Queens­land Reg­is­tered Nurse and researcher Dr Amy-Louise Byrne out­lines here the ben­e­fits of this role.

“The cur­rent health sys­tem, we have to acknowl­edge, is dis­joint­ed. It is just not fit for the mod­ern sit­u­a­tion,” says Amy.

“Some­one goes to hos­pi­tal because of their heart, a can­cer, a bro­ken leg. They are dealt with, and dis­charged and then are chan­nelled into silos – a spe­cial­ist here, a com­mu­ni­ty ser­vice there.

“Nowa­days, peo­ple are liv­ing longer and the typ­i­cal per­son in the sys­tem has mul­ti­ple chron­ic ill­ness­es, say a heart issue, asth­ma and a skin cancer.

“The orig­i­nal sys­tem is not designed for this and the cre­ation of the Nurse Nav­i­ga­tor role is a recog­ni­tion that bet­ter coor­di­na­tion is needed.

“These peo­ple need holis­tic care: pos­si­bly mul­ti­ple spe­cial­ists, ser­vices, med­ica­tions. And the Nurse Nav­i­ga­tor is there to tra­verse and coor­di­nate them all.”

In her pre­sen­ta­tion at the recent CRANAplus con­fer­ence on Nurse Nav­i­ga­tors and where they fit with­in the Rur­al Remote Nurs­ing Gen­er­al­ist Frame­work, Amy point­ed out that this new mod­el of care fits in with and sup­ports all the oth­er roles, be it RN, RAN, spe­cial­ist, GP, com­mu­ni­ty nurse etc. 

“Nurse nav­i­ga­tors fit into that frame­work with their advanced skills in nego­ti­a­tion, prob­lem solv­ing, col­lab­o­ra­tion and coor­di­na­tion, and nav­i­gat­ing the com­plex­i­ty of the sys­tem,” says Amy.

“They under­stand the sys­tem and the con­straints of the sys­tem. They can do cre­ative things and are encour­aged to work at the mar­gins. They have the courage to bend the rules to nav­i­gate red tape and the cum­ber­some bureau­crat­ic system.

“Nurse nav­i­ga­tors exist through­out the entire­ty of Queens­land – and offer val­ue to all ser­vices. How­ev­er, I believe they are par­tic­u­lar­ly effec­tive in rur­al and remote contexts. 

“While rur­al and remote nurs­es cham­pi­on health care and health equi­ty for their com­mu­ni­ties, see­ing gaps in ser­vices and work­ing to ensure that their com­mu­ni­ties have safe and effec­tive care avail­able, the Nurse Nav­i­ga­tor cham­pi­ons the work of the rur­al and remote nurs­ing. With­in the gen­er­al­ist frame­work, this goes some­way in sup­port­ing, cel­e­brat­ing and shin­ing a spot­light on the gen­er­al­ist roles they under­take,” says Amy.

As we all know, rur­al and remote nurs­es are stretched to the lim­it; it is dif­fi­cult to keep health work­ers in a com­mu­ni­ty for any length of time; and there is often a pre­dom­i­nance of FIFO work­ers and stu­dent nurses.

Amy, an RN with 15 years’ expe­ri­ence includ­ing emer­gency care and rural/​remote prac­tice, tak­ing on roles such as clin­i­cal nurse and Direc­tor of Nurs­ing, moved into the world of acad­e­mia, research and edu­ca­tion in 2019.

“My research areas are nurse-led mod­els of care, rur­al and remote health, Abo­rig­i­nal and Tor­res Strait Islander health equi­ty and health sys­tem redesign with a focus on per­son-cen­tred care. She is cur­rent­ly Senior Lec­tur­er and Post­grad­u­ate Research Coor­di­na­tor in the School of Nurs­ing, Mid­wifery and Social Sci­ences at Cen­tral Queens­land University 

“I am very hap­py work­ing in acad­e­mia. It suits me. I feel I can con­tribute to nurs­ing in a very dif­fer­ent way. Once it was in the clin­i­cal sphere, now it’s advo­cat­ing for the pro­fes­sion­al nurse from a research perspective.

The Nurse Nav­i­ga­tor role was intro­duced into the Queens­land health sys­tem in 2017 and that state now has more than 400 Nurse Navigators.

“Peo­ple who are referred to the Nurse Nav­i­ga­tor usu­al­ly have very com­plex sit­u­a­tions, lots of chal­lenges, and are using the hos­pi­tal a lot,” says Amy.

“The Nurse Nav­i­ga­tor is a con­duit, and could be work­ing across per­haps the hos­pi­tal area and the com­mu­ni­ty area; across acute and pri­ma­ry care; pub­lic and pri­vate health care.

“They may have to trav­el or liaise and assist with trav­el and accom­mo­da­tion; speak to all nec­es­sary areas not just health, for exam­ple, hous­ing or Cen­tre­link; make health appoint­ments on the same day and maybe advo­cate for families.

“The peo­ple who choose to go into this area are very senior nurs­es, with pro­fes­sion­al matu­ri­ty and a high lev­el of skills and expe­ri­ences,” says Amy.

“This role suits peo­ple who don’t want to become a man­ag­er or an edu­ca­tor. They want to be per­son-cen­tred and remain as a clin­i­cal nurse – and yet use all their skills.”

In most nurs­ing roles, case man­age­ment focus­es on clin­i­cal care and coor­di­na­tion, while patient nav­i­ga­tion focus­es on social sup­port and advo­ca­cy. Case man­age­ment is typ­i­cal­ly dis­ease-spe­cif­ic, while nav­i­ga­tion is typ­i­cal­ly indi­vid­u­alised. ​“There is room for every­body,” says Amy.

Data col­lect­ed since the intro­duc­tion of Nurse Nav­i­ga­tors in Queens­land shows that:

• Nav­i­ga­tor-led align­ment of care for out­pa­tient appoint­ments result­ed in a cost sav­ing of$3,350 per nav­i­gat­ed per­son per annum
• Read­mis­sion rates decreased by 6%
• Fail­ure to attend appoint­ments decreased by 5.7%
• Dis­charge against med­ical advice reduced from 1.7% to 0.2%
• Nurse Nav­i­ga­tors embed­ded a nov­el clin­i­cal path­way with senior nurs­es lever­ag­ing their exten­sive knowl­edge and expe­ri­ence to jour­ney the patient across the health care boundaries
• Nurse Nav­i­ga­tors deliv­er per­son-cen­tred care 
• Peo­ple receiv­ing care and their fam­i­lies loved navigation.

“I am clear­ly a huge advo­cate for the Nurse Nav­i­ga­tor mod­el of care,” says Amy. ​“Nav­i­ga­tion is a gold­en oppor­tu­ni­ty – and cer­tain­ly they are a mod­el which can be looked upon to dri­ve the rur­al gen­er­al­ist framework.

“The spe­cif­ic area, how­ev­er, that does need fur­ther atten­tion and devel­op­ment is lever­ag­ing sys­tem improve­ment. And I believe that more needs to be done to cap­i­talise on Nurse Nav­i­ga­tors’ under­stand­ing of the lim­its of the sys­tem from both the health care and from the con­sumer perspective. 

“This will go a long way to help con­sumers con­nect with the care that they need.

“This is the area that needs future attention.”