Good afternoon, welcome to our webinar. We're going to get started in just two or three minutes. We've got people trickling in, so appreciate your patience. We'll get started shortly. Good afternoon, all. We're going to give it just one more minute. We've got people joining, and we'll get started in just another minute. Good afternoon, all. All right, it is 1.02, so we're going to get started. I thank you all for your time and joining me today as we go over our findings from the recent Nurse Navigator and Coordinator Survey. Just a few housekeeping things. We do have, you'll find in the bottom of your Zoom screen, a chat, which you'll find the link to the presentation in this box. We also have a Q&A box, so if you have any questions, please make sure you put them in the Q&A box, not the chat box. I am going to hold off all questions until the end, and when we have time at the end, I'll go ahead and answer those questions. If not, I'll be happy to reach out and connect and answer those after. We're going to get started with a quick question. Curious to know what interested you in this webinar. Today, we're talking about nurse navigators and coordinators, and want to know if you're just here to learn more, you don't have a lot of knowledge about the roles or the responsibilities, but you have navigators or coordinators, and you are trying to understand those roles better, or you're looking for some support, or maybe another reason. Give everybody just a minute to answer that. All right. Do we have those answers in? Yes, Jenny. It looks like 65% selected B. Okay, great. Thank you. Wonderful. Well, I'm glad you're here, so let's dive in. Our goal, as I said, we released the survey at our spring CVT, and we're really trying to understand these roles better. We know we have got navigators and coordinators within cardiology. Today is going to be a very high-level overview of the answers and the responses we got. Little history is the whole patient navigation really started in, I'm sure a lot of you know this, the oncology space. It was really initiated by the American Cancer Society. The really first documentation we see of nurse navigators is in oncology around 2009. Navigators have been around a while, more recent for cardiology, so we really want to understand in more detail how we can structure these positions, how we can clarify their roles and responsibilities. Lots of information that we're going to go through. We had a good response rate. We've got 48 programs that responded to our survey. We really appreciate you providing that information. It gives us a starting point, and it's programs from academic, a wide variety of program models and areas, so we appreciate that. We've got about 41 positions that are represented in today's survey, so it is a good start. We want to look at these different sites, and those sites that engage with the survey do, for the most part, employ coordinators or navigators. You'll see 90% have these roles in their organizations currently. I do like this map, even though it's not really representative of the whole country. A lot of our respondents you'll see are on the east side, so you'll see there's areas that have maybe one and up to six or more that have responded to the survey, so dense in terms of east coast, and would love to know more about what's going on in the Midwest and the West, but just to show you kind of where our responses are coming from. So, of those sites that do not actually have coordinators, it's kind of telling that this is a hot topic, because 75% are looking to hire or have open positions, so what we are looking for is heart failure, structural, and advanced heart failure. Those are the top sought out, most sought out programs that are looking for this support. You can also see consideration in EP, just the general cardiovascular space, and CV surgery. This thing you're going to kind of see with these trends in terms of dominance within heart failure structural throughout the report, but I think it's interesting that we are, you know, there is this interest and this desire to grow these roles. So, wanted to kind of understand as well how long these roles have been in systems, so you'll see that the majority have been in place for the last three or more years. So, those sites that are newer are smaller, so it kind of tells me that these positions that have been in place, they're pretty stable and the sites are utilizing them. So, hoping to, you know, continue to increase this, but already seeing some stability in terms of this role. So, a lot of the questions that come up are even kind of big questions. What is their reporting structure? Who do they, who actually employs them? What's their compensation model? What's their schedule? So, when we're looking at employment and reporting structure, most are employed by hospitals or systems. Now, it doesn't differentiate if it's a single hospital or if it's multi-hospital system, but you can see that there's not very many that are housed within clinics or practices. Most of them are under a hospital or system. Looking at reporting structure again, you're going to see just over half are reporting through a CV service line. Again, is that just CV service line for one hospital or a multi-hospital system? That's not really clear in this, but it is showing kind of that most of them are going up through the service line. Now, the second largest reporting structure is the other category. So, you're going to find a multitude of reporting structures, including nurse navigators reporting to nurse coordinators who report up through the hospital or service line. Some report directly to dyad leaders. Some are reporting through nurse managers and others through quality departments. And then you'll see outside of that, again, those numbers in the medical group reporting through the medical group are pretty small. So, it's