2013
Oncology Nursing Society
ONCOLOGY
NURSE NAVIGATOR
CORE COMPETENCIES
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 3
Oncology Nursing Society Oncology Nurse Navigator Core Competencies
Project Team Members
Karyl Blaseg, RN, MSN, OCN
®
Manager of Cancer Programs
Billings Clinic
Billings, MT
Marie Borsellino, RN, BSN, OCN
®
, CBPN-C
Breast Health Navigator
Sarasota Memorial Hospital
Sarasota, FL
Carol J. Bush, BS, RN
Nurse Navigator
The University of Kansas Cancer Center–Midwest
Cancer Alliance
Wichita, KS
Ellen Carr, RN, MSN, AOCN
®
Nurse Case Manager
UCSD Moores Cancer Center
La Jolla, CA
Lori McMullen, RN, MSN, OCN
®
; Team Leader
Senior Oncology Patient Navigator
The Edward and Marie Matthews Center for Cancer
Care
University Medical Center of Princeton at Plainsboro
Plainsboro, NJ
Teri A. Banman, RN, BSN, OCN
®
Lead Navigator
The University of Kansas Cancer Center–Westwood
Westwood, KS
Judy M. De Groot, RN, MSN, AOCN
®
Lead Oncology Nurse Navigator
Penrose Cancer Center
Colorado Springs, CO
Susan T. Jacobs, RN, BSN, OCN
®
Oncology Nurse Navigator
Head & Neck and Lung Cancers
Disney Family Cancer Center
Burbank, CA
Dominique M. Srdanovic, RN, MA, OCN
®
Oncology Nurse Navigator Supervisor
GU Nurse Navigator
Stamford Hospital, Bennett Cancer Center
Stamford, CT
Oncology Nursing Society Staff
Emily Franey
Program Assistant, Education
Oncology Nursing Society
Pittsburgh, PA
Heather T. Mackey, RN, MSN, ANP-BC, AOCN
®
Project Manager, Education
Oncology Nursing Society
Pittsburgh, PA
Expert Reviewers
4 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
Diane McElwain, RN, OCN
®
, M.Ed.
Oncology Coordinator
York Cancer Center/WellSpan
York, PA
Britta Newcomer, RN, BSN, OCN
®
Clinical Quality Specialist
Catholic Health Initiatives
National Oncology Service Line
Woodland Park, CO
Karen Overmeyer, MS, RN, APRN-BC
Lung Cancer APN Navigator
Henrico Doctors’ Hospital
Richmond, VA
Jean B. Sellers, RN, MSN
Administrative Clinical Director
UNC Cancer Network
Chapel Hill, NC
Patricia Strusowski, MS, RN
Clinical Director, Cancer Program
Christiana Care
Newark, DE
Donna Moore Wilson, BSN, RN, CBCN
®
Oncology Nurse Navigator
Bon Secours Virginia Health System
Richmond, VA
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 5
Table of Contents
Overview ..................................................................................................................... 6
Key Terms Used in This Document ............................................................................................................. 6
Background ................................................................................................................................................. 6
Purpose of Competency Development ....................................................................................................... 7
Definition of Oncology Nurse Navigator Core Competencies ..................................................................... 7
Process of Competency Development ........................................................................................................8
Step 1: Develop List of Core Competencies .........................................................................................8
Step 2: Field Review .............................................................................................................................8
Step 3: Expert Review ........................................................................................................................... 8
Professional Practice Framework ...............................................................................................................9
Applicability and Dissemination ..........................................................................................................10
Initial Requirements ............................................................................................................................10
Summary ..................................................................................................................................................10
References ................................................................................................................................................11
Oncology Nurse Navigator Core Competencies ....................................................................... 12
Introductory Statement ..............................................................................................................................12
Competency Category 1: Professional Role .............................................................................................12
Competency Category 2: Education ..........................................................................................................12
Competency Category 3: Coordination of Care ........................................................................................13
Competency Category 4: Communication .................................................................................................13
6 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
Overview
Key Terms Used in This Document
• Oncology nurse navigator: An oncology nurse navigator (ONN) is a professional registered nurse with oncology-specic
clinical knowledge who oers individualized assistance to patients, families, and caregivers to help overcome healthcare
system barriers. Using the nursing process, an ONN provides education and resources to facilitate informed decision
making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum.
