Abstract

The role of "pivot nurse in oncology" also called nurse navigator elsewhere in Canada, is a key factor in the renewed descriptions of cancer services in Quebec and in other industrialized countries. The implementation and outcomes of this new role are the subject of few studies and not yet well understood. The goal of this study is to gain a better understanding of how this function translates into professional practice in a cancer network. The study identifies organizational, conditions that support the new role integration, and evaluates the effects of different models of implementing the role on the responsiveness of the cancer services; responsiveness being an indicator of the capacity of health care systems to provide services needed by the clients.

The design of the study is multi-site (n = 9) case study. The actor-network-theory is utilized as the conceptual and methodological tool to trace the deployment of the pivot nurse function in various settings. A qualitative approach was utilized to analyse the organizational conditions in nine hospitals that had introduced this function. The data was derived from several sources: semi-directed interviews, (n = 37), observation of management meetings (n = 12), pivot nurse practice observation (n = 40 hours) and, documents (n = 121). A quantitative approach was utilized to evaluate the effects of the pivot nurse function on responsiveness. The "Health System Responsiveness" questionnaire was distributed to clients (n = 538).

Results revealed five dimensions that explain the variations in the translation: the meaning given to the project, the presence of recognized and legitimate leadership, commitment at every level of the organisation, interprofessional collaboration within the oncology team, and the level of flexibility in resource allocation. The configuration of these conditions produced two models of translation of the pivot nurse function. The "Optimal translation" model characterized by collaborative alliances was conducive to integration of the nurses' practice and the coordination of care. The "Partial translation" model characterized by alliances based on independence is less successful. In the "Optimal translation" model, the pivot nurse provides a significantly higher responsiveness (p = 0.002) more specifically with regard to the quality of the environment of care (p 0.001) and client centered care (p = 0.03). An early intervention by the pivot nurse in the first two weeks following a cancer diagnosis is associated with a higher responsiveness outcome (p = 0.001).

This study illustrates the complexity of introducing new professional roles in the clinical milieus. The results show the relationship between the translation of innovation and organizational contexts. The potential of the pivot nurse role is maximized when the conditions allow the co-existence of professional practice and the coordinating functions of the organisation.