more a hospital-specific or a systematic approach for reporting of these positions. Job titles. So, this is where I think things are really interesting because we want to understand what the difference between the navigator and the coordinator roles are. Unfortunately, I'm not going to have a lot of answers for you. We've got some information, but you can see it's pretty well split almost right down the middle, coordinator, navigator. And then there's a few other titles of roles that pretty much function as those but are not titled those. So, when you look at coordinators, the most common titles are program coordinator and structural heart coordinator. So, again, there's that structural heart that we're going to see a lot. And then under nurse navigator, the most common are just nurse navigator or heart failure nurse navigator. So, those were the most commonly reported job titles. I think it was interesting. A lot of organizations have roles, have both roles. And so, that's going to come up later in terms of how do we differentiate what's a coordinator versus a navigator. Other titles include device coordinator, chest pain coordinator, clinical coordinator, EP, and RN coordinator. So, you can see we've got some that are broad and some that are very focused, like structural heart or EP. For navigator, other titles, we've got patient service line navigator, cardiac navigator, AMI navigator, and the CV health and wellness navigator. So, huge broad titles with broad responsibilities, I'm sure. And then others have more narrow focus on disease-specific programs and patients. So, some other titles they just refer to as, you know, cardiovascular nurses, but they had these navigator or coordinator responsibilities. One used a term advanced nurse clinician. And then I thought this was really a great point. Though it's not a nurse, one site used these MA facilitators to help offload the nurse navigators and coordinators and the APPs. So, I wanted to plug that in because, you know, we're talking in terms of a team-based care model, and that was a great example of using our MAs to help support these teams. So, again, just lots of variation in terms of what are the job titles. So, when we look at requirements, you know, obviously experience is huge. That's one of the top-seeking requirements. We need somebody who can function independently, who can make those clinical decisions, use their critical thinking. So, obviously, we know experience is key. Interesting, most, almost 88% require BSN. So, not too many require an MSN or higher. And there was mention of several that they wanted certification. So, disease-specific certification, which I'm a huge proponent of that. I think that's great. These team members are crucial, and they're seen as your expert. So, they need to know, and to be certified is just another layer of education and promoting them to be the expert for your system. So, interesting, the nurse coordinators really were BSN or higher, and the nurse navigators were BSN preferred, or someone would consider somebody who has an associate's degree with enough experience. So, a little bit of variations there, but for the most part, we're looking for BSNs. And again, just worth mentioning that MA facilitator. I think that's just such an important call-out because the site used that for a growth opportunity. So, when we think about, you know, in terms of retention and all the staff turnover, there's internal growth opportunity that can really elevate a MA that's worthy of some extra responsibility and keep them in your practice or in your program to support the team. So, let's look at compensation. So, lots of questions on the listserv about this in the past few months. And what we see is that most of these positions are salary positions. So, 34% are hourly pay and 66% are salaried. You'll see the min and the max over here. The minimum, we're ranging at $35 to up to $52 an hour. So, that's a pretty significant difference or range. So, when we average it out, we're averaging about $44 an hour or close to $92,000 annual salary. So, these positions are costly. They are expensive, but again, when we're looking at their requirements, the expertise that they're expected to have, they are, you know, getting that compensation. In terms of schedule. So, what are their schedules? What's their work week? What does it look like? We've got, for the most part, you'll see 88% are working those five, eight-hour shifts a week. So, it seems to be very important that someone is there consistently so there's no gaps in care and it's probably easier for someone to continue their work when there's that continuity during the week. We saw only 3% offering four 10-hour shifts. And then, we did have one site. So, they have multiple nurse navigators and coordinators and their goal is to cover six days a week in the hospital. So, every fourth week, they would have a day off, but then that person would pick up a Saturday or a Sunday so that there's coverage six days a week in the hospital. In terms of weekend, not much work happening on the weekends for this team. Most of that is in the transplant and VAD space, usually taking call and coming in as needed. And again, just that coverage and the rotation. So, most often, weekends are not covered by the nurse navigators or coordinators. So, I wanted to take a minute because this is also another topic that's generated a lot of discussion is what's the remote versus in-person ratio? And I think it's important that we really kind of look at this because if we've learned anything through COVID, people can be effective, right? And maybe there's opportunity here to improve that because what we see is most of them are working in person 90 to 100% of the time. And then when we look at our percentage of remotes, that's 17%, but that's anywhere in the range of 5% of their work week to 80% of