• Lay navigator: A trained nonprofessional or volunteer who provides individualized assistance to patients, families, and
caregivers to help overcome healthcare system barriers and facilitate timely access to quality health and psychosocial
care from prediagnosis through all phases of the cancer experience (Oncology Nursing Society [ONS], 2010b).
• Novice: A nurse who has worked two years or less as an ONN and is building upon his or her academic preparation,
nursing knowledge, and oncology experience to develop expertise in the ONN role.
Background
In 1990, Harold Freeman, MD, initiated the rst patient navigation program at Harlem Hospital Center in New York
City for patients with breast cancer. One of the major goals of the program was to expand access to cancer screening and
clinical follow-up among medically underserved women through community outreach and the elimination of health
access barriers (Freeman, 2006). Freeman was able to demonstrate that ve-year cancer survival rates can be improved
with increased access to screening and patient navigation programs by addressing and working to eliminate issues pre-
sented by lack of health insurance, fear and distrust of the medical community, and cultural and communication barriers.
e program was based on the role of lay navigators working to eliminate these health access barriers, thus increasing
screening rates among underserved women, promoting timely care by reducing the time from abnormal nding to the
determination of a cancer diagnosis and treatment, and ultimately improving breast cancer survival rates (Freeman, 2004).
Over the past two decades, the success of Freeman’s patient navigation program has had a signicant impact on the
delivery of cancer-related health care across the nation. In 2001, the President’s Cancer Panel, established by the National
Cancer Act of 1971 to monitor implementation of the National Cancer Program, released Voices of a Broken System: Real
People, Real Problems. e details of the report revealed that barriers limiting or preventing access to cancer care are not
unique to poor Americans but are experienced by Americans across all socioeconomic levels (National Cancer Institute,
2001). Four years later in 2005, President George W. Bush signed legislation that provided funding for patient navigation
demonstration projects under the Patient Navigator Outreach and Chronic Disease Prevention Act (American Cancer
Society, 2009). e projects provided grants for the development and operation of patient navigator services for the pur-
pose of improving healthcare outcomes (H.R. 1812, 2005).
In 2012, the American College of Surgeons Commission on Cancer (ACoS CoC) released standards that reected the
goal of “ensuring patient-centered care.” One of the new standards, to be phased in for 2015, is standard 3.1, requiring
cancer programs that are seeking accreditation to establish a patient navigation process driven by a community needs
assessment (ACoS CoC, 2012). is community needs assessment enables facilities to identify potential healthcare bar-
riers and determine a navigation process aimed at eliminating those barriers. e National Accreditation Program for
Breast Centers (NAPBC) also requires a navigation process to obtain and maintain accreditation as a Breast Center of
Excellence. Most recently, navigation and care coordination concepts were addressed within the Patient Protection and
Aordable Care Act (PPACA), which was signed into law by President Barack Obama in March 2010. Patient navigators
in this role assist uninsured Americans in transitioning into healthcare program exchanges following the opening of
enrollment into the PPACA in October 2013.
As care delivery evolves to include the role of the navigator, healthcare systems across the nation attempt to replicate
Freeman’s success while acknowledging the need to fulll CoC and NAPBC standards for accreditation. In numerous
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 7
articles published addressing the role of navigators in the oncology setting, navigators were identied in a variety of
capacities: patient navigators, care navigators, professional nurse navigator, cancer care navigator, nurse navigator, and
ONN, among others. In 2010, ONS, in collaboration with the Association of Oncology Social Work and the National
Association of Social Workers, released a position statement addressing patient navigation (ONS, 2010b). e position
clearly supported the importance of the patient navigator role, stating that the patient navigator could either be a lay
person or a professional.
