The Impact of Advance Practice Nursing in a Comprehensive Breast Center

Mary Ellen Egger, APN, WHNP-BC, CBPN-IC, The Vanderbilt Breast Center, Nashville, TN

The Vanderbilt Breast Center (VBC) is a comprehensive, full service, multidisciplinary outpatient facility located in Nashville, TN, that offers screening, imaging, biopsy, medical oncology, radiation oncology, plastic surgery consultation, nutrition, social work, infusion, wellness and survivorship care, clinical trials and genetic counseling all in one setting.   The program is affiliated with Vanderbilt-Ingram Cancer Center, a national leader in patient care and cancer research.

In recognition for our world-class care, we have been honored with a NAPBC certification and a Breast Imaging Center of Excellence designation. The Vanderbilt Breast Center at One Hundred Oaks is a designated American College of Radiology (ACR) Breast Imaging Center of Excellence. The Breast Center received this prestigious award for our outstanding personnel and use of state-of-the-art equipment for mammography, stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy. Nearly 25,000 patients are imaged annually with approximately 1900 breast biopsies, of which 95% are image guided.

Important contributions have been made by advance practice nurses in the successes of the VBC in the areas of patient throughput, healthcare economics, patient and provider satisfaction, and nursing professional development.

A diagnosis of breast cancer is disruptive and distressing. The comprehensive breast center has seen great success in streamlining the process of diagnosis and treatment planning through Advanced Practice Nurses (APNs). In the breast center, the APNs have a variety of roles that encompass a wide spectrum of care. They practice in partnership and under the supervision of attending physicians in multiple disciplines. Practice protocols that are utilized, are structured in accordance with NCCN guidelines. The APNs work independently and in collaboration with healthcare team to provide expert care to patients and families. In the spirit of a Magnet® designation, APNs partner with other staff to advance clinical practice through the introduction of current evidence, by elevating performance through oversight and mentorship, and by personalizing patient care. Nursing practice is based on the Vanderbilt Professional Practice Model wherein each member of the healthcare team is valued and critical to providing excellent patient care. Seven certified patient navigators (CBPN-IC) practice in imaging and the clinic setting closing gaps in patient care, facilitating smooth transitions between disciplines and services, and improving outcomes.

APNs contribute also to the professional development of nurses. Nurses are empowered to practice at the top of their license by promoting autonomy, knowledge, skills and evidence-based practice while monitoring quality and quality improvement. They partner with patients, families, support systems, and the team to impact patient care favorably.

The impact of this APN model is more effective care that eliminates redundant consultations, reduces costs and facilitates rapid access to care that includes onsite imaging and specialty consultation with a breast physician when indicated. The time to final diagnosis decreased because of better patient navigation through imaging, surgical and medical oncology. Most patients are seen with a surgical or medical oncology plan within 2 weeks of diagnosis. Benign pathology results are communicated to the patient by APNs within 2-5 days of the procedure. Emergency room re-admission rates are also decreased because patients experiencing problems can be evaluated and treated in the clinic by APNs. Patient satisfaction scores are high in all aspects of care, including quality of care, involving patient in decision making and likelihood of recommending our center to family and friends.

By expediting care at all points of contact, the large psychological burden is lessened, satisfaction is improved and care is more efficient.

The APN model of care used in the VBC results in timely, efficient, and effective care delivery for both patients with breast concerns and breast cancer. Please see the accompanying Graph and Table for a more pictorial illustration.

For more information, please contact Mary Ellen Egger []


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