Examining the hurdles in defining the practice of Nurse Navigators

Soft Skills: The Work of Communication and Persuasion Among Nurse Navigators in Hospital at Home Programs

OBJECTIVE

To assess the role of soft skills in the work of Hospital at Home (HaH) nurse navigators.

BACKGROUND

In HaH programs that employ them, nurse navigators are often responsible for identifying, assessing, referring, and educating potential HaH patients. The experiences of these navigators have gone understudied.

METHODS

Researchers conducted semistructured interviews and observations with nurse navigators (n = 7) who collectively cover 14 North Carolina-based HaH sites. Navigators were asked to keep diaries of responses to directed questions.

RESULTS

In their capacity as navigators, interviewees said they served several roles: intermediaries between hospital and HaH staff, interpreters of clinical knowledge for patients, and champions of, and educators for, the home-based program. The navigators noted that the interpersonal soft skills of building rapport, clear communication, and gentle persuasion were of the utmost importance in this work.

CONCLUSIONS

The job descriptions of nurse navigators in HaH programs should fully reflect the breadth of their responsibilities, including time performing soft skilled labor. Also, training for these roles should include techniques to develop and refine these skills.

Our Nursing Profession at a Crossroads: Time to Chart a Course for the Future

Nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. As the role evolves, nurse navigators are demonstrating proficiency and achieving success transforming care delivery to improve population health while improving quality outcomes, patient satisfaction, and decreasing cost. One innovative health system's clinical nurse specialist team partnered with primary care providers, ancillary care teams, home care, skilled nursing facilities, community agencies, and partners in public health and schools. Clinical nurse specialists, now called "transitional care nurses (TCNs)," have created an accountable community of health for their high-risk population. By following patients from one setting to the next, TCNs identified opportunities for improvement, created innovative programs to bridge gaps, improved teamwork, and integrated care, resulting in lower cost, high-quality care. Results included 50% reduction in hospitalization for patients with chronic disease, pre- and post-TCN partnership. Patients with diabetes were supported with access to diabetes coaches, which resulted in a 12% reduction in AIC, while patients completing pulmonary rehabilitation programs experienced reduced readmission rates from 24% to 2.7%.

Nurses' attitudes and emotions toward caring for adults with intellectual disability: An international replication study

PURPOSE

Negative nurse attitudes and emotions toward caring for adults with intellectual disability have been implicated as a contributing factor to the cascade of health disparities faced by this population. The purpose of this study was to identify influencing factors of nurses' attitudes and emotions toward caring for adults with intellectual disability that transcend national borders and differing systems of care.

METHODS

This cross-sectional correlational predictive replication study used an online electronic survey with a snowball sample of 115 Australian nurses, from March to August 2020.

RESULTS

Nurses' attitudes toward adults with intellectual disability were significantly less positive compared to adults without intellectual disability, and nurses' beliefs about the quality of life of adults with intellectual disability predicted nurses' attitudes, replicating findings of the USA study. The frequency of both the professional and personal contact was associated with positive and negative emotions in both countries, however no consistent predictive pattern was evident.

CONCLUSIONS

Our findings suggest that worldwide, there is room for improvement in nurses' attitudes and emotions toward this underserved group. Future research should investigate the role of nurses' beliefs about quality of life of adults with intellectual disability for potential interventions to improve nurses' attitudes toward care.

CLINICAL RELEVANCE

Assisting nurses to identify misconceptions about the quality of life of adults with intellectual disability is suggested as an intervention to improve nurses' attitudes toward caring for adults with intellectual disability.