Freeman’s patient navigation model focused on overcoming barriers associated with access to screening in order
to improve detection of cancers at an early stage (Freeman, 2004). Over the past 20 years, the role of the navigator has
expanded to encompass cancer care across the continuum, from prevention to survivorship to end-of-life care. In many
cancer programs, oncology nurses are functioning in the role of professional navigator secondary to their cancer-specic
knowledge and clinical expertise. Benets of a nurse performing the role of the navigator include the skill to clinically
assess patients, provide support and education, manage the complexity of the cancer diagnosis, and communicate and
collaborate with other clinicians (Gilbert et al., 2011). Additionally, the oncology nurse in the role of navigator has the
ability to proactively anticipate patients’ needs, initiate appropriate referrals, and provide valuable education to equip
patients with knowledge and understanding, thereby reducing anxiety and stress, which allows patients to feel more in
control of their situation (Wilcox & Bruce, 2010).
Purpose of Competency Development
ONS recognized that a growing number of oncology nurses identify oncology nurse navigation as their primary role
function. Supported by data collected in the ONS Nurse Navigator Survey and ONN Role Delineation Study (Brown et
al., 2012) and anecdotal information from the ONS Nurse Navigator Special Interest Group (SIG), ONS identied the
need to clearly dene the role of the ONN, as well as support growth and standardization of the role by developing core
competencies. is need led to the ONS Board of Directors’ plan for the development of ONN competencies as well as
the planned publication of a textbook on oncology nurse navigation.
e ONS Oncology Nurse Navigator Core Competencies are intended to describe the fundamental knowledge and
skills that novice ONNs should possess or acquire during their rst one to two years in the role. ese competencies
are meant to reect practice across the majority of settings but must be considered within the context of the individual
navigation program.
Several challenges arose during the development of these competencies. To begin, nurses enter the specialty
of oncology nurse navigation with diverse clinical experiences and educational preparations. Some function as
advanced practice nurses with a different scope than the registered nurse. These differences in clinical background
and education preparation lead to variability in the skills and knowledge brought into the role. Similarly, ONNs
operate differently across geographic and institutional settings. Many ONNs specialize in one type of malignancy,
whereas others function in more of an oncology generalist role. Those who practice in larger centers with access
to significant resources (providers, community and institutional support programs) function quite differently than
those in rural areas where they may be the only ONN. Additionally, the orientation and development of ONNs is
not standardized. In many cases, the ONN must learn on the job without other ONNs to mentor them. Many new
ONNs must bear the responsibility for identifying their baseline knowledge and skill level, recognizing professional
development needs, and locating resources to meet these learning needs. This can be quite challenging in settings
with limited resources.
Definition of Oncology Nurse Navigator Core Competencies
ONN competencies include the fundamental knowledge, skills, and expertise required to prociently (a) participate
in the care of patients with a past, current, or potential diagnosis of cancer, (b) assist patients with cancer, families, and
8 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
caregivers to overcome healthcare system barriers, and (c) provide education and resources to facilitate informed deci-
sion making and timely access to quality health and psychosocial care throughout all phases of the cancer continuum.
Process of Competency Development
e ONN Core Competencies were developed using a multistep process. e rst step involved a literature review
to identify and compare common competency themes and gaps. e project team also reviewed past ONS competency
projects: the Oncology Clinical Trials Nurse Competencies, the Oncology Clinical Nurse Specialist Competencies, the On-
cology Nurse Practitioner Competencies, and the Leadership Competencies (ONS, 2007, 2008, 2010a, 2012), to gain an
understanding of the scope and process involved in professional competency development.