their work week. So, we're still finding a lot of variation and most of us want those people to be in-house. Even if they're not seeing patients at all, even the 100% patient-facing positions did not work remotely 100% of the time. And those that did work remotely generally had those dedicated days to try to balance out in-person versus remote. So, it just begs the question as we're looking at developing kind of workflows and models, is there a balance of remote versus in-person time that can be utilized for these positions in an appropriate way? Again, just further looking at the schedules, so nobody reported call schedules or call coverage. We do know just from that last comment that some BAD and transplant coordinators do take call. But for the most part, we are not expecting our navigators or coordinators to be on call. In terms of vacation and sick days, most people do not have coverage or are not expected to cover. So, you'll see about 42% are. So, what that means is if I'm the navigator or the coordinator and I take that day off, there's nobody covering my responsibilities. There's a gap. And, you know, sometimes that's just the way it is because of resources. If there is coverage, it's still going to be questionable because that person probably still has their full workload and they're just going to have to prioritize the needs. So, just because there's not abundant resources available to do that. All right. So, looking at FTEs by category, and by category I mean disease state. So, we're talking about heart failure, structural, EP, all those. So, you're going to see, again, a huge variety. So, you've got people here on this one end that have a large number of these positions. And, again, on the other end, you're going to have organizations that have a smaller number and maybe it's just one type of coordinator. So, it just really, again, shows to the sites that really buy into it what are their priorities in terms of disease centers versus maybe these sites are just getting started. Maybe they're, you know, just were able to hire one and they're still struggling to show the value or maybe they're just starting this in their hospital. So, just continue to see a lot of variation within this role. So, I want to spend a few minutes talking about what's the difference between nurse navigators and nurse coordinators. I'm not proposing that there's a hierarchy, but I do want to do another polling question because I get this a lot. So, I'm asking if your organization, do you have a hierarchy in terms of is your nurse coordinator higher? Is your nurse navigator higher? Are they both kind of on the same even playing field or you're not sure? So, I'm going to give you a few minutes to answer that and then tally up those results. All right, Jenny. It looks like most are. and Afrin. Jenny most of us are answering C, neither of both are the same 62% right now. Now I can see them? Perfect. We're going to go into that a little bit deeper. I'm not sure. I do appreciate that too. I think that's a figure, Amber, and one that's probably pretty common. What we did is took answers straight from the survey, and I want you to kind of just see what we're talking about. I'm going to go back to the survey, and I want you to bear with me a minute as we talk through some of these, and then we'll summarize. There's really no standard. There's a wide variety of who makes these decisions, who says what a coordinator is, who says what a navigator is, and who says what a navigator is. One said that their coordinators are really in charge of quality, and that's what their differentiator is, and they're also doing bedside work. One said that their coordinators are transplant VAD, and the others are nurse navigators. One said that their coordinators are really in charge of quality, and they're also doing bedside work. One said that their coordinators are really in charge of differentiating. RN coordinator delegates, so they delegate to clinic staff, and the navigators are helping with throughput. I've heard this before, years of experience in compensation. One said that their coordinators are really in charge of transition of care, so system population issues within the system, and then also with the individual patients, so more care continuing, advocacy, education, empowerment, psychosocial support within the hospital. And then the coordinator is more in charge of the hospital, and the navigator is more in charge of this clinic versus hospital. And just to show some more examples, someone said they're not sure, that's up to HR. They don't have navigators, but they're really not sure what the difference would be. So that's a little bit like a hierarchy there. Over here we've got coordinators have less patient management, more coordinating schedule and patient care, so that's a little bit opposite of the site who said that was really the nurse navigator's role. This site uses their navigators to handle referrals and relationships, and the coordinators are really specific programs, so they're really more in tune with the patient, so they're working more with disease process, such as lifestyle management, appointments, daily weights, smoking, and those sort of things, so really more in tune with that patient. And then the coordinator is managing logistics and care through interventions, so more structural heart working up to the nurse navigator, and they're really using their coordinators, they love those spreadsheets, pulling in notes and doing virtual education to their sister hospital, so this site is really using them to provide those evidence-based practices that are also tracked in registries, so they're making sure they're following up on that. And then the coordinator is managing things between the departments, those relationships, and collaborating with the service lines and trying to impact those metrics like readmission