	In part II of her article, Amy Sebastian-Deutsch continues to describe the potential for a collaborative relationship between Oncology Nurse Navigators (ONNs) and community health workers (CHWs). Sebastian-Deutsch discusses the development and implementation of a practicum through which ONNs would mentor CHWs, with the goal of facilitating improved cancer screening and care within the community. 

	The February 2011 meeting with Elizabeth Kelley, PhD, RN, CNS-CH, BC-HSP, (the driving force for the Houston Community College Community Health Worker Program) was behind me, and I had completed additional research to familiarize myself with CHWs and their role.

	It was now time to try to “pitch” the idea of an affiliation between my hospital system and the Houston Community College (HCC) for the purposes of providing practicum sites for the college’s CHW students. This would include practicum mentorship provided by our own oncology nurse navigators (ONNs). Knowing the size of our hospital system and the fact that I wanted to be ready to accept our first CHW students in June 2011 (only eight short months after first learning about CHWs), I knew it would not be a small challenge, and yet, I did not think it would be an insurmountable one.

	Let me first describe our hospital system. Memorial Hermann Hospital System (MHHS) is the largest not-for-profit healthcare system in Texas, and was recognized this year by Thomson Reuters as one of the top 15 healthcare systems in the United States. We serve the greater Houston community, which has a population of nearly six million. We comprise 21 imaging centers, 19 diagnostic laboratories, 10 surgery centers, 12 hospitals, eight breast-care centers, and seven cancer centers accredited by the American College of Surgeons Commission on Cancer (now recognized as an integrated network cancer program). Our academic campus, Memorial Hermann—Texas Medical Center, is part of the largest medical center in the world, the teaching hospital for the University of Texas Health Science Center (UTHealth) at Houston and the UTHealth Medical School. We are known locally for our Life Flight air ambulance program, which maintains six helicopters (including one strictly for pediatrics) and covers those within a 150-mile radius of Houston. We contribute in excess of $300 million annually for uncompensated care and community benefits.

	While I envisioned CHW students being mentored by any of our ONNs across any cancer diagnosis, the existing CHW student cohort was supported in part by the Houston Chapter of Susan G. Komen for the Cure, so the need to present my idea to the ONNs who navigated breast-cancer patients became my prime area of focus. Although I would have liked to have opened all seven of our cancer centers to the program, I knew I needed to first pilot this project at a few sites. Additionally, our breast-care centers are separate from the cancer centers, with separate administrative personnel. Therefore, both entities would have to agree on the pilot practicum program.

	It was important for me to approach the ONNs first, because without their approval, the program would not get off the ground. In April 2011, I approached the ONNs to discuss the CHW role and the HCC program, and to see who might be interested in being part of the pilot. Four ONNs expressed interest. I also spoke with both our attorneys and personnel from HCC to learn about the requirements of affiliation agreements and what changes might be necessary; I discovered that we would need to add CHWs to the current agreements. Unfortunately, given the time remaining, we could only get three practicum sites up and running.

	It then became necessary for me to confer with the directors of education to find out about our system’s requirements for students in clinical settings. While this would be primarily an observational experience, and CHW students would not be performing any patient chart documentation, it turned out that each student would still be required to complete specific facility orientations (including HIPAA requirements). Prior to that, they would need to obtain required immunizations, a tuberculosis test, a hepatitis B test, a drug screen, and a background check. They would also need to be CPR credentialed, and their school clinical instructors would need to sign off on everything.

	My next task was to develop a PowerPoint teleconference presentation to provide an overview of the proposed pilot practicum. Personnel from the respective institutes—including the ONNs, directors of education, cancer service-line administrators, and breast-care center administrators&mdash;were invited to participate. The proposed pilot was also presented during cancer committee meetings at the respective facilities. My objectives for these presentations were to describe the CHW role, the HCC CHW student program, how students would be mentored by the ONNs, and how the practicum would be rolled out at the chosen sites. I also hoped to gain the agreement of all parties to participate in the pilot.

	The following key points were presented:

		ONNs would not be obligated to take any students.

		Interested candidates would contact me via phone and briefly present themselves and their interests as well as their first, second, and third choices for practicum locations. They would be told there was no guarantee they would be offered a practicum.

		Selected potential candidates would then be referred to respective ONNs so they could be interviewed for “fit” with the facility and the populations being served. (Note: Some of the most positive outcomes have been achieved by CHWs who have worked within their own residential communities.)

		Summer practicum would begin in June 2011.

		Students would need to fulfill 224 hours over 12 weeks.

		If selected, students would be mentored by ONNs.

		Students would be rotated through multiple activities: clinic, exams, support groups, cancer treatments, and some of our community resource partner locations.

		Students would be required to complete a project deemed beneficial to themselves and their site’s ONN.

		Table. MHHS CHW Practicum Requirements (Based on DSHS Core Competencies for CHWs)

					Attend practicum "kick-off" meeting.

					Meeting with APN, ONN, and instructors; signatures of APN and ONN/facility educator

					Visit with city/state government official(s). Send birthday card (if applicable).

					Signature of legislative aide; copy of birthday card

					Identify patient in need of support (eg, newly diagnosed patient). Provide information/invite patient to support group.

					Survivor attends support group; confirmed by social worker or ONN signature

					Observe ONN/PT/MD interaction. Attend support group.

					Name of MD/signature of ONN; signature of ONN

					Follow patient across care continuum.

					Dates of attendance; signature of ONN

					Observe screening mammogram, diagnostic mammogram, breast biopsy, lumpectomy/mastectomy, XRT, and chemotherapy administration.

					Signatures of oncology nurses, mammography technicians, MDs, and ONN

Articles

Amy Sebastian-Deutsch describes the potential for a collaborative relationship between Oncology Nurse Navigators and community health workers.

Amy Sebastian-Deutsch, RN, DNP, CNS, APN, AOCNS

Articles

Oncology Nurse Navigators and Community Health Workers: Building Unique Relationships for Cancer Care, Part II of II