Step 1: Develop List of Core Competencies
Starting with a thorough review of the literature, the ONS ONN Project Team met in November 2012 and began
the process of clearly dening the role of the ONN. A brainstorming session resulted in the following denition of an
oncology nurse navigator:
An oncology nurse navigator is a professional registered nurse with oncology-specic clinical knowledge
who oers individualized assistance to patients, families, and caregivers to help overcome healthcare
system barriers. Utilizing the nursing process, an oncology nurse navigator provides education and
resources to facilitate informed decision making and timely access to quality health and psychosocial
care throughout all phases of the cancer continuum.
e development of a clear denition of an ONN allows for a uniform understanding of who lls the role of ONN.
e next step in the process was a review of the literature for skill and knowledge requirements, job position descrip-
tions, and the ACoS CoC guidelines. e “Oncology Nurse Navigator Role Delineation Study: An Oncology Nursing
Society Report” (Brown et al., 2012) was reviewed to solicit input about essential knowledge, skills, and expertise required
of an ONN in a variety of settings. All the information was expanded upon and further detailed during project team
brainstorming sessions. e project team divided the knowledge base and function of the ONN into four categories:
professional role, education, coordination of care, and communication. ese categories were rened to a list of 47 ONN
professional core competencies.
Step 2: Field Review
To validate the competencies, a eld review was then conducted. Field reviewers were asked to comment on the clarity
of the dra competency statements and whether these behaviors and skills were core to the ONN role and whether they
were appropriate for a novice navigator. ey were asked to comment on whether each competency should be included
in the nal ONN core competencies document and to make suggestions on competencies that might be included.
e eld review survey was sent to all ONS Nurse Navigator SIG members, as well as all ONS members who reported
their primary work function to be nurse navigation, for a total of 486 nurses. A total of 189 responses were received. Of those,
142 were complete surveys for a 29.2% return rate. e responses represented all regions of the country and a wide variety of
practice settings. Participants reected diversity in educational levels, years of practice as a nurse, and tumor sites navigated.
Based upon eld review ratings of each statement as well as individual comments, the list of core competencies was
edited and rened to clarify individual statements, reduce redundancy, and eliminate competencies deemed beyond the
scope of novice ONNs.
Step 3: Expert Review
Ten expert reviewers were identied and agreed to complete a review of the ONN core competencies. ese experts
were chosen based upon their years of experience and leadership role in oncology nurse navigation. e expert reviewers
were asked to comment on the ow, clarity, completeness, and appropriateness of the overall competencies, as well as to
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 9
provide further feedback on individual statements. Based on their feedback, additional edits were made and a nal count
of 40 core competencies was produced to dene the role of the ONN.
Professional Practice Framework
In an attempt to provide a foundation for professional nurse navigation and to better understand the role of the navi-
gator, the ONN Project Team relied on their extensive review of the literature to support the development of the organiz-
ing framework for the ONN. e framework articulates the ONN practice model and role function, thereby providing
support for the development of the competencies (see Figure 1).
e dening feature for the ONN is the ability to deliver care using the steps of the nursing process: assess, plan,
implement, and evaluate. In practice, the ONN demonstrates the functional skills to educate, facilitate, and advocate, all
within the context of cultural sensitivity.
e core of the framework, and key element in understanding the function of the ONN, is the concept of working
for and within two operational domains: the patient and the healthcare system. e ONN works to inuence positive
patient outcomes but also to promote positive system outcomes through improved interdisciplinary communication,
patient retention, and downstream revenues (Desimini et al., 2011; Fillion et al., 2012).
Figure 1. Oncology Nurse Navigator Professional Practice Framework
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10 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
Applicability and Dissemination
e intent of the development of these core competencies was to assist with dening the role of the novice ONN.
Because of the lack of consensus around the role of the navigator, the competencies were intended to provide a basic
framework for the ONN role and responsibilities. e competencies can be used in many ways, including but not limited to
• Developing the role of the ONN
• Writing job descriptions
• Providing managers with information to successfully screen applicants for nurse navigator positions
• Developing orientation programs
• Providing guidance for preceptorship of new ONNs
• Developing competency checklists
• Assisting managers in developing evaluations for ONNs
• Contributing toward the overall evaluation of a navigation program
• Promoting the role of the ONN.
e use of the ONN competencies will help guide experienced oncology nurses into becoming ONNs and provide a
backbone for the development and evaluation of the ONN role.