and length of stay. So all that to say, we still don't have a clear understanding, it's very organization-specific, and I think there's no right answer. But you can see that the majority don't really differentiate, or maybe they just aren't sure what those differentiators are. I'll say just from what we found in the summary, and this is just from those responses that were provided, so it does not mean it's the end-all, be-all, these are just some insights meaning from those responses we found that the coordinators are really responsible for program development and the logistics, so, you know, workflows, three-puts, quality and data, so all those process improvement, quality improvement initiatives that we all have. Some mentioned more direct patient care, some mentioned they were clinic-based, and they seemed to be more the delegators, so people would be reporting to them and they're helping set them up for what would happen. The nurse navigators seemed to be more disease management, so focused on education, social support, lifestyle management, modification, helping them through their disease process. Also tasks focused on scheduling appointments and procedures. More of them were hospital-based, and they seemed to be more taking kind of being delegated the task force. So that's just a very general overview and summary from the responses that we've received. In terms of what they're managing, we were curious, are they more focused on a programmatic standpoint, meaning the overall care, are they really more focused on one-on-one patients? And a lot of them said both. So most are disease-specific, so, again, that's just a general overview. A lot of them cross over, and they wear their quality and their programmatic hat, but they also wear their patient care, education, scheduling, and all those tasks hat as well. So it's a lot of crossover in their responsibilities. And when we look at those patient programs, we see a lot of programs that are developing. We've seen a lot of programs that are developing that have a longer heart failure structure. That's really where our navigators started. And, of course, our advanced, we've seen ischemia, EP, and cardiovascular. We've seen those build as well. But these here in the middle are kind of in alignment with what we're hearing, especially around the interest of cardio OB and cardiovascular, which is in alignment with what we hear from practices and organizations across the country as well. And then we have this interesting bucket of other programs or kind of responsibilities for navigators. So they're used for a variety of reasons. So some of them were focused on highlights, so they're maybe running reports and they're managing those and they're managing referrals. So that was one kind of bucket. We've got some that are working in genetics and with hypertrophic cardiomyopathy and amyloidosis patients. And this is to say they may not have just one. They may be working in multiple buckets here too. So we are seeing increasing programs around lipids and cardiometabolic clinics and then we have some that are focused on intervention and wellness. So that's a really interesting space and opportunity to work in. Device clinics and imaging. We have one do fetal cardiology and then also some inpatient ECMO and CICU. So you can see there's a lot of areas and a lot of opportunities for these roles. So the next question is, how many patients is one nurse navigator or coordinator expected to handle? And again, we've got quite a wide range of answers. So you're going to see anywhere from 100 to 500 depending on the site. And this is patient lives per year. So it could be recurring, it could be kind of that interventional episodic period that we're working with the patient. But a lot of variety. And so I know you may not be able to see it as well, but for heart failure, our navigators are managing around 250 to 275 on average. So again, they're just showing this opportunity that there needs to be some work around what's a safe patient panel. And really that's in order, one, to not burn out our navigators to make sure they can safely manage these patients, but also from a leadership standpoint, how can you plan for program growth? How can you be strategic about it? So right now we're kind of estimating, usually we add as much as we can to those navigators and coordinators until they're about to kind of buckle and then we have to go and ask for more. So how can we be more proactive and anticipate the growth of our program so that we can support our teams and really manage those patients well? So looking at their responsibilities, we ask the question of how your team members are really dividing their work. Are they focusing more on those clinical duties? Are they focusing on administrative? Maybe they're doing more accreditation and certification responsibilities or program growth and outreach. So what you're seeing is almost an inverse relationship between clinical duties and administrative duties. And then some here in the middle have more to do with this accreditation and certification maintenance. And so it's really interesting to see kind of the relationship between clinical duties and administrative duties. So we're going to dive in a little bit more here. I'm going to break this down a little bit more. So you can see the top two responsibilities are those clinic and administrative. And that's probably not all that surprising. But you can see on average most of their 59% of their time is clinical responsibilities. And then the rest of their time is administrative. So they're spending time administratively. And then accreditation and certification is 12%. And then program outreach and growth, 15%. And so when you look at those mins and those max, you'll see that there's some that are not involved in the accreditation or certification or any outreach. But you can see