Nurse Navigation: An Integral Part of the Patient Experience

March 05, 2018

OSI's Kim Jablonski and Ann Dickinson.

Kim Jablonski can rattle off the path of her nursing career quite easily: 

  • Seven years in Refractive Eye Surgery, as a scrub tech, circulating RN, and laser/refractive technician
  • Five years in Cardiac Surgery ICU, providing direct one-on-one care for patients recovering from cardiac surgery
  • Two years in Prep/PACU, prepping patients for orthopedic surgery, starting IVs, prepping skin, reviewing charts/medications 
  • Three years in orthopedic, pediatric, medical/surgical nursing, providing direct patient care, overseeing a 35 bed unit, coordinating assignments, rounding with physicians
  • Eleven years as Total Joint Program Director, coordinating the entire care path experience for patients undergoing total joint replacement 

Recently Jablonski learned she has also been a Nurse Navigator. And she never even knew it.

Nurse Navigators have been in use for many years, mainly for oncology patients. Lately the designation has become a buzz term in orthopedics as well.

When the Orthopedic & Sports Institute (OSI) first opened in 2006, the capability of performing joint replacement surgery in the facility was two years away. At the outset, OSI needed someone with a varied background and extensive experience to coordinate the push to realize that goal. 

Jablonski, comfortable wearing many hats, became that person.

After the organization instituted a nationwide search to discover best practices at ambulatory surgery centers across the country, Jablonski was tasked with utilizing the information that was gathered to define the trajectory of the nascent program. With this came the management of an iterative learning process based on weekly meetings and feedback as well as the development of a monitoring system to identify key factors for success.

As the program took off, Jablonski added becoming a certified research assistant for an international quality improvement and registry project to her list of responsibilities. During this time, the first total hip, knee, shoulder, ankle, and bilateral procedures were performed at OSI.

“Yes, it was an arduous process,” Jablonski admitted, “but we created the program we envisioned at the start.”

Oh, and she was meeting with every joint replacement patient in a pre-surgical meeting. As of 2017, OSI was performing over 400 total joint replacements a year. 

This role, as Jablonski found out in a course she took last year, is called Nurse Navigator.

Jablonski frequently needed to remind herself that none of her responsibilities was more important than being the Nurse Navigator, the single point of contact for every patient about to embark on a joint replacement journey.

“Being there for patients and families, providing the help and support they need, was always the focal point of my job,” said Jablonski.

At OSI, Jablonski was ubiquitous, leading patient and spouse after patient and spouse on tours of OSI, getting them familiar with the campus – surgery center, imaging center, skilled nursing facility, physical therapy, café – and winding things up in a small conference room to review, one more time, the pre-surgical routine, the surgical expectations, and recovery timetable. 

And to make sure every question was answered to put the patient and family in the very best spot.

The rest of her duties, however, remained.

With the help of Ann Dickinson, RN, who assumed the bulk of pre-surgical patient meetings, Jablonski has transitioned from being OSI’s Nurse Navigator in order to focus on the program responsibilities that fall under the title of Orthopedic Total Joint Coordinator.

In this role, Jablonski oversees the entire process improvement for the joint program, facilitating communication among those involved in its delivery: surgeons, physical and occupational therapists, primary care physicians, skilled nursing, home health, leadership, and many other individuals and groups too numerous to mention.

In February, Jablonski will present at the Northeast Wisconsin Chapter of the National Association of Orthopedic Nurses, where she will share her journey at OSI, from the beginning of the joint program, to where it is now, to where it’s headed.

She has been there for it all.

“The program has evolved and continues to grow,” said Jablonski. “It’s all about advancing a healthcare model that provides quality at a lower cost by improving the patient experience.”

Total Joint Program Components
Providing the best patient experience requires attention to detail:

  • Furnish patient and family education
  • Maintain consistency of practice
  • Provide continuity of care
  • Expedite transitions 
  • Utilize risk stratification methods
  • Analyze outcomes
  • Make process improvements 
  • Facilitate, collaborate, and communicate
  • Manage all details to ensure the “WOW” experience