Initial Requirements
e ONN plays a vital role in achieving successful outcomes for patients with cancer. Research has clearly shown
improved patient outcomes that resulted from the presence of an ONN (Case, 2011). To achieve successful patient out-
comes, the ONN must possess a certain skill set. ese skills may include but are not limited to
• Strong organizational skills
• Ability to prioritize and reprioritize quickly
• Ability to develop collaborative relationships both internally and externally
• Strong leadership skills
• Strong interpersonal skills
• Strong verbal and written communication skills
• Ability to work in teams
• Ability to work autonomously
• Strong oncology knowledge
• Basic computer skills
• Basic knowledge of managed care
• Critical-thinking skills
• Working knowledge of insurance coverage and procedures
• Working knowledge of community resources
• Registered nurse license
• Oncology nursing experience
• Certication as an Oncology Certied Nurse (OCN®), Advanced Oncology Certied Nurse (AOCN®), Advanced On-
cology Certied Nurse Practitioner (AOCNP®), or Advanced Oncology Certied Nurse Specialist (AOCNS®).
Summary
e process to identify ONN core competencies and behaviors was supported by evidence-based practice and validated
by a consensus-driven, peer-review process. e professional practice framework highlights a bidimensional accountability
because the ONN not only promotes timely access to care (Desimini, 2011; Fillion et al., 2012; Wilcox & Bruce, 2010) but
also supports improved communication and continuity of cancer services across the organization for patients, the cancer
care team, and the healthcare system. e competencies outlined in this document will provide novice ONNs, practic-
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 11
ing across any tumor site, patient population, or healthcare setting, as well as their employers, foundational concepts to
establish and grow programs by supporting the functional role and job responsibilities that are determined by the needs
of the patient, the community, and the organization (Pedersen & Hack, 2010; Wilcox & Bruce, 2010).
References
American Cancer Society. (2009, April 14). Navigating dicult waters: e history of the patient navigators. Retrieved from http://www.cancer.org/cancer/
news/features/navigating-dicultwaters-the-history-of-the-patient-navigators
American College of Surgeons Commission on Cancer. (2012). Cancer program standards 2012: Ensuring patient-centered care [v.1.2]. Retrieved from http://
www.facs.org/cancer/coc/programstandards2012.pdf
Brown, C.G., Cantril, C., McMullen, L., Barkley, D.L., Dietz, M., Murphy, C.M., & Fabrey, L.J. (2012). Oncology nurse navigator role delineation study: An
Oncology Nursing Society report. Clinical Journal of Oncology Nursing, 16, 581–585. doi:10.1188/12.CJON.581-585
Case, M. (2011). Oncology nurse navigator: Ensuring safe passage. Clinical Journal of Oncology Nursing, 15, 33–40. doi:10.1188/11.CJON.33-40
Desimini, E.M., Kennedy, J.A., Helsley, M.F., Shiner, K., Denton, C., Rice, T.T., … Lewis, M.G. (2011). Making the case for nurse navigators: Benets, outcomes,
and return on investment. Oncology Issues, 26(5), 26–33. Retrieved from http://accc-cancer.org/oncology_issues/articles/SepOct2011/SO11-Desimini.pdf
Fillion, L., Cook, S., Veillette, A., Aubin, M., de Serres, M., Rainville, F., … Doll, R. (2012). Professional navigation framework: Elaboration and validation
in a Canadian context [Online exclusive]. Oncology Nursing Forum, 39, E58–E69. doi:10.1188/12.ONF.E58-E69
Freeman, H. (2004). A model patient navigation program. Oncology Issues, 19(5), 44–46.
Freeman, H. (2006). Patient navigation: A community centered approach to reducing cancer mortality. Journal of Cancer Education, 21(Suppl. 1), S11–S14.
doi:10.1207/s15430154jce2101s_4
Gilbert, J.E., Green, E., Lankshear, S., Hughes, E., Burkoski, V., & Sawka, C. (2011). Nurses as patient navigators in cancer diagnosis: Review, consultation
and model design. European Journal of Cancer Care, 20, 228–236. doi:10.1111/j.1365-2354.2010.01231.x
H.R. 1812, 109th Congress. (2005). Retrieved from http://www.govtrack.us/congress/bills/109/hr1812
National Cancer Institute. (2001). Voices of a broken system: Real people, real problems. President’s Cancer Panel Report of the Chairman, 2000–2001. Bethesda,
MD: National Cancer Institute.
