For many children and families, going to the hospital is overwhelming. Hospital visits are especially difficult for patients with chronic or complex health conditions. Whether families are facing a new diagnosis or coming for a routine outpatient appointment, they often experience added stress navigating the hospital and coordinating care with multiple departments. Through our core values, the Nurse Navigators strive to ease families’ worries and help our patients focus on healing.

Nearly a decade ago, we launched a new referral-based pilot nurse navigation program by creating a unique position within nursing to support patients and families with complicated health issues. It quickly became an essential service for our patients and families. In 2016, an additional nurse navigator was added to work specifically with children and families with autism. Today the program has six nurse navigators who support 10-12 families per week throughout the organization. The Nurse Navigators serve as a single point of contact to streamline communication, facilitate care, educate families, and offer emotional support. Referrals are received from the front-line staff to hospital board members.

In 2022, the program sought to focus on specialized patient populations who would greatly benefit from these services. Through a partnership with the foundation, the Nurse Navigator program received a gift to support our Behavioral Health population. Our vision is that all patients and families facing complex treatment journeys or requiring special coordination have access to nurse navigators.

Even before the COVID-19 pandemic, our community and nation faced a worsening pediatric mental health crisis. The pandemic turned the ongoing crisis into an emergency that will continue to impact young people for years to come. Depression and anxiety among youth doubled during the pandemic, according to a recent analysis published in JAMA Pediatrics (Slomski, 2021). Additionally, last winter, the average number of weekly emergency department visits for suspected suicidal ideation among adolescents 12–17 in the U.S. was up by 39 percent from 2019.

“The concept of teamwork and the idea of involving parents as team members — lessons I learned early in my career — form the foundation of the nurse navigator position,” says Dr. Kurt Newman, president, and CEO of Children’s National. “For me, the navigator role is a symbol of a radical rethinking we should invest in as a society for the health of our children.” On a typical day, nurse navigators connect with doctors and social workers, comfort families after a difficult diagnosis, and discuss next steps of a child’s treatment plan with parents. “We often meet families during some of their worst moments and work with them for months,” says Modupeola “Tosin” Hinga, BSN, RN, CPN. As one of our nurse navigators, she helps patients and their families solve problems. She advocates for them and coordinates care. “We create strong bonds with patients and families.”

Our nurse navigators are members of the care team and help to facilitate communication for a positive patient experience. They work closely with medical staff to relay questions from families and share updates or important context with providers. This facilitation is particularly useful for patients with chronic health issues who often see multiple specialists. Nurse Navigators support our safety culture through their connection with the care team and patient families. They close communication gaps by ensuring parents are heard and understand plans of care, including the medication administration process. In addition, there is follow up with patients after discharge to assess compliance to the care plan and address concerns.

The Nurse Navigators act as advocates, removing various barriers. During one encounter, the Nurse Navigator recognized a language barrier as well as an educational barrier. It was identified that the parent was having challenges understanding the medication administration process for discharge. The Nurse Navigator contacted pharmacy, explained the prescribed medications to the parent, and provided a color-coded reference document. The document was a visual outlining important information including what the medication is as well as the days and times the medication is due. The Nurse Navigator was able to connect the family to our patient and family education resource. This led to the development of a discharge education plan in the language and at the educational level of the parent, which supported a safe patient discharge.

On another occasion, a Nurse Navigator noticed a medication that a parent was holding. She inquired about the medication and identified a knowledge deficit as well as a need for medication reconciliation through the MAR. Her collaboration with the medical team supported the parent’s knowledge of a lifesaving medication. Through their connection with the foundation, the nurse navigators have supported referrals, which has played an important role in building relationships with donors and those close to them by making sure they have a positive experience and feel well taken care of.

The team is helping to build the pipeline for philanthropy totaling over $14 million. An example of the Nurse Navigator’s compassion, commitment, and connection is the story of H.O., a 10-year-old Nigerian girl admitted to the hospital with burns sustained in a gas explosion in November 2020 intended to assassinate her father. Her burns cover 40% total body surface area (TBSA) requiring extensive burn care. According to her mother, she was hospitalized in Nigeria for three months before being discharged because the nurses became tired of taking care of her. Mom says the family hired nurses for the home, but they tied her down and beat her if she resisted care. When H.O. arrived in the United States, her care was complicated by severe PTSD from her experiences in Nigeria. To manage her care and reduce stress related to PTSD, H.O. would be taken to the OR for dressing changes with sedation. The Nurse Navigators were consulted. They would often meet H.O. in her room and walk her to the pre-op waiting area. Due to being the only caregiver for the patient’s younger brother, the mother was not able to come for each dressing change. The Nurse Navigator willingly donned a “bunny suit” and accompanied H.O. into the OR, holding her hand until she drifted off to sleep. The Nurse Navigator team collaborated with H.O.’s care team, including nurses on the Surgical Care Unit and in Perioperative Services, LIPs, social work, child life, and Psychiatry, and her PCP, to ensure H.O felt safe and supported while in the hospital.

When it was time to register for school, the team connected with the school nurse and teacher to formulate a plan for a successful school year. Prior to the start of the school year, the Nurse Navigator team collected donations of school supplies and uniforms to relieve some of the financial stress from the mom. Almost a year later, the Nurse Navigator team continues to support both the patient and family by attending appointments and working with our partners at Children’s School Services.

References Slomski, A. (2021). Pediatric Depression and Anxiety Doubled During the Pandemic. JAMA: Journal of American Medical Association: 326(13):1246. doi:10.1001/jama.2021.16374