The Transition from Bedside Nursing to Virtual Nurse Navigation

Margot Albin, BSN, RN, OCN has over six years experience working as a bedside oncology nurse specializing in Malignant Hematology, Stem Cell and Bone Marrow Transplants, CAR T-cell therapy, and inpatient chemotherapy/immunotherapy administration and education. She is also a palliative care educator and certified yoga instructor who has taught mindfulness and yoga to cancer patients.

She joined Thyme Care in August 2021 as a Oncology Nurse Navigator, supporting members by answering questions about their diagnosis, monitoring their symptoms, educating them on their medications, and helping them make informed decisions as they navigate a complex cancer care system. 

The foundation of my nursing career was built as a bedside nurse on Malignant Hematology and Bone Marrow Transplant units at large teaching hospitals, most recently UCSF and Emory.  A typical shift consisted of darting between patient rooms to infuse chemotherapies and medications, transfuse blood products to combat critically low blood counts, and manage severe side effects. It was a fast-paced environment where everything could, and often did, change at the drop of a hat. At the start of my shifts, I would enter my patients’ rooms and was, without hesitation, welcomed into their sacred space for the next 12 hours. To be wholeheartedly trusted by patients I’d only just met is something that still humbles me years into my nursing career. 

As I began preparing to support Thyme Care members, I worried how I might connect and build trust with patients without being physically with them.  One of the biggest learnings from a year of virtual nursing is the realization of how profoundly words matter as what I say can make or break a connection no matter how well-intentioned. The challenge, albeit a fun one, comes from learning cues and getting to know individuals so that we can cater our services in such a way that each member feels comfortable with their level of support and engagement. To my surprise, I find that members are generally even more willing to open up over the phone - perhaps they feel more at ease in the comfort of their homes, or perhaps they recognize that, unlike in the hospital where nurses have other responsibilities like inserting IVs and giving medications, my agenda is simply to lend an ear and be their support and advocate. Listening skills are crucial as I can no longer rely on vital signs, labwork, grimaces and gestures to clue me into potential concerns that might otherwise be overlooked. My ability to provide excellent care to members is dependent upon my ability to really listen to what it is they’re telling me in order to quickly identify and address any adverse symptoms, barriers to care or needs that might otherwise fall through the cracks. Remote nursing requires a robust foundation of clinical knowledge and keen intuition to know when to investigate further and when to give space and try again a different day. 

Working as a frontline nurse during the first year of the COVID-19 pandemic, the ache for genuine connection, particularly during challenging times, became impossible to ignore. Strict no visitor policies forced me into a unique role of being both the nurse and also wanting to step up to be the loved one for those who would otherwise be alone for weeks or months. I lingered in patients’ rooms for longer than I had the time for - to listen to stories, offer a hand to squeeze during a bone marrow biopsy or delicately shave the head of someone who couldn’t bear to see loose hairs on their pillowcase another morning. In the ever fast paced environment of the hospital, I began to savor these moments when time would slow down. On the rare occasions when my work phone was silent for a couple of hours, I would pull up a chair to a patient’s bedside and learn who they were outside of their disease and what brought them to the hospital. These moments of connection became my lifeline amidst the uncertainty of early 2020 and I gradually realized that learning who a person is outside of their illness made it easier to advocate for their wishes and anticipate their needs. I knew I wanted to find more time and ways to do just that. 

As the pandemic wore on, I began to wonder: how could I more permanently reach this depth of relationship with my patients? How could I position myself to really be the advocate and support people need when they’re sick? In the spring of 2021, as I was preparing to move to Nashville and considering my next career move, I was serendipitously connected through a mutual friend to Thyme Care. While I was intrigued by the company’s mission of providing that whole-person support to cancer patients that I’d been looking for, I was hooked after my interviews. It was evident how mission-driven everyone at the company was and I knew instantly that I wanted to be part of this organization that really is making a difference in the lives of people living with cancer.  

Thyme Care has armed me with the most precious resource when it comes to delivering high quality care: presence. I am able to meet members where they are and provide the support they need without my attention being split between alarming IV poles and interrupting phone calls.  Thyme Care is there for members from pre-diagnosis, through treatment and beyond resulting in deeper and more longitudinal relationships.  When before I would discharge patients from the hospital knowing I might never see or hear from them again, the relationships we build now extend beyond just those brief snapshots of time.  It’s been heartwarming to walk alongside our members throughout their entire journeys, no matter how arduous those journeys may be.

My career as a nurse was born from a deep desire to show up and care for people during some of the worst days of their lives.  Where I could once help three or four people per shift, I can now help dozens of people per day thanks to constant advances in technology. For nurses entertaining the idea of doing something different, my advice for you is simple: think about what it is that buoys you in your daily work and focus your attention towards harnessing that in your next role. Nursing is an expansive profession and, with constant health technology growth and innovation, more and more nurses are needed in non-traditional roles. There is always something new to learn, and you never know where your next path might take you and whose life you may end up changing all the while.