Cancer Nurse Navigator

Sciences

Cancer Nurse Navigator, Oncology Clinic

Date of Interview: April 4th, 2017

Transcript:

Q: So would you please state your job title, where you currently work, and how long it’s been since you graduated from college?

A: So I am a cancer nurse navigator, I work in Milwaukee, Wisconsin at a cancer care clinic, and I recently – it was May 2016 where I graduated with my bachelor’s degree.

Q: Great, and you had an associate’s some time before that?

A: Correct. May of 2006 is when I graduated with my ADN in nursing.

Q: Excellent. And how long have you been in this current job?

A: My current job I’ve been in since November of 2016. So not too long, but I’ve been an oncology nurse my entire nursing career, almost eleven years.

Q: Eleven years, great. Could you please provide a brief description of your primary job functions?

A: My primary job functions are really helping patients who are from the spectrum of newly diagnosed all the way to end of life and beyond, even in survivorship, who have peers, to help them navigate the system. Whether it’s local resources, or helping them connect with other hospital systems to make sure that they’re getting the care that they need.

Q: Great. How frequently are you required to write in your job, and if you could maybe estimate in an average week, what percentage of your job requires writing? Anything from emails or very casual writing to more formal things.

A: So daily. We’re daily writing, because I’m seeing patients every day. So even in brief interactions, I do have to document in an electronic medical record, talking about what I did, what I taught them. I would say percentage of it, I mean, it’s not a large percent, I would probably say about 20 percent of my time is in documenting.

Q: Great, okay. And–

A: Which is– oh, go ahead.

Q: Oh no, please go ahead.

A: Well I was saying, which is very different than I think a lot of nurses, especially if you’re a nurse who works in a hospital. I would say that percentage would be much higher. They spend a lot of time behind a computer documenting.

Q: Okay, that’s good to know. What forms or types of writing or what kinds of documents do you most often complete?

A: Progress notes within the electronic medical record, and then again, email – there’s still email – I don’t communicate with patients via email, but definitely with other staff members, with doctors at other clinics. We also have something, they’re called staff messages, that we can use within the software that we use, and it’s how other caregivers at other sites, and other systems even, can communicate with one another, but it doesn’t go into a patient’s medical record.

Q: Okay, great. And so the audiences, could you tell me a little bit about the varying audiences that you’re writing to?

A: Medical assistants, the doctors, other nurses, and then other clinic staff, so my boss. It could be general, just clinic staff as well – so we have lab techs, there’s pharmacists, pharmacy techs, it’s kind of a wide spectrum. I mean, even our PSRs, which is a patient service representative, which is pretty much who you see when you walk into a clinic, who checks you in. So really, I’ll communicate with all of them on different times.

Q: Okay. It sounds like from the description that most of those communications, that the purpose is informative. Are there other purposes that you’re writing– are you ever trying to sort of make an argument in some way, or is it usually pretty informative or like relaying information?

A: Very informative in this role. Prior to me being a cancer nurse navigator, I was a supervisor of two oncology clinics for four years. So in that role, there was more policies, process changes, I think bigger-picture items that I was disseminating to staff that reported to me. But in my current role, it’s more informal, if anything, just because I’m part of the clinic staff, so it could just be honestly, something as simple as a potluck, like, “What are you going to bring?” [laughter], as far as emails are concerned. Recently, however, there’s a group of nurses within our clinic, and a nurse practitioner that we started a journal club. And as far as a journal, not like a writing journal, but where you’re reading nursing journals and specific areas of interest and, so even those, everybody is designated per month to come up with what journal we want to present, and then you have to write questions for people to think about, like your peers to think about. So in that sense, it’s more informative.

Q: Oh cool, that’s really cool, okay.

A: Yeah, it’s great.

Q: That’s great, okay. Were you familiar with the types of writing that you do in your daily work when you were a student?

A: No, I think as a student, any time you’re writing papers or anything that you had to write, there was obviously, we had to follow APA style, the format for writing. So not so much in electronic medical record, because to me, I feel like what I learned in school – it’s not as strict, it’s much more casual, what you can write in electronic medical record.

Q: In your actual work, it’s much more casual?