some are heavily embedded in only clinical and solely administrative. And then the rest of the time, they're really inversely related. So those that are doing more clinical are not doing as much obviously administrative. So it seems that we're kind of pushing them to one end of the spectrum or the other. So it brings the question is what's the goal? Where is that happy medium? And I don't know if this is the answer, but I think it's important to understand that there's a lot of different ways that we can look at quality administrative work versus clinical patient impacting work. So this is something, one of those questions, we really got to dive into and look at how we want to use these roles. So let's look at administrative duties. And what we asked was specific responsibilities that they have. So these include things like chart abstraction, process improvement. Are they leading those efforts or are they participating in them? Because there is a difference there. Data collection. Are they reviewing, you know, responsible for reviewing that data? How are they participating in meetings and subcommittees? Are they leading those or participating in those? And then are they responsible for staff education or program growth and outreach? So those are some of the questions that we asked. And then the other questions that we asked are that quality and process improvement really as a. A team member, not leading those, but then also data collection and review. So. Those do, you know, fall together. And then they're followed by. The second kind of largest group was chart abstraction. So that's a, that's where we're spending a lot of our administrative, kind of, if you will. Time in this bucket here. So when we look at our clinical duties, we're, we're talking about more patient facing things. So like the patient education, direct patient care, whether that's in the hospital or in the clinic. Is that scheduling appointments doing remote monitoring, making those hospital follow-up calls. Or scheduling procedures or diagnostic tests. And so. Pretty clearly the top two responsibilities are performing patient education and making those hospital follow-up calls. Which are obviously very important. And then the last group is the team members. So this is where we want to be utilizing these very valuable team members. Because they're, they're important. They're registry metrics. They can impact readmissions. But it does kind of beg the question if I'm paying a highly qualified, very expensive position. Is this where I really want them to be spending their time and working to top of scope? Maybe it is maybe, you know, with, without the resources and the extra staff, maybe there's no one else to do it, but it does beg that question. Is this where we want. Yeah. So. A lot of the things they're spending their time on are as scheduling. So you'll see the second. Most common tasks are those scheduling appointments and then the diagnostics and procedures. So. They are doing a lot of those things and then others. Other tasks they're doing are inpatient rounding those pharmacy authorizations, which we know those are very time consuming. And then they're doing a lot of. Medical and clinical. So they're doing a lot of these things. And then they're doing a lot of the other resources as they're identifying them. So. If you look about these, they're all probably touching each one of these buckets. Either in the clinical or the administrative or both. So they're responsible for many, many tasks. And often there's not very many of them. And we all know metrics are important. So we asked, we asked that question. What are you guys measuring? What are you measuring? What are you measuring? What are you measuring? What are you measuring? And then one would be our, our registry. So we've got NCDR. Our get with the guidelines. So a lot of these. Positions are responsible for those metrics, reviewing them, seeing the opportunities now collaborating with the care teams and the committees that are responsible for them. And then the other metrics that are being. Tracked are really more volume based. So more KPIs, like. Clinic visits, echoes. Diagnostic testing, cardiology consults. Prevention medications. So a lot of these metrics are being. Tracked to make a difference for your system. Some other metrics that are being. So we're going to take a few minutes and talk about the challenges. Again, these are direct from the surveys. So. Submitted some of these, but if you didn't, you probably are going to be, yeah, that is a big challenge. So we're going to take a few minutes and talk about the challenges. Again, these are direct from the surveys. So you probably. Submitted some of these, but if you didn't, you probably are going to be. Yeah, that is a big challenge. So I want to spend some time and talk through these challenges. Because it gives us some guidance of where we need to dig in and what we, some of the work that we need to do moving forward. So. I hear this. This is probably the top. Issue or challenges that these positions are expensive. They're non-revenue producing. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. They're not. And that is a hard one because they do not show a very clear ROI. We're working on readmission. Avoidance. We're working on quality metrics, length of stay things of those natures. We're working on quality metrics. One site said that their challenge is demonstrating that they're working to the top of their license to free up APPs. So again, thinking about those clinical duties, are we working them to the top of their scope? Are we using them appropriately? And are we using our whole team appropriately? I think that's a hard one to answer. I think it's a hard one to answer, but it is very valid. Especially with the. Compensation that's associated to it. Justifying the role with. Staffing constraints. Obviously that is something we saw in COVID, you know, a lot of people were working to the top of their roles. And, and I think for, for my perspective, when we pulled them out of their roles. A lot of what we saw was all the metrics that they were working so hard on. Actually got impacted. It actually, where I came from we were able to show that they did not need to be compensated for their role. And that, that speaks volumes. So. Getting cand we saw how important it is to have experienced candidates. So it's really important that we are making our nurses aware of these opportunities. This is a way to really keep some of our nurses internally, those that are trying to leave because they're tired of bedside, this is a really unique position. And I think if we get the word out more, I think we'll have more nurses that want to stay within cardiology and grow and know about this opportunity so we can really grow our own for this area as well. We've got a couple of challenges in terms of compensation and salary. So someone said their hospital pay is less than the competitors, salary expectations, and not getting a cost of living increase with the bedside nurses. So unfortunately, I've heard some of these things, and we saw that some of our navigators are making $35 an hour, which may be less than the bedside nurses. And then if they don't get included in a cost of living, is it worth it for them? It may not be. They need to be compensated. Especially if we get those right candidates, we want to make sure that they're compensated for their skill, their knowledge, and their performance. So a lot about the salary and compensation, and then we've got in terms of supporting multiple programs. We saw the vast array of programs that they're covering. Some are disease specific. We know heart failure, structural heart, but there's a lot of general cardiology, or there's those very specialized ones that you don't have volume to have one navigator per specialty. So they're cross-covering. They're managing a lot of different things, and that can really burn them out if we're not supporting them. Leadership expectations. So this aligns with the next one as well. So this site said that their coordinators should be separated because they're not understanding that the clinic teams, the clinical teams are not understanding their value, and then the leadership expectations are different. And then they have heavy workloads with significant phone time. And I could be off on what I'm interpreting this, but my thought is, you know, we think about these roles. Tons of time in front of the computer, tons of time on the phone. They're connecting. They're researching. So from if they're in an office and they're on a busy unit or in the middle of a clinic that's busy, the perception from those that are, you know, rooming patients or, you know, why are they not out of there? Why are they not doing this? Well, they are working, but that's the perception from the others is that they're not. But they're the ones that are really digging in, addressing those challenges, doing some deep dives, coordinating with their providers or other ancillary services and working with those patients. They're taking those 20 minute calls and calling them back and doing all these communications so that the patient has everything they need in this complex care disease process. So it's a misconception that they're not working as hard or as much. And so that can impact care teams. These new subspecialties, we already saw the new programs that are growing, especially around cardio OB and cardio oncology. And how do we, how do we plan for accelerating, accelerated growth in these and meeting those demands of those? That's something we've got to really work on. And then support career development, retaining staff who are well-trained and qualified, staying competitive in the marketplace. They say this is a challenge and that is, but I think this is also a great opportunity. Again, as we get word out that this is a standard of care within cardiology, as we develop these workflows and processes, this is an opportunity to re-engage and retain nurses that want to stay, maybe just not in the position they're in currently. So we can work on that and we can help with some of, not all, but some of the nursing retention challenges. And then this last site said they had some issues or challenges with compliance where navigators are working in the hospital, but the private practice physician or physicians want them more involved. I'm not sure of exactly what those dynamics are, but that can be, one, yes, a compliance issue, but two, it really stems down to being a patient issue because patients and diseases don't care if you're in the hospital or you're in the clinic. There has to be, it's really about the program and the continuum of where the patient is. We've got to meet them where they are. So we do have to do some collaboration and some efforts to build those relationships and close those gaps. So I don't like to end with challenges. These are all great things that we're talking about and we need to work on, but let's also spend some time and talk about the wins and successes that people have had with these positions. And I think it's great that we're calling out these applicants and those that are in the roles are very passionate about their specialty patients. So they're interested in improving outcomes and actively involved in management conferences. So this is a site that, again, these are direct quotes from the survey, from people who've experienced and seen this within their organizations. So high satisfaction in the role, very little turnover, success and retention. So those that are hired in the positions are generally have been there for a long time, promoted from within CV services. Someone said they weren't really any challenges because they had