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Martha Mackay, RN, PhD, CCN(C)

British Columbia and Yukon

Why did you decide to become a clinical nurse specialist?
I wanted to be a leader in pushing the boundaries of cardiovascular nursing and clinical practice. I had been a nurse educator for about ten years and, although I still enjoyed that work, I was becoming more interested in the idea of change and measuring improvement. I saw this more in the realm of CNS practice, with the role of an educator being to help maintain current standards. The work a CNS does tends to be about change and incorporating new practices.

In nursing during the ’80s and ’90s, there wasn’t a clear pathway for nurses who wanted to advance in their career but stay in practice. The traditional path was from bedside nurse to educator and then head nurse or manager. So for those of us who want to continue in clinical practice, the CNS role provides an opportunity to tackle more complex work.

How do you feel you help patients the most?
By never settling for the status quo. By constantly looking for improvement. And by making sure many perspectives are considered. For example, just because you have met a target or a benchmark, or you have introduced some successful change, nothing should be beyond critical examination to evaluate its effectiveness. The motto “if it ain’t broke don’t fix it” doesn’t work in health care; you have to keep examining your practices and pathways because everything — patients, treatment options and the environment — is constantly changing. That is how the clinical nurse specialist helps patients.

I don’t do a lot of direct patient care. The work I do is more at the macro or program level, so it can have an impact on large groups of patients. There’s always something that can be done to make things better for patients. In my experience, when there is no CNS support in a in clinical setting, change can seem overwhelming because most people are caught up maintaining the status quo — change may not be seen as part of their job descriptions.  However for a CNS, it literally is their job: leading change thoughtfully, carefully and deliberately.

What is the most rewarding aspect of your job and what is the most challenging?
The most rewarding part is when a patient, family member or colleague says that I have helped them in some way — be it advocating, counselling, mentoring or collaborating. Working directly with patients has also given me some of the most rewarding experiences during my career. Supporting people by helping them steer through a problem and the whole treatment process is also incredibly rewarding.

Now, as a CNS, my biggest rewards come from the people I mentor and lead, such as nurse educators, bedside nurses and newer CNSs. Another important reward is the feedback I receive when I implement a change in practice. Even if I know the data shows the change has had a positive effect, it’s an even bigger boost for me when care providers come to you and say, “this is way better.”

The most challenging aspect is trying to bring people who have disparate points of view to consensus. Change is hard, and it’s human nature to resist it. At times it’s challenging to get a wide range of disciplines — nurses, physicians, other care providers —  to come to a consensus. Sometimes, in the end, not everybody “gets their way,” but through consensus-building, people see each other’s perspective and come to a mutually agreeable solution.

More about Martha
Since obtaining my doctorate about six years ago, I’ve combined my clinical and research roles to become a “clinician-scientist.” I am a principal investigator for studies examining the effects of behavioural and socio-demographic factors (such as sex, gender and ethnicity, or conditions like depression) on cardiovascular symptoms, treatment-seeking and recovery, as well as testing interventions to improve treatment gaps.  It’s very rewarding and exciting to be able to combine my years of cardiac and critical care clinical experience with my research skills and I hope that my research is applicable to the “real-world” needs of cardiac patients.