Guest Editorial View on Australian clinical chairs - Contemporary Nurse: Healthcare Across the Lifespan

home > archives > 5/1 > Guest Editorial: View on Australian clinical chairs

Guest Editorial

View on Australian clinical chairs

Judy Lumby
Professor, Executive Director, The College of Nursing, Burwood NSW

PP: 002 - 003

Article Text

I have been asked to write about clinical chairs in nursing and to that end I have attempted a discursive glance across this relatively new phenomenon within the ranks of nurses. In a few short years we have grown clinical chairs across a variety of contexts and specialty clinical areas throughout Australia. Does such a rapid proliferation indicate how valuable such appointments are or is there another (or several other) explanations? Is it merely a trend which requires that every health care facility must have one, that is a clinical chair in...? Is it a mimicking of medicine? Is it a balancing weight to pull the pendulum swing back to a more appropriate position in terms of theory and practice? Is it driven by resources which may be less available in the future within health and/or education as fiscal tightening continues?

As a nurse in such a clinical chair I would like to believe that the growth of such chairs over the last two years has something to do with a recognition of the valuable part they can play within a practice-based profession such as nursing. Certainly my own experience, albeit only eighteen months short, has informed me of the multiple ways in which such a position as mine can help to position nursing within the hierarchy of health care credibility. It opens up possibilities previously closed not only to nursing but to nurses even at senior clinical and management level. While not so naive as to assume that presence equates with an audience, gatekeeping mechanisms of the past have worked to silence our voices in a variety of arenas. A seat at the table of decision making merely presents the opportunity. It is then up to individuals to put the case from a nursing perspective in a well argued and reasonable way. So often recently I have experienced epistemological support from the most unlikely quarter of medicine thus supporting Julie Thompson Klein's (cited in Messer-Davidow, Shumway and Sylvan 1993) view on the permeability of disciplinary boundaries. Klein debunks the myth that disciplinary boundaries tightly circumscribe knowledge, pointing out that rather than being natural entities, disciplines are 'arbitrary classifications'. Within such classifications, numerous fields exist, often with less in common than with some disciplines outside their particular classification. This is certainly evident in universities within arts faculties but I have experienced it even in architectural, mathematics and engineering faculties and now I am so closely involved, I am experiencing it within medicine.

Because of the above, the political position at the ward, hospital, area and state level should be borne in mind when appointments to clinical chairs are made. The opportunities provided by these positions insist that the incumbent be a wise communicator at all levels, have a big picture of health care not only state wide but also nationally and internationally and be articulate about the issues impacting on contemporary nursing, nurses and the health of society.

So what about research I hear you asking? Surely these chairs are research appointments. And herein lies the difficulty, or the difficulty as I have encountered it and which I am still clarifying - hence this editorial. There is no doubt that each of the clinical chairs with which I have close contact are evolving in different ways. Research may be the major focus for many such chairs but for others it may form one part of a gestalt of roles and responsibilities. A clinical role is similar in its emphasis across the various chairs of nursing already established. The difference seems to depend on the clinical context, the opportunities for the particular specialty, the expectations of the university and the health facility and the skills and experience of the incumbent. For example, a chair in mental health or midwifery offers tremendous potential for being involved in a clinical case load but in my own area of intensive care, it is not possible to have one's own case load. There are other ways to be involved but they are less satisfactory and certainly not easy to organise. Likewise, certain chairs are in the areas of national priority and so have a variety of funding avenues while others are competing with well established international research centres.

So what do we mean by a clinical chair in nursing? Can we contain it within prescribed guidelines and protocols? Certainly we have things in common but we also have differences which I find the most exciting part of this evolution since we are all working in different ways, developing alternative paths for nursing and nurses. Clinical chairs offer a breakaway from the stereotyping which has hindered so much of nursing's development and recognition within health care. I firmly believe that they are our future in terms of immersing ourselves in the affairs of health care at all levels and across the sectors of health and education. After all, nursing does not exist without a clinical partnership with one who requires nursing care, and so the presence of chairs in nursing in such environments where this is happening is vital for creating and nurturing a culture of inquiry about our practice.

Perhaps the overwhelming concern among my colleagues in clinical chairs is finding a balance between the various roles of research, teaching, administration, committee work within the university and the health care facility, student supervision, external examining of thesis, external reviewing of grant applications, networking with colleagues nationally and internationally, public speaking, writing, workshopping, research seminars, consultancies, providing advice and support to staff in both health and education, organising resources and undertaking clinical work, to name a few. The joint nature of the role, positioned as it is at a senior level between health and education, means that it is very easily stretched across too many sites and responsibilities. For this reason we all need to be vigilant regarding our priorities and our resources given the enormous pressure for nurses to obtain research funding in an increasingly competitive environment. And we need to choose our chairs wisely with regard to the individuals who employ us since they are pivotal to how well we can get on with our job. They require a balance of vision and trust which has not been abundant among nurses in the past. After all, personal freedom and individuality is not encouraged within the profession. Knowing this assisted me greatly in choosing my clinical chair since both the Dean and the Director of Nursing have provided a trusting framework in which I can work independently and interdependently as a colleague. Rather than prescribing my role, they left me to create it and while particularly rewarding, this has been rather unsettling. For example, how does one measure the creation of a research culture at all levels in a very large teaching hospital?

While there have been obstacles, my move into a clinical chair has been one of the most exciting roles of my career. I have been very welcomed by medical, allied health and nursing colleagues at all levels in the hospital and the area. In a short period of time I have been accepted into the community at Concord which is quite special. My position within both the faculty of nursing and the department of surgery has opened up possibilities of interdisciplinary research and teaching, in turn opening up channels of informal communication so necessary for improved patient care. New friends have been made through the veterans, particularly the army nurses, because of Ethel (Storky) Lane whose service as an army nurse and supporter of world veterans has been honoured through the bestowal of my chair. Storky and I share many nursing stories of past and present - an unexpected but special bonus of this particular chair. Other chairs will have their own unique bonuses.

Clinical chairs in nursing are only in their infancy in this country. They require nurturing by us all if they are to take their place within the health care arena as a credible and collective source of wisdom regarding the future of health and health care in Australia.

View references