The ACC launched the Patient Navigator Program in early 2014 to apply a team-based approach for keeping patients at home and healthy after hospital discharge. Learn more about Nancy Albert, CNS, PhD, chair the of Patient Navigator Program, her vision for the program and what other care team members can do to become involved at the national level.

What led you to a career in the medical field?

Nancy Albert, CNS, PhD

I became a registered nurse in 1977. My first job was in a mixed medical-surgical intensive care unit. My passion was caring for patients with cardiac conditions and the unit I worked in received open heart surgery cases daily, so I was able learn about cardiovascular care, hemodynamics, cardiac dysrhythmias and treatment of many comorbid conditions. In 1990, I took a nurse manager position at the Cleveland Clinic in their 16-bed coronary care unit. Our acuity was extremely high and I began to appreciate caring for patients with very advanced cardiac disease, cardiogenic shock and life-threatening dysrhythmias. In addition, since I was employed by a leading research center, I was involved in treating patients involved in many research studies of both drugs and devices. Over time, my roles changed to that of a clinical nurse specialist and now, a nurse scientist. I maintain my advance practice nursing skills by managing patients in our heart failure clinic.

What interests you the most about the ACC’s Patient Navigator Program?

After completing a very thorough review of the literature on transition care programs, we know that doing something is better than doing nothing, and we know some key components of care that are needed during the transition period. These include medication reconciliation, early follow-up and optimal communication between transferring and receiving health care providers. However, most transitional care programs were researched in single centers. Program methods varied and activities were most often bundled, rather than having an isolated intervention. It is difficult to really know what works best and how much of any component is really needed to optimize patient outcomes. The Patient Navigator Program will help us learn what components of transition care work in real-world hospital settings. The program allows hospitals to develop transition programs based on their local needs and capabilities and also to learn from each other. We are poised to develop best practices that may improve workflow and outcomes for hospitals around the country.

What are your goals for the program in the future?

In the initial phase of the Patient Navigator Program, goals are to finalize the performance metrics we will use to assess the effectiveness of the program and complete the onboarding of all hospitals that will participate. However, shortly after that work is done, the goals will shift toward helping patient navigators and hospitals achieve their goals for improved clinical outcomes of hospitalized patients with myocardial infarction and decompensated heart failure. We will be able to provide resources such as site visits, webinars, sharing of best practices and communication of performance metric data to aid in forward progress.

As one of the first non-cardiologist chairs of an ACC workgroup, what new things do you bring to the table?

As an advanced practice nurse, administrator and nurse scientist, I think I bring a unique perspective to the program. I have been in multiple leadership and clinical roles in two clinical settings: a community hospital that cared primarily for minority and disadvantaged people and a quaternary care medical center. I have also worked in both critical care and ambulatory care settings, so I have a broad understanding of the complexities of patient care delivery, hospital services and processes, and patient responses to care, including adherence to self-care expectations. I believe that the combination of all workgroup member talents will aid us in determining the strengths of hospital programs, systems and processes and in cultivating solutions so that they can be disseminated on a national level.

What is your advice for other care team members looking to take on similar leadership roles?

There are so many talented care team members who need to share their voices on a national level to help us improve health care and patient outcomes. Leadership roles broaden your network of contacts with other national experts and leaders in your field and stimulate both personal and professional growth. To get started, I would suggest (1) understanding the content area you wish to participate in by thoroughly reviewing the literature, so that you have a broad perspective that is beyond your local, clinical perspective; (2) volunteering as a member of national task forces, workgroups and committees so that you can contribute to and learn about the work flow, team cohesiveness, ethics and politics of national groups; (3) speaking up and letting the national office know of your desire to be involved; and (4) having fun!

Keywords: Nurse Administrators, Follow-Up Studies, Coronary Care Units, Hospitals, Community, Critical Care, Hemodynamics, Minority Groups, Shock, Cardiogenic, Vulnerable Populations, Self Care, Intensive Care, Delivery of Health Care, Medication Reconciliation, Heart Failure, Politics, Patient Navigation, Cardiac Surgical Procedures, Workflow, Leadership, Nurse Clinicians, Cardiology Magazine, ACC Publications

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