Jeana FrancoJeana Franco, RRT, had heard of “nurse navigators” before, but the concept of an “RT navigator” had never occurred to her. So when she was approached by her department director at Hoag Hospital Presbyterian in Newport Beach, CA, in March of 2014 about starting a pilot program for COPD disease management that would be driven by an RT navigator she was more than a little intrigued.
“The idea of an RT navigator was very exciting so I accepted the challenge,” says the AARC member. Six months later the pilot program had met its goal of reducing readmissions and the hospital approved a full time pulmonary disease management navigator position. Franco applied and got it, and she’s been working to bring these life-enhancing services to COPD patients throughout the facility ever since.
Additional training helps
Franco says her previous experience as a staff therapist and charge therapist helped prepare her for the role, but she also acquired additional training to ensure she would have the skills necessary to serve as a navigator for patients with pulmonary disorders. “I also obtained the COPD Educator certification through the AARC and the asthma educator certification through the National Asthma Educator Certification Board. Both of these helped me prepare for the case management and educator aspects of the navigator role.”
She spent some time training with RN case managers and social workers at Hoag as well, and worked with the team in the hospital’s outpatient pulmonary rehabilitation department too — additional preparation that she says gave her a “broad understanding of the bridge between inpatient and outpatient services.”
Responsibilities are many
The navigator position at Hoag requires Franco to wear many hats. According to the therapist, major responsibilities include —
- Performing MDI and FFN instructs and training patients on the proper use of CPAP, BIPAP, and other equipment; airway clearance methods; pacing and breathing exercises; smoking cessation; and all aspects of symptom management.
- Assisting discharge planners with respiratory equipment orders for discharge.
- Referring patients to outpatient services when appropriate.
- Working with MDs, RNs, and other hospital staff to coordinate the patient’s care.
- Providing training to home health and SNF agencies that receive patients from the facility to ensure best practices are used in the care of Hoag patients.
- Performing audits for home health, SNF, and medical equipment providers and reporting back to hospital administrators about which providers have the best outcomes for pulmonary patients.
- Making follow up calls to patients to ensure follow through with the plan of care after discharge and encourage adherence to therapy and physicians’ recommendations.
Challenges and rewards
The biggest challenges she’s faced in the job so far are keeping up with CMS changes and getting buy-in from other staff for the RT navigator position. “It’s a dynamic time in health care and we have had to reevaluate processes and roll with the punches over the last year and a half to make sure we are targeting the right patient population to positively affect our readmission numbers and our mortality,” she says.
Convincing other disciplines of the value she could bring to the care of patients has taken some extra effort as well, but the level of professionalism and expertise demonstrated by the RT staff has done the trick. “We won them over in the long run and we have earned the respect of the entire inpatient to outpatient team,” says Franco.
It’s all been worth it, continues the therapist, especially when she thinks about how her services are changing the lives of COPD patients at Hoag. “Working with chronically ill patients is never easy, but it is always rewarding, having that patient that gives you that ‘ah ha moment,’ when they finally realize that they can take steps to manage their symptoms and improve their quality of life all because we took that extra time to work with them and give them the tools to help themselves,” says Franco.
For some patients, it could be as simple as being able to get dressed without overwhelming feelings of dyspnea. For others spinning around the dance floor again with a spouse means the world. “These are the things we are working to accomplish. Little rewards every day that make a big, big difference in our patients’ lives.”
Potential abounds for RT Navigators
Indeed, Franco has seen so much success in her new role that Hoag has now hired a second pulmonary disease management navigator to cover overflow patients on its main campus and patients seen at its smaller facility in nearby Irvine.
She believes the area has a lot of potential for other therapists as well — as long as they realize working as a navigator is not the same as delivering bedside respiratory care.
Her advice: “I would encourage RTs to learn as much as they can before making a big career change. There are many resources for RTs looking for info about disease management — the COPD Foundation, AARC, and NAECB were all very useful. Talking with case managers and pulmonary rehab therapists is also a great way to learn about the processes involved.”
