May 01, 2017
By Roy Poules, MN, RN

Wanted: A new role as a clinical nurse philosopher

A short while ago I changed jobs, moving from a position as nurse clinician (NC), where I was a charge nurse in a cardiac ICU, to one as clinical nurse educator (CNE) in a coronary care unit and a cardiology ward. Since the switch, I have been asked many times which of the two I like better. I usually answer that each has rewards and challenges and that I am happy working in either role.

I have also been asked what the ideal position for me would be: clinician, educator or a combination of the two. I have thought for some time on this and decided that in an ideal world, I would create a new role for myself: clinical nurse philosopher (CNP).

I would like to be able to combine the aspects of each role that I feel are important and provide the most personal and professional satisfaction. I love the clinical activity of the NC role — being involved in the assessment and decision-making process and helping nurses and physicians work together to provide the best care for complex cardiac patients. As well, though, I love the teaching component of the CNE role — instructing in the classroom, offering one-on-one learning opportunities and developing educational materials for use in a variety of settings.

But what I enjoy more than anything else in nursing is pondering practice issues and encouraging co-workers to think about every aspect of their approach to their day-to-day activities and interactions. If I could be a CNP, I would work in a clinical area but would devote my time to questioning underexamined practices, challenging assumptions and promoting dialogue about the underlying foundations and values of nursing work.

When I see ward nurses reading journal articles or I come across academics doing research on nursing units, I find myself believing that the gap between theory and practice is not as wide as some think. Clinical nurses do more than follow procedures, and academics do more than generate theory in isolation. But it is not easy to learn to make the shift from asking how nursing practice is conducted to why practice is the way it is. As a CNP, I would be there to help nurses integrate these two realms.

The essence of the roles of NC and CNE is to promote the professional development of nurses. But I sometimes have to reflect on whether what I am teaching is something nurses could look up in a journal article or find in a policy document. If I can educate them to more closely examine their practice, I will be doing a better service to them and the profession than if I simply answer their questions. As an NC or a CNE, my responsibilities limit the time I have available to foster this type of thinking. As a CNP, I would be able to focus my efforts on encouraging the habit of thinking and questioning to the point that it becomes part of the character, in the Aristotelian sense of the word, of every co-worker. In an age of having an overwhelming number of guidelines, policies, procedures and standards to consult, critical thinking and judgment remain as important as ever to cultivate in nursing.

Until such time as a CNP position is created for me, I will incorporate thinking and questioning into whatever my role may be, with the hope that co-workers continue to approach me with a phrase that is a favourite of mine: “I have a question…”

Roy Poules, MN, RN, formerly a nurse clinician in cardiac ICU at Foothills Medical Centre, is a clinical nurse educator in cardiology at Peter Lougheed Centre in Calgary.
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