There are four general nursing roles at the Segal Cancer Centre:
- Nurse Navigator (Infirmère pivot en oncology or IPO)
- Clinical Nurse Specialist (CNS)
- Primary Nurse
- Acute Care Nursing Team
The overall strength of these nursing roles within the Segal Cancer Centre is the provision of continuous and comprehensive nursing care throughout the course of the illness from diagnosis through to treatment, follow-up, supportive care and palliative care. Constant collaboration between nurses in these various roles and other healthcare professionals ensures that issues are identified early, concerns are addressed and questions are answered, thus supporting and enabling health throughout the illness experience.
1. Nurse Navigator
Nurse Navigators play a central role in the care of the oncology patient. Their primary duties are:
- Coordination of care.
- Helping the patient and family navigate through the health care system.
- Acting as a support to patients and their families.
- Providing information and education to patients and their families.
Nurse Navigators are available to the patient and family throughout the course of the illness and wherever the patient is located, be it during clinic visits, while receiving treatment as an outpatient, on an inpatient unit if the patient has been hospitalized for investigation, treatment, symptom management or palliative care, or even beyond the hospital in the community. They are the bridge which links the patient and family with various health care professionals who are involved in the patient’s care, as well as with the various necessary resources outside the hospital. Nurse Navigators work in close collaboration with the treating physicians and are present during the patient’s clinic visit to offer teaching and support as well as to facilitate referrals to other health care professionals on the team.
2. Clinical Nurse Specialist
Clinical Nurse Specialists are not only involved in clinical practice but they are also the teachers and educators, mentors, leaders and researchers within the nursing field. Their duties include:
- Coaching and guidance.
- Teaching and education.
- Policy and procedure development.
Clinical Nurse Specialists act as resource person to other nurses in practice both in the outpatient clinics and on the inpatient wards, and provide education and support to nurses in direct patient care roles. They are involved in the development of evidence-based resources and in-services for the continuing education of nurses, support new nurses in establishing themselves in their new role, attend patient care rounds with other nurses in their area of interest, and provide direction on complex cases and treatments. They teach and supervise undergraduate and graduate nursing students in both clinical training and clinical research and also participate in the education of other health professional students both informally and by facilitating inter-professional education initiatives. Clinical Nurse Specialists are actively involved in the development of best practice guidelines through medical and nursing research and offer a nursing perspective on various clinical and systemic issues. They are often consulted by other health care professionals regarding complex cases or specific patient care issues.
3. Primary Nurse
Primary Nurses work in the outpatient cancer care clinics. Each patient is followed by one specific primary nurse in the clinic throughout the duration of their treatment. These nurses have a broad base of knowledge with respect to various types of cancer and various tumour sites, and very specialized knowledge concerning treatment administration, patient and family experience of treatment, and symptom management. Throughout the treatment period, the primary nurse provides the patient and family with in depth teaching and information while maintaining an ongoing assessment of the patient and family’s response to treatment. They are available for phone and drop-in consultation, working to facilitate admission to the emergency room or an inpatient unit as required.
4. Acute Care Nursing Team
The Acute Care Nursing Team consists of resource nurses and staff nurses providing care to cancer patients who may be admitted for treatment, symptom management or palliative care. They have specialized knowledge concerning the management of oncologic and hematologic emergencies and inpatient care. By collaborating with the Nurse Navigator and Primary Nurses in the outpatient clinics, the Acute Care Nursing Team is able to ensure continuity of care and have access to a global perspective on the patient and family’s treatment and care.
Blending of Roles
The boundaries between several of these nursing roles are permeable. In some situations, the Nurse Navigator may also be a Primary Nurse in an outpatient cancer care clinic. In cases where the Primary Nurse is also the Nurse Navigator on a team which addresses a particular concern, this blending allows the nurse to identify patients undergoing treatment who may benefit from referral to the team. In the case of blended Nurse Navigator - Clinical Nurse Specialist roles, the nurses use their knowledge of the patient and family experience from their clinical practice as Nurse Navigator to guide their Clinical Nurse Specialist activities. For example, the duties as a Nurse Navigator will allow the nurse to identify areas where direct care nurses may need additional coaching, and policy development will naturally attend to the patient and family experience. Nurse Navigator – Clinical Nurse Specialists are able to identify with and support direct care nurses because they are directly involved in patient care.