"Float[ing] in the Middle" Nurse Navigators and the Interface of Access to Care

The Australian health care system continues to struggle to meet the needs of people experiencing multiple complex chronic conditions. Australians who report poorer health continue to report poorer access to health care. Inequities in access are attributed to a "mistmatch" between the health care system and individuals' clinical and social needs. To address this misalignment at the interface of access, innovative approaches that consider both individual and system-level barriers to care need to be examined. Nurse navigation models designed to support people negotiating complex care and bridge systems and service gaps have been touted as a method to enhance access, but how nurse navigators work at the interface of access in practice is unclear. This qualitative study examined the mechanisms by which nurse navigators facilitate access to care for people experiencing complex care needs through an exploration of key stakeholder perspectives: nurse navigators, nurse navigator patients, and care professionals. Data collection involved in-depth semi-structured interviews, and analysis included reflexive thematic analysis and data triangulation processes. A conceptual framework of access to health care was used to explore nurse navigators' roles at both system and patient levels. Nurse navigators supported both patients and care professionals by building relationships across the interface of access, challenging norms of care, and facilitating empowerment. Nurse navigators acted as intermediaries to negotiate access, work made possible through their knowledge of systems and capacity to identify and respond to multidimensional care needs and systems challenges. This research highlights the importance of holistic and relational approaches to overcome issues of access for all involved.