordinates the care of our most complex and chronic pediatric patients,” said Vanessa Van Gilder, RN, manager of the clinic. “She assists with coordination of their multiple pediatric specialty appointments, their supplies and the resources they need in the community.”

The American Medical Association (AMA) defines a patient navigator as someone who provides personalized guidance to patients as they move through the healthcare system. Goals for a navigator include reducing healthcare disparities and increasing access to care, improving patient outcomes for a specific illness or chronic disease, and helping patients negotiate the healthcare system, according to the AMA. 

Allen is just one of the patient navigators who work across the New Hanover Regional Medical Center system.

Some navigators, like Allen, focus on a defined group of patients, such as those who visit a specific clinic. Others specialize in patients with a specific health diagnosis, like COPD or cancer. Below is an overview on their roles.

COPD

Tony Bollhorst, a respiratory therapist and COPD Navigator, said his primary focus is to educate patients and their families on Chronic Obstructive Pulmonary Disease (COPD) with an emphasis on self-management. He is based in the hospital, and typically sees patients who are hospitalized while they receive treatment. 

He explains COPD and how it is diagnosed and points out the differences between emphysema and chronic bronchitis. He goes over the medications that have been prescribed and educates patients on pneumonia and the importance of flu vaccines.

He is also a champion of smoking cessation, including offering resources and identifying potential roadblocks. He offers free, quarterly smoking cessation classes for the community.

After his patients leave the hospital, he will call them regularly to check on scheduled primary care follow-ups, identify any unmet needs and answer questions.

Breast Cancer

Laura C. Clark, RN, is a Nurse Navigator/Program Coordinator of the Breast Clinic at NHRMC Zimmer Cancer Center, and a Certified Breast Cancer Navigator. Clark coordinates the multi-disciplinary breast conference and clinic. At the weekly conferences, the care team creates an individualized treatment plan for each patient. During the breast clinics, the patient will meet their physicians and other resources, which could include a dietitian or financial counselor.

The patient will leave knowing the next step in their treatment, which could be surgery, scans, blood work or chemotherapy.

As a nurse navigator, Clark explains the rationale behind the planned treatment, which can help reduce anxiety and enhance follow-through with appointments and prescribed treatment.

She will meet with patients when they are receiving chemotherapy or having an office visit, but she also fields phone calls to offer timely answers to questions and help leveraging resources, such as finding transportation to appointments.

Lung Cancer

Lorraine Sieminski, RN, is the Lung Program Coordinator/Nurse Navigator at NHRMC Zimmer Cancer Center.

Sieminski sees newly-diagnosed lung cancer patients as part of the Lung Program, which provides a streamlined, collaborative approach to treatment. Each patient’s records and test results are reviewed by a multidisciplinary care team, who collectively decide the best course of treatment. After that, the patients have their initial appointments.

Once the plan of care is in place, Sieminski focuses on educating the patient while expediting the treatment plan, which could include surgery, chemotherapy, or radiation.

Throughout treatment, Sieminski stays in touch with each patient to provide support, building close relationships with the patients. She answers their questions and can connect them with other supportive resources at Zimmer Cancer Center or in the community.

Transitional Care Clinic

Karen Kemmerer, RN, serves as the Transition Nurse Navigator at NHRMC’s Transitional Care Clinic. The clinic sees patients who have recently had a hospital stay who could otherwise fall in a care gap because they don’t have a primary care physician or find it difficult to get a quick appointment with a provider.

Patients who need prompt follow-up treatment after being released and don’t get it are more likely to get sicker, have complications and may need to be readmitted to the hospital.

Kemmerer visits patients in the hospital to get early buy-in and explain the clinic’s role. Once a patient leaves the hospital and comes to the clinic, she does an assessment to identify barriers or gaps in care and works to address those barriers and connect them with a primary care office.

Kemmerer encourages and educates patients to help them manage their illness, which may be chronic, and avoid future hospitalizations.

NHRMC Physician Group – Glen Meade Center for Women's Health

Glen Meade offers a wide range of obstetric, gynecologic and women’s health specialties and services at three locations.

After reviewing patient feedback, the practice launched patient navigators in 2018 to serve as a patient’s primary contact for their physicians. The navigators can help with appointment needs, medication refills, triage needs, and any other questions. The practice goal is to answer or return every patient call the same business day, and the navigators play an important role in linking the patients with the medical staff.

For example, a newly-pregnant patient may have a lot of questions about her plan of care and appointments, whereas someone preparing for a gynecological procedure may benefit from help leading up to the surgery and post-op care.

“The goal is to increase patient access and communication with their physician’s care team,” said Amanda Batts, Manager of Patient Engagement. “Our care teams allow staff and patients to develop trusting relationships with their providers which inevitably helps to achieve better patient health.”

Categories: NHRMC People
I am interested in getting involved with outpatient/caregiver support. I have been involved with Geisinger Medical Center for six years developing a caregiver guide and resource center. I recently moved to Wilmington and would like to participate in NHRMC endeavors to support effective programs to improve patient outcomes.

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