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Montana VA Health Care System

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Nurse Navigator

 Joan Stewart inside the Nurse Navigator Control Center

Joan Stewart, the Nurse Navigator at Fort Harrison's hospital checks her computer inside the control center where she guides patients through the VA Health Care System.

By Randy Martin, VA Montana Health Care System Public Affairs Officer
Friday, June 20, 2014

A caller was distressed and needed immediate help for his elderly brother, a Veteran who had been treating his own condition with over the counter medicine.  The Vet suddenly seemed incoherent.  From her control center at Fort Harrison’s VA Hospital, Nurse Navigator Joan Stewart listened and carefully coordinated the path for patient and care giver alike.  Having maneuvered one Veteran to safety, the registered nurse checked her computer and surveyed the hospital’s busy waiting area for the next person in need.

The Nurse Navigator is a recent, unique, and important part of the hospital’s patient-centered strategy for efficient healthcare access that is personally rewarding for Veterans.  
Debera Charlton, the Nurse Manager for Ambulatory Care at VA Montana Health Care System visualized and implemented the strategy a year and a half ago.  She credited Stewart and two preceding Nurse Navigators, Loreen Skinner and Karen Zawacki, for helping her realize a dream she says works.
 
Charlton, a cancer survivor, first saw the effectiveness of Nurse Navigators in the private sector.  “They steer cancer patients through often complex treatment systems,” Charlton said.  Where non-emergency, walk-in patients had previously received treatment in the emergency department, the Nurse Navigator is able to identify what a patient needs through triage and direct the route to a point of access, Charlton said.  “She constantly interfaces with members of the Patient Aligned Care Teams to assure continuity of care is provided as this really is a collaborative position with all the PACTs and not independent of them.”
   
“I took this position in January so that I could have more contact with patients,” said Stewart when there was a calm.  “I talk to about 27 patients daily - which is a lot,” Stewart said from inside the glass-walled cube that provides privacy for face-to-face and phone consults.  Her shift is from 8 a.m. to 4:30 p.m. Monday through Friday and someone covers for her during breaks.  Otherwise, she is the only Nurse Navigator for the VA in Montana.

Most inbound calls for routine appointments are handled by other schedulers.  “The Veterans that I speak to want same day access and their medical need is either urgent or emergent,” Stewart said.  She talks to patients with questions ranging from administrative matters like billing and enrollment to behavioral health consultations and treatment for complex physical ailments.  “The most important thing is access.”
 
Stewart, a retired Montana Army National Guard lieutenant colonel, Helena native, mother of three, and nurse with 30 years of experience, knows her patients and her craft.  They don’t come in here unless they need help now,” Stewart said, as she helped one Veteran enter the lab next door.

“I enjoy the patient education aspect of this job,” Stewart said.  She recently earned a Master’s Degree using the VA Scholarship Program and is one of four instructors who will participate in nurse-led education clinics aimed at building knowledge on personal health.
  
Fellow registered nurse, Helen Williams, the Veteran Health Education Coordinator, said that Stewart is a shining example of someone who has personalized her education and is returning her knowledge to the VA.  “She is helping to lower utilization of healthcare resources, by developing Veterans who are engaged and by connecting them to what’s important to them, creating that ‘ah  hah’ moment,” Williams said.

“Joan, can I come in and talk?” asked a Veteran with silver hair, polarized glasses and cane.  The Nurse Navigator immediately got up, smiling, greeted the man by name and helped her patient to a chair in the privacy of her navigation center.

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