A: Correct. And I think I should be careful on how I say that, because I think, I mean, you still want to make sure you’re, like at least when I’m writing, I want it to be concise, and not using a lot of “its”, “the”, “he”, “she”, you know? So I’m pretty concise, but I think there was a difference, there was just more of a focus on a certain style, and bibliographies, and things like that, that I had to make sure the spaces were correct and you had things in the correct order, where it’s not like that when I’m documenting in my current job.

Q: Okay, okay. Could you describe, and it might be useful in this question to think of maybe just a typical writing project, like maybe think of one, because I’m sure that they vary significantly, but in a typical writing project, could you tell me a little bit about your writing process, starting from how writing assignments or tasks come to you, if there’s any preparation, steps in writing or revising, getting feedback, like what’s that typical process look like?

A: In my current job?

Q: In your current job, yeah. And like I said, if you want to think of a particularly specific example, that’s fine.

A: I think I’m going to revert back to even when I was a supervisor, having to write a document to pretty much ask for more staff members. So in that, I think you’re having to follow a very strict guideline of again, how you document within a medical record, being very precise, using data, making sure that you have numbers that correlate your need. So I would say that would probably be my sample.

Q: Okay, great, yeah. And so when you write a draft of something, is there a feedback process – a document like that – or is it just you revising it yourself?

A: No, no, definitely feedback process. And in that process it would have been from my boss, kind of giving it to her, who would look over it and give suggestions, or say, “Yeah, this part’s great, but add this, if this is needed to emphasize whatever the need is based on.” Because basically, when you’re sending something like that, you’re sending it to higher-ups in finance, so it can’t just be like, “Give me a staff member!” You really have to– and even if you have everything laid out and the numbers make sense, and you can still see a real need, you have to realize, you have to be able to speak to that. Because as a finance person who’s looking at that, they’re looking at those numbers, but they don’t understand the clinical side of it, so the actual piece of when somebody’s working in that clinic, what does that look like. So you can’t always write that in your document, so you have to speak to what you’re writing as well.

Q: Great, okay. And when that feedback comes from your boss on a document like that for example, could you tell me a little about the comments? Meaning like, are they high-level suggestions, or are they very specific line edits?

A: Could be both. It could really be both. It could just be rewording something, but typically yes, it’s high-level and wanting to I think cut out any extraneous verbiage that might be in there or things that just don’t pretty much cut to the point of what you need. Yeah, it could be both depending on how much time I’ve worked on it.

Q: Got it, okay. How long do you typically have to complete a writing project? That one maybe even, for example?

A: Typically, with that specifically example, I think we had a couple weeks to kind of go back and forth. And even once you submit something, there’s still going to be questions back, where you have to submit additional data. So if there’s a strict deadline, you’re going to go by that. I would think there’s typically, in that role as supervisor, we weren’t ever under very, very tight timelines. So, within a week, you can usually have something done. If not, even several days. It wasn’t really complicated.

Q: Okay, okay. And you mentioned that your boss oversees the more formal writing that you have. How would you say that he or she judges the success of your writing?

A: I would say I think as long as really looking over it, if they can understand it from a high level, looking at the document and say, “I understand exactly what you need and you’re laying out bullet points of what it is that required this.” Basically, I think if they can understand it, and feel comfortable with submitting it, that’s the feedback, and we’re able to move forward.

Q: Okay. Can you tell me a bit about what is at stake in your writing?

A: What’s at stake in my writing – I think any electronic medical record, and I think you hear this in nursing school, is – it’s a true document. So I don’t want to put things in that I maybe assumed the patient felt or said. So if I’m using verbatims, I’m using quotation marks, I’m basically stating exactly what a patient may say. Because ultimately, it has to be an accurate document to reflect, I mean, worst case scenario, if there’s ever a lawsuit, that document should be true to whatever conversations or whatever had occurred at that time, because it could be looked at. And there’s a big thing in nursing where basically, and I think in general in the medical profession, that if you don’t document, it didn’t happen. So you can have all these interactions with patients, and I could talk to a patient all day and educate them on any type of treatment or side effects or whatever it may be, but if I don’t actually put that I did all those things, it didn’t occur. So I think that’s a really big piece that’s at stake.

Q: Yeah. Is that difficult to ensure that you get all of that down every time?