flexibility hours and compensation. So these are the things that I think are what makes a good program and can really, like we were just talking about, drive that retention. If we do this right, there's ways we can really build this as a standard in our team and our delivery models. And we can help keep nurses, we can grow them internally and really help develop them. And those that are in these roles and really love the role, it's well thought out and they're empowered, they're going to stay and they're going to work hard for you. So this is a really good opportunity to be impactful to our disease centers, our team-based care and our patients. So I highlighted this last one because I really liked the feedback or response of this site that said that the type of nurses seeking these roles are typically high achievers and they have a vast knowledge of CV. And it's important to keep them challenged and engaged. They get burnout easily because the work is demanding and the patients are complex. Absolutely true. I will say these people are generally when you find the right people, they will work. The hard work does not scare them. They will work endlessly. You probably know this. They're the ones, even though they're not taking call, they're giving the patients their cell phone numbers. They're texting patients. Patients are texting them. You probably don't want to hear that, but it's happening because they're dedicated and they will go above and beyond. And the thing that makes things fall apart is when they don't feel supported. Generally, these nurses are just motivated. They want growth. They want to be challenged. They want to be included. And all they need is to be supported. They need a leader, administrative and a physician leader who they can get direction from. They need someone they can talk to when they're encountering barriers or challenges. And they don't need much, but they do need a little bit of support. So it's very important that you touch face with them, that you're asking them how they're doing. And sometimes that's all they need and develop that relationship. And they will work hard all day long and they will love what they do even on the hardest days. So when you're looking at these candidates and just ask yourself, am I supporting my navigator and my coordinator? So as we're kind of wrapping this up, we found probably what most of us expected, that there is a lot of variation. But in terms of key takeaways, we know that there's a lot of variability, including in the reporting structure, compensation, that we need to streamline processes and best practices for both of these roles. We know that there's no standard definition for navigator or coordinator. Seems like based on this feedback that the coordinator seems to be kind of a hierarchy, I can't speak, hierarchy above a navigator. But there's really nothing in writing to support that. And then in our poll earlier, we saw that it seemed to be different. So I'm asking you to kind of think about and talk to your organization and see how do you define these roles? How do we need to? So just start thinking about the answers to these questions. We're lacking defined roles and responsibilities. So really what that means is we're delaying effectiveness. Often these nurses in these positions are told, okay, great, you're here now go and do, figure out. They don't have any clear direction. And they will go and they will do that. But they're going to encounter somebody who says your priority is this and another person who says this. And pretty soon the weight of the world is on them. And we're asking why they're not being effective and why our readmissions aren't impacted. So how do you onboard? How do you set your nurse navigator up for success or your coordinator? How do you set them up to be effective? I'm not saying it has to be a crystal clear roadmap. You know what the needs of your facility and your populations are. Give them some structure and help them prioritize. Otherwise they will get bombarded with different tasks and responsibilities and they will not be effective or it will take them a long period of time to figure out how to be effective. And I'd say reach out. I'd be happy to connect or reach out to some places if you need a starting point. We can help kind of get you started. So I want you to think about that. How are you orienting and onboarding these team members? And then positions are high cost. We saw that. We know it's hard to show their value. So how do we advocate and protect these positions? So that's something we're going to address in a couple of months. Have some administrators coming on and talking to us about that. But you know we've got to be able to impact or speak to impact how we can hire them and retain them and show how valuable they are. And then this last thought is with team-based care. We know the shortages and the physician side and nursing that we're running into over the next few years. We've got to do our part to retain these positions and also protect our patient population and protect our delivery, our care delivery teams. So how do we incorporate effective team-based care, meaning the physician, the APP, the nurse, the MAs, potentially pharmacists, social workers. They all are going to have to be able to work together to the top of their scope to funnel the most important things up appropriately to our providers. So my question is and my charge is, will you and your organization adopt this model if you're not already? Are you willing to leverage your nurses to the top of their scope and promote this retention and improve our care? So I'm going to ask you that as our last polling question. We'll pop that up there and give it just a minute. All right. How are we doing on responses? Looks like we're at 73% very likely, 20% likely, and 7% neither. Okay. I will take those odds. So I'm glad to hear