The Emergence of the Nurse Navigator Role in Patient Flow

Today's reality―an aging population with increasing healthcare needs, highly complex inpatient cases, and sharply rising costs combined with shrinking reimbursement, are challenging hospitals to optimize internal operations and improve the efficiency and effectiveness of care.  Additionally, emergency department (ED) overcrowding that results from delays in getting patients placed in a bed can also result in ambulance diversions―all of which negatively impact the quality and safety of patient care.  Not to mention the fact that hospitals risk losing revenue from inefficient processes.

This is where effective patient flow comes into play.  Hospitals that have successfully tackled the delicate matching of available capacity with the demand for care have learned that: it is a critical operational priority, it requires executive sponsorship, and both people and technology resources are necessary.  Rigorous process improvement approaches, such as Lean and/or Six Sigma methodologies, are often used to uncover blockages in the system, as well as underlying root causes.  These operational improvement strategies often include engaging with nurses to share their expertise in clinical decision-making, a critical variable in effective patient flow management.

In August 2017, TeleTracking interviewed eight nurse leaders at hospitals using TeleTracking’s solutions about the role that nurses play in flow management at their institutions.

The questions included:

• What are the various roles and titles that nurses or nurse-led teams hold in your health system or hospital?
• What are the necessary attributes that nurses who work to streamline or manage patient flow must have to be successful?
• Are these nursing roles focused on patient flow expanding in numbers and breadth, and are they working across multiple care settings and populations?
• Will these nursing roles require specialized certification in the future?

And the key takeaways included:

• Patient flow management is a strategic process that needs to be orchestrated across the entire care continuum and involves  staff from almost every department and at all levels.  All of the hospitals designated an executive sponsor, usually a Chief Operating Officer or Chief Nurse Executive, to oversee patient flow management.
• As part of their routine “on-boarding” process,  new nurses observe the hospital’s bed flow process in order to understand its intricacies and metrics.
• The criticality of patient flow management is being used for applications for Magnet Recognition® from the American Nurses Credentialing Center (ANCC), the prestigious distinction a healthcare organization can receive for nursing excellence.
• Patient acuity continues to increase and that’s why the leadership of system-wide patient flow requires a nurse with clinical knowledge, critical thinking skills, and a holistic approach to care. The patient care coordinator or nurse responsible for overseeing patient flow – sometimes called a Nurse Navigator (or expeditor, flow coordinator, or patient flow improvement leader) – is the “captain of the ship”, reporting directly to the executive sponsor.

Janet Hanley, Vice President Patient Technology, Innovation, Efficiency at California’s Sharp HealthCare noted, “It is important to understand that these nurse navigators perform different work than that of case managers; patient flow or navigator nurses must focus on movement of patients at the system level and not get too involved in individual patient care management or daily operations.  They are often seen as the unsung heroes of the system who are passionate about their work in assuring safe and high quality patient care.”

• Specialty certification for patient flow nurses or nurse navigators makes sense to pursue

The nurses also shared their thoughts on the DAISY Award for Extraordinary Nurses in Patient Flow, agreeing that compassion, drive for results, leadership, change facilitation, resource management, and clinical knowledge  are the necessary competencies to be an extraordinary patient flow nurse.

Susan Kilgore, RN, Vice President Patient Management/Rural Outreach for Methodist Healthcare in San Antonio, TX, is the winner of the inaugural DAISY Award for Extraordinary Nurses in Patient Flow.  Ms. Kilgore underscores the criticality of planned patient flow in her description of her health system’s response to Hurricane Harvey in September 2017.  The system had only 48 hours to prepare for the potential large number of transfers or patient admissions―in all, a total of 190 patients were placed at Methodist Healthcare, a process that with real-time technology was handled seamlessly.

Acknowledgements

I'd like to acknowledge and express appreciation to the following nurse leaders who participated in the structured interviews about the role of nursing in managing patient flow:

• Janet Hanley, Vice President, Patient Technology, Innovation, Efficiencies; Sharp Healthcare, San Diego, CA
• Amy Finnell, Director, Patient Logistics and Nurse Staffing; St. Elizabeth Healthcare, KY
• Hope Stack, Systems Flow Director; Palmetto Health, Columbia, SC
• Catherine Baker, Transfer Center Coordinator; George Washington University Hospital, Washington DC
• Eileen Barrett, Director of Capacity Management; MedStar Washington, Washington, DC
• Nicole Piken, Patient Flow Manager; White Plains Hospital, White Plains, NY
• Roz Lumpkin, Coordinator of Clinical Bed Management; Advocate Good Samaritan Hospital, Downers Grove, IL
• Susan Grimwood, Director, Patient Flow, Clinical Logistics, Observation Services, and Departure Lounge; Sarasota Memorial Hospital, Sarasota, FL
• Tonya Scarborough, Nurse Manager; NMMC, Tupelo, MS
• Joy Moody, Vice President, Patient Care Services; Maine Medical Center
• Annel Gibson, Care Coordinator; Trinity Mt. Carmel East, Columbus Ohio