A: I think it can be at times, especially if you’re feeling overwhelmed and very busy, because they want you to document in real time – so you have an interaction with a patient and family member, you want to go back and it’s like anything, if you start writing about it right away, you’re going to retain more of actually what occurred, versus you know, an hour or two go by, and you’ve met several patients, and I’m like, “Well who did I tell this to and that to?” So I really attempt to make sure, and in my job can make that happen, but it can be difficult, where if you don’t have that opportunity because you’re so busy and seeing a lot of patients, I will still even revert to writing things down, patient’s names, what we talked about, just to trigger my memory of what we did.

Q: Gotcha, gotcha, okay. In what ways do you think your academic background prepared you to write in this job?

A: If I would go back to when I started school at 18 and I took an English class, I would say not at all. Because I feel like I was not engaged as a student, and I feel like, oh I didn’t like English. But as I matured age-wise and also personality-wise, which could be debateable whoever’s hearing that [laughter], I feel like even having the experiences within my job, and again going back to school as an adult who is working fulltime and has a family, I feel like when I took a writing course within the last year, it definitely meant more to me and I was able to utilize what I had learned more in my everyday job. And to me it’s important that, I don’t know, I feel like writing proper and making sure that what I have to say makes sense to whoever is reading that. I don’t know if I answered the question, I’m sorry I got a little bit off track.

Q: No, no, you did. That’s great, that’s great. So that was about the ways in which school did prepare you to write in the workplace, and I’m wondering if there are other ways that you feel school maybe left you unprepared in other ways as a writer in the workplace?

A: Unprepared?

Q: You cut out, say that again?

A: Am I on okay?

Q: Yep, you’re good now, thank you.

A: Do you hear me?

Q: I do.

A: I don’t know if I would say I was unprepared, because in school we didn’t exactly document in a medical record, but you were writing out careplans, and so pieces of what you would have to do within your daily life as a nurse, so it definitely prepared me. The unprepared part, I feel like it’s a given in any, especially as a new nurse – yes, you get a foundation in school about anatomy and physiology and maybe English and microbiology and things like that – however, I feel like you do most of your learning, and how you want to– you learn most, in my opinion, from actually starting as a new nurse. So I’m sure if I looked back to what I wrote my first year of nursing to what I am now, I’d probably be like, “Oh!”, you could see how much is probably grown as far as being concise in what I have to say. So I don’t know, I don’t feel like I was unprepared in my education, in writing in college.

Q: That’s great. So when you think back to those early challenges that I think are very universal to anybody coming out of college and going into the workplace in terms of writing, were there specific strategies that you utilized to sort of learn the things about writing that you felt you needed to learn? For instance, a strategy might be looking at the writing of coworkers, or supervisors, or seeking out training, or anything like that.

A: Yeah, definitely. And so even in my current role as a navigator, yes, definitely looking at other navigators and what they write and what they– yes, definitely utilizing them as examples of what I think is important to put into it. And then also realizing no, I’m not going to utilize what they have, and kind of go with what I feel is important to add in a medical record. So there is definitely that.

Q: Great, okay. And have you had any, I know the most recent college graduation is pretty recent, but have you had any writing training or education since then?

A: No.

Q: Alright. And two more questions. The first is, would you say that you are a successful workplace writer?

A: I would say yes. I think yes, I feel like I am deliberate and conscious of what I’m writing and again, want to make sure that what I have to say makes sense, and I use– which can sound kind of strange at times, but I feel like I want to be proper in what I’m writing, because I don’t always see that in electronic medical records. Sometimes you see things where you’re like, “Oh that doesn’t make sense in how that’s–” you know, in what people are using. So yeah.

Q: Great, great. And what skills would you say are most central to writing in your very specific role, and in your very specific organization and industry?

A: What skills in writing – I think definitely understanding medical terminology, understanding– I speak a lot to treatments, so knowing what those things are, knowing the road that people have to be on and really incorporating that into my writing. Because you can look at a doctor’s note, and it has so much information, and so what I do is I feel like I take out the important pieces, where honestly, even if a patient read it, that they would understand really what’s going on, and not so much from a higher level from like a doctor who’s speaking certain medical jargon within their documentation, I will still use certain obviously treatment names and specifics as far as surgeries, if they’ve had biopsies, but really, if a patient were to read that, they would completely understand what I had said. And that’s kind of how I feel the role of the nurse in really important, is conveying that information to the patient in a way that’s understandable.

Q: Gotcha.

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