that and I hope you are encouraged. I know we have a lot of work to do and I am ready to take the charge on that and I would love to have you all on this journey. So what are next steps? This is going to be a journey, but what we need is some supporting evidence. So obviously, we talked about the high cost. We talked about how it's hard to show their value. So we've got to do some research. We've got to provide some evidence that supports these very important, actual crucial roles within our organizations. We need to establish those workflows and best practices so our teams can be effective and efficient. And we've got to incorporate them. We've got to welcome them as part of our team-based care models. If we keep waiting, we're going to be behind the ball. We're losing nurses and physicians and our patients are getting sicker every day. So we've really got to jump on this opportunity to leverage these positions within our organizations. And then I need your help just to continue. Thank you for joining us today. Thank you for providing your feedback. I need your engagement and your input as we continue on because we've got a lot of work ahead of us. So looking forward to that. And we do have two more scheduled webinars this summer. So thank you for joining this initial one. We've got one in July where we'll have a couple of nurse navigators on sharing their programs and the opportunity to ask them questions and have some open discussion. That'll be July 19th, same time, same place. So 1 p.m. Eastern. And then August, we're going to answer some of those hard questions about how do I get approval for a nurse navigator or nurse coordinator and how do I protect those roles? How do I really support them from an administrative side? So that one will be in August. So I look forward to continuing these discussions and appreciate all of your time and attention today. I do have, we have five minutes left. So I know there may be some questions. Are there any questions, Karen? So Jenny, yes, we did have one coming through just asking if you could share the job description for the medical assistant facilitator that you had mentioned earlier. I will connect with that person at that site. I will connect and reach out and see if they'd be willing to share some more information on that. So yes, I will follow up on that. And then just one more, just given your own experience with these types of roles, as you started to go through and summarize the results of the surveys, what surprised you the most? Were there any surprises that you saw as you were starting to go through the information? So great question. I actually am not surprised at all by any of the information. I think it just shows this opportunity that we have to really provide some more structure. I think it was very interesting to show how vastly different we are kind of defining the coordinator and the navigator roles. I maybe didn't expect it quite to be so drastically different in terms of more clinical versus administrative, but it does make sense because they're also time consuming. So you can't really do both and do them well if you don't have the support around you or the infrastructure or more nurse navigators or coordinators that are working with you. So often they're left to prioritize and do what they can. So it just really showed me and motivated me that we've really got to dive into this and help develop some structure for these roles. I've just seen such an impact and they're such driven, motivated people that we really want on our team. So thank you for that question. Hopefully that kind of answered it. Great. We've had a couple more pop up that they're just job descriptions tend to look like they're the popular ask. So just other requests for job descriptions for coordinators and navigators. So maybe we can get together and talk about how best to distribute those to attendees or through listservs. Because I know we do have some examples that have come through listservs and I'm sure you have others. And then another question about do others use RN liaisons? So I have not seen many RN liaisons. I've seen, and you know, sometimes the title doesn't match the description or clearly defined. I'd probably need a little bit more information on that. I've seen, you know, transition of care nurses and maybe that's more what it is that really just facilitate that initial 30 days post hospital discharge. I'd be happy to connect with that person as well and try to get a little bit more background and see how I can help with that. In terms of job descriptions, yes, I have plenty. We have some examples. So we'll be sure to connect Karen and see the best way to distribute those. I will say one of the goals of all this work in the future is to have a toolkit with workflows, job descriptions, and things of that nature for you guys. But we will not hold that off. We'll get you what we have as soon as we can. And then just there were a couple of questions, just thanking you for the webinar and wondering if it was going to be accessible via recording. And the answer to that is yes, we make all of our webinars available as on demand sessions on the academy on our website. And so it takes us about five to seven days to get them ready and posted, but they will be available there for watching later at your own time. And I think that's it. I believe so. And I just realized I didn't have my email up. Please do not be shy. Reach out to me. I love to get feedback. I love suggestions and questions. So please reach out directly. And those of you that ask for things, we will follow up with you as well. Thank you all so much for your time. I really appreciate it. Hope to see you again in July.

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Nurse Navigator

Coordinator Survey

cardiology

survey findings

responsibilities

challenges

successes

team-based care models