Tag Archives: staffing

Navigation Caseload Quandary?

Learn about 2017 ACCC Innovator Award winner USA Mitchell Cancer Institute’s homegrown Oncology Navigation Acuity Tool.

By Rev. Diane Baldwin, RN, OCN, CBCN, and Meredith Jones, MS, BSN, RN

FinalSealUnfortunately, nurse navigation services are typically non-revenue generating, necessitating a cost/benefit evaluation of these services for many programs. To justify nurse navigation in this new era of value-based care, we must define appropriate caseload volumes through risk stratification, and determine how best to allocate nurse navigation time and resources among those caseloads.

How Best to Measure & Define Acuity?
Acuity tools have been used in healthcare for decades and have proven successful as a means of determining staffing needs, improving patient care, and controlling costs.  Most acuity tools score patients on a scale of specific attributes. For nurse navigation programs, an acuity tool can be used to determine caseloads and aid in more efficient nurse navigator caseload management.

At USA Mitchell Cancer Institute, our nurse navigators, known as Clinical Care Coordinators, maintain a caseload of approximately 175 patients. However, as we identified more patients needing navigation services, we recognized the need for an acuity tool specifically for caseload management.

As we researched acuity tools, we found limited options related to oncology nurse navigation. Each of the tools we identified was specific to a facility, and was either used to determine overall staffing or focused specifically on the amount of time spent with patients.  We believed that a more generalized tool, including more patient factors, was needed to accurately determine patient acuity. Therefore, the USA Mitchell Cancer Institute began developing an Oncology Navigation Acuity Tool, universally designed to benefit our practice, while also allowing for use and adaptation by other cancer programs.

More Than Just a Number
USA Mitchell Cancer Institute’s goal was to develop a tool that measures a patient’s acuity through a holistic lens. As cancer care providers know, each patient’s navigation needs depend on a variety of factors. Our Oncology Navigation Acuity Tool considers 11 factors that we identified as directly correlating with patient resource utilization and, therefore, acuity level.  Each factor is reviewed individually to determine the acuity score, placing less emphasis on cancer type and stage, and more emphasis on overall patient context. For example, two patients with the same type and stage of cancer, receiving the same treatment, may present with different comorbidities and levels of family support, resulting in two very different acuity scores.

An inherit weakness in most acuity tools is that the “score” assigned to the patient determines overall acuity. However, we know that our patients are more than just a number.  Standardized tools often fail to identify important elements needed to address individual patient needs. Therefore, our Oncology Navigation Acuity Tool includes a 12th factor in determining a patient’s acuity: The clinical assessment of the nurse navigator.  This factor is essential to assessing the “whole patient” and our aim of providing holistic care.  Our nurse navigators use the 11 factors of Oncology Navigation Acuity Tool as a guide to assess the acuity of the patient and combine this with their overall clinical assessment, for a final acuity score.  Ultimately, our nurse navigators, may elect to change the acuity level based on their assessment of the individual patient.

Putting the Tool to Work
The Oncology Navigation Acuity Tool allows us to easily assess the needs of each navigated patient prior to caseload allocation and to quickly determine the level of navigation the patient will need. The tool has also guided managerial decisions to adjust caseloads based on acuity rather than patient count alone.  Further, we’ve utilized this tool for both quality and process improvement to study the varied needs of patients among the acuity levels, and to determine the effect of accurately navigated patients on system utilization and cost.

In our presentation at the ACCC 34th National Oncology Conference, October 18-20, in Nashville, TN, we’ll share more on how using this low-cost, simple to implement tool has resulted not only in a cost-effective, efficient means of refining navigation utilization, but also in the delivery of more personalized, comprehensive, improved quality of care for our navigated patients.

We look forward to seeing you in Nashville!


Rev. Diane Baldwin, RN, OCN, CBCN, is Manager, Quality Assurance, and Meredith Jones, MS, BSN, RN, is Director, Quality Management, at the USA Mitchell Cancer Institute.  

Desperately Seeking Oncology Nurses?

Stressed by nurse staffing shortages? Learn how 2017 ACCC Innovator Award winner Loma Linda University Cancer Center tackled this challenge.

By Lexine Thall, MN, RN-BC, AOCN, and Kristina Chase, BSN, RN, OCN

FinalSeal

One of the most challenging issues in healthcare is the ongoing balancing act of staffing and retention. For specialty areas, such as oncology, staffing presents an even more difficult challenge. Finding those perfectly qualified individuals with all the right experience to fill open positions can be a taxing, time-consuming task. As a result, cancer programs may find themselves dealing with lengthy vacancies, which can cause some real strains on a growing clinic and may led to an unhappy environment for nurses and patients. When our cancer program encountered this understaffing dilemma, chemotherapy skilled and oncology experienced (CS-OE) RNs in our cancer center began facing increased workloads, which put them at risk for potential burn out, being vulnerable to making errors, and causing longer wait times for patients.

Our cancer program leadership team had to think outside of the box and create a road map to alleviate some of these staffing strains. An analysis of appointment types and RN skill level needed for each visit type revealed that 40 percent of our supportive care therapies (e.g., hydration, blood transfusions) did not require a CS-OE RN. Given this information, we decided to pilot a program that would fill RN vacancies with experienced non-oncology nurses and create a pathway for these RNs to attain the ONS Chemotherapy/ONCC Chemotherapy Biotherapy Certificate. Our aim was to provide a mentorship program in conjunction with vetted education tools to develop these RNs professionally and alleviate our staffing crisis. The pilot program launched in 2014, and to date, 17 nurses have been accepted into the mentoring program. All RNs who opted to pursue the ONS/ONCC Chemotherapy Biotherapy Certificate (7 of 7) have attained their goal and 86 percent (6 of 7) of the RNs who attained this certification have remained with our organization.

Our mentorship program has drastically decreased the length of time we have unfilled RN positions posted—from an average of 113 days down to 29 days. It has also given many nurses an opportunity to gain focused experience in a specialty area for which many employers may not be willing to bear the educational costs. In addition to the benefit for the non-oncology nurse, the program has provided professional satisfaction and role expansion for the CS-OE RN mentors. A win-win for all parties involved.

At the ACCC 34th National Oncology Conference, October 18-20, 2017, in Nashville, TN, we’ll be sharing the details of our mentorship journey, “how to’s” for developing a program like ours, and some lessons we’ve learned along the way.  I hope you can join us in Nashville!

Hear more from all the 2017 ACCC Innovator Award winners at the ACCC 34th National Oncology Conference, Oct. 18-20, 2017, in Nashville, TN. Learn more.


Lexine Thall, MN, RN-BC, AOCN, is Director, Patient Care, Loma Linda University Cancer Center; Medical Oncology/Hematology; Women’s Cancer/Surgical Oncology; and Kristina Chase, BSN, RN, OCN, is Patient Care Supervisor.