Oncology Nursing Society. (2007). Oncology nurse practitioner competencies. Retrieved from http://www2.ons.org/media/ons/docs/publications/
npcompentencies.pdf
Oncology Nursing Society. (2008). Oncology clinical nurse specialist competencies. Retrieved from http://www2.ons.org/media/ons/docs/publications/
cnscomps.pdf
Oncology Nursing Society. (2010a). Oncology clinical trials nurse competencies. Retrieved from http://www2.ons.org/media/ons/docs/publications/
ctncompetencies.pdf
Oncology Nursing Society. (2010b, March). Oncology Nursing Society, the Association of Oncology Social Work, and the National Association of Social
Workers joint position on the role of oncology nursing and oncology social work in patient navigation. Retrieved from https://www.ons.org/about-ons/
ons-position-statements/education-certication-and-role-delineation/oncology-nursing-0
Oncology Nursing Society. (2012). Oncology Nursing Society leadership competencies. Retrieved from http://www2.ons.org/ClinicalResources/media/ons/
docs/clinical/leadershipcomps.pdf
Pedersen, A., & Hack, T.F. (2010). Pilots of oncology health care: A concept analysis of the patient navigator role. Oncology Nursing Forum, 37, 55–60.
doi:10.1188/10.ONF.55-60
Wilcox, B., & Bruce, S. (2010). Patient navigation: A ‘‘win-win’’ for all involved. Oncology Nursing Forum, 37, 21–25. doi:10.1188/10.ONF.21-25
12 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
Oncology Nurse Navigator Core Competencies
Introductory Statement
e ONN demonstrates critical thinking and uses the nursing process to assess and meet the needs of patients by
providing care coordination throughout the cancer continuum. He or she works between the domains of the patient and
family unit and the healthcare delivery system to improve health, treatment, or end-of-life outcomes. is is accomplished
through competent practice in the following functional areas.
Competency Category 1: Professional Role
e ONN demonstrates professionalism within both the workplace and community through respectful interactions
and eective teamwork. He or she works to promote and advance the role of the ONN and takes responsibility to pursue
personal professional growth and development. e ONN
1. Promotes lifelong learning and evidence-based practice, by self and others, to improve the care of patients with a
past, current, or potential diagnosis of cancer
2. Demonstrates eective communication with peers, members of the multidisciplinary healthcare team, and com-
munity organizations and resources
3. Contributes to the knowledge base of the healthcare community and in support of the ONN role through activities
such as involvement in professional organizations, presentations, publications, and research
4. Contributes to ONN program development, implementation, and evaluation within the healthcare system and
community
5. Disseminates knowledge of the ONN role to other healthcare team members through peer education, mentoring,
and preceptor experiences
6. Obtains or develops oncology-related education materials for patients, sta, and community members as appropriate
7. Participates in the tracking of metrics and patient outcomes, in collaboration with administration, to document and
evaluate outcomes of the navigation program and report ndings to the cancer committee
8. Collaborates with the cancer committee and administration to perform and evaluate data from the community
needs assessment to identify areas of improvement that will aect the patient navigation process and program and
participate in quality improvement based on identied service gaps
9. Promotes a patient- and family-centered care environment for ethical decision making and advocacy for patients
with cancer
10. Establishes and maintains professional role boundaries with patients, caregivers, and the multidisciplinary care team
in collaboration with manager as dened by job description
11. In collaboration with other members of the healthcare team, builds partnerships with local agencies and groups
that may assist with cancer patient care, support, or educational needs.
