Amy Graber (right) says
nurse navigators are an integral part of the cancer care team.
When they hear they have cancer, many patients react with shock, fear, horror or resignation. "They shut down," said Amy Graber, R.N., Alegent Creighton Health oncology nurse navigator supervisor. "They only hear so much of what the doctor's saying." According to Graber, they're often so stunned or overwhelmed "they only hear seven percent of what the doctor's telling them."
Enter the cancer nurse navigator.
The nurse navigator is an oncology-certified nurse who guides the patient and his or her family through the entire process of cancer diagnosis and treatment at Alegent Creighton Health. This service is free of charge and is available at all Cancer Center locations. For Graber, that often means close interaction with 12 to 15 patients a day.
Whether it's on the phone or in person, Graber and her fellow nurse navigators are a single point of contact for their patients every step of the way.
This particular morning, Graber started by calling a woman to see how she was doing after her surgery.
"Any problems?" Graber asked. "Do you have pain in the chest area or underneath your arm?"
She cautioned the patient not to lift anything weighing more than 10 pounds and to avoid driving while on her medication. The woman had a lot of questions and Graber took her time answering them. "I'll check in with you later in the week. If you need me, call me!"
Graber typed some notes in her computer and reached for the phone again. This time she was checking on a patient with melanoma.
"The news was good? That's awesome!" she told the patient as she volunteered to go to the next appointment with her.
After hearing the patient's questions, she suggested she work with a dietitian. "I can send you some information that would be helpful and Carol, the dietitian, will call you." There is no charge for consulting with the dietitian—just as there's no charge for everything the nurse navigators do.
Graber made a quick dash upstairs to find a lung cancer patient she feared wouldn't put on the weight he needed.
"You put on three pounds!" she encouraged him as he gave her a big smile from under his Nebraska ball cap. Graber promised to check on the doctor's orders for his physical therapy and rushed back to her office. In the next half hour she would, among other things, run down the doctor's orders, set up transportation for a patient who needed it, and call one of the cancer team's social workers about another patient's housing concerns. Then she called a younger patient, reminding him of an important appointment later that day and mentioned that she would look into a free gas card for him.
Graber said nurse navigators are an integral part of the cancer care team. They assist in scheduling tests and consultations, helping patients understand the diagnosis and plan of care and collaborating with the medical team to ensure information is current and clear.
"For many patients, it's comforting just knowing that there's someone they can call, who can answer their questions," Graber said. One patient in her 90s appreciated that Graber went to all of her appointments with her. Others have countless questions about chemotherapy and side effects. Graber answers them all. The nurse navigators rotate being "on call" so they can even field questions in the middle of the night, if necessary.
With that kind of TLC, many patients include Graber in their celebrations. Late in the morning, a woman walked in with two plates of red velvet cupcakes that she'd baked. "It's my last day for chemo! I'm happy but it's scary too," she said as she handed a plate to Graber.
Graber then met with a patient who was facing a long series of appointments—including everything from heart and lung tests to scans and stem cell transplants. Graber reviewed each appointment, making sure the patient understood where she had to be and when. The woman clutched the stack of papers and gave Graber a long hug as she left, telling her: "Love you!"
Graber was off to the chemotherapy room, where she spoke again with the patient who was having her last treatment. The woman was cold; Graber ran to get her a blanket. Then it was down the hall to track down a physician about radiation treatments. She returned to the patient and filled her in on what to expect from radiation. They hugged. "Congratulations on your last chemo appointment!" Graber told her.
Not far away she encountered a woman battling esophageal cancer and checked to see how she was feeling. "You're good at what you do," the grateful patient told her. As she walked away, Graber spotted another patient. "How's it going?" Graber asked."It's going. I'm very tired," the woman responded.
Graber comforted her and took time to see what she could do to make her life a little easier. That included giving the patient information on the Road to Recovery program with the American Cancer Society and offering to assist her, if she needed.
"I like being there for my patients and seeing them get through their treatments," Graber said. "People tell me, ‘What a depressing job you have.' I tell them the happy moments outweigh the sad."
Graber has an extensive history helping cancer patients. She worked in oncology at another local hospital after getting bachelor's and master's degrees in nursing. She worked for Alegent Creighton Health for a dozen years, both in radiation and as the breast care coordinator. In 2006, she became an oncology nurse navigator.
She's never forgotten the impact one of her first patients had on her. "He was being treated for colon cancer. He did well for two to three years. The cancer came back and spread. But he called it as it was, no pussyfooting around. He taught me, ‘Enjoy the time you have because nobody knows when it'll be taken away from you.'"
She's learned a lot from her patients, but Graber also gives a lot.
A note with the red velvet cupcakes read: "To Amy, my Angel! You're the best! Thanks for everything you do! God bless you."
You can reach a Nurse Navigator at (402) 717-CARE (2273)