Competency Category 2: Education
e ONN provides appropriate and timely education to patients, families, and caregivers to facilitate understanding
and support informed decision making. e ONN
1. Assesses educational needs of patients, families, and caregivers taking into consideration barriers to care (e.g., lit-
eracy, language, cultural inuences, comorbidities)
2. Provides and reinforces education to patients, families, and caregivers about diagnosis, treatment options, side eect
management, and post-treatment care and survivorship
3. Educates patients, families, and caregivers on the role of the ONN
Oncology Nursing Society Oncology Nurse Navigator Core Competencies — 13
4. Orients and educates patients, families, and caregivers to the cancer healthcare system, multidisciplinary team
member roles, and available resources
5. Promotes autonomous decision making by patients through the provision of personalized education and support
6. As part of the multidisciplinary team, provides education and reinforces to patients, families, and caregivers the
signicance of adherence to treatment schedules, protocols, and follow-up
7. Assesses and promotes healthy lifestyle choices and self-care strategies through education and appropriate referrals
to ancillary services
8. Provides anticipatory guidance, education, and appropriate referrals to assist patients in coping with the diagnosis
of cancer and its potential or expected outcomes
9. Promotes awareness of clinical trials to patients, families, and caregivers.
Competency Category 3: Coordination of Care
e ONN facilitates the appropriate and ecient delivery of healthcare services, both within and across systems, to
promote optimal outcomes while delivering patient-centered care. e ONN
1. Assesses patient needs upon initial encounter and periodically throughout navigation, matching unmet needs
with appropriate services and referrals and support services, such as dietitians, providers, social work, and -
nancial services
2. Identies potential and realized barriers to care (e.g., transportation, child care, elder care, housing, language, cul-
ture, literacy, role disparity, psychosocial, employment, nancial, insurance) and facilitates referrals as appropriate
to mitigate barriers
3. Develops or uses appropriate assessment tools (e.g., distress thermometer, pain scale, fatigue scale, performance
status) to promote a consistent, holistic plan of care
4. Facilitates timely scheduling of appointments, diagnostic testing, and procedures to expedite the plan of care and
to promote continuity of care
5. Participates in coordination of the plan of care with the multidisciplinary team, promoting timely follow-up on
treatment and supportive care recommendations
6. Facilitates individualized care within the context of functional status, cultural consideration, health literacy, and
psychosocial and spiritual needs for patients, family, and caregiver
7. Demonstrates knowledge of clinical guidelines (e.g., National Comprehensive Cancer Network, American Joint
Committee on Cancer) and specialty resources (e.g., ONS Putting Evidence Into Practice resources) throughout
the disease process
8. Assists in the identication of candidates for genetic counseling and facilitates appropriate referrals
9. Supports a smooth transition of patients from active treatment into survivorship or end-of-life care
10. Uses an ethical framework regarding patient care to assist patients with cancer with issues related to treatment goals,
advance directives, palliative care, and end-of-life concerns
11. Ensures documentation of patient encounters and provided services
12. Applies basic knowledge of insurance processes (e.g., Medicare, Medicaid, third-party payers) and their impact on
staging, referrals, and patient care decisions toward establishing appropriate referrals, as needed.
Competency Category 4: Communication
e ONN demonstrates interpersonal communication skills that enable exchange of ideas and information eectively
with patients, families, and colleagues at all levels. is includes writing, speaking, and listening skills. e ONN
1. Builds therapeutic and trusting relationships with patients, families, and caregivers through eective communica-
tion and listening skills
2. Acts as a liaison between the patients, families, and caregivers and the providers to optimize patient outcomes
14 — Oncology Nursing Society Oncology Nurse Navigator Core Competencies
3. Advocates for patients to promote optimal care and outcomes
4. Provides psychosocial support to and facilitates appropriate referrals for patients, families, and caregivers, especially
during periods of high emotional stress and anxiety
5. Empowers patients and families through education and encouragement to self-advocate and communicate their needs
6. Adheres to established regulations concerning patient information and privacy
7. Ensures that communication is culturally sensitive
8. Facilitates communication among members of the multidisciplinary cancer care team to prevent fragmented or
delayed care that could adversely aect patient outcomes.
Oncology Nursing Society
125 Enterprise Drive
Pittsburgh, PA 15275
412-859-6100
www.ons.org
Copyright © 2013 by the Oncology Nursing Society
