Why did you decide to become a clinical nurse specialist?
In life when we reach a certain plateau with work, we need to look at how we can improve our practice and learn new things. I wanted to go back to school and challenge myself in a different area of nursing practice. I went into palliative care and I did a master’s program from 1989-1990. There were quite a few theory courses and a clinical placement in Montreal at the Royal Victoria Hospital, a leader in palliative care in North America.
After my first master’s, I went right into a master’s in nursing to see how I could improve upon my nursing skills. In 1991, I did over 700 hours of clinical work with people who had HIV/AIDS. I wanted to learn how to counsel these people because often in the early ’90s you were facing death if you had HIV/AIDS — the treatments were not that effective. The things I learned in the first program working in palliative care were quite helpful in my second master’s when I was working with people with AIDS. After that, I went to Edmonton, Alberta, to do my PhD in nursing to specialize and further learn about how qualitative research can improve care.
The master’s level program in nursing is where people get a lot of clinical time and practice. In order to be a specialist in a health-care environment, you need to be an expert in that clinical area. People cannot say they are specialists if they have not done the clinical work in the master’s program. I like to use a swimming analogy. Theory and practice are like swimming: you can take 10 swimming courses in a classroom and do very well, but you still will not be able to swim until you practise in the water. You need to learn in the water, and if not, you will drown. It is the same with clinical nursing practice.
How do you feel you help clients the most?
By being present and attentive to their needs. You have to be attentive to what your clients are saying and what they are experiencing. My doctorate was about the challenges and concerns nurses face in the health-care system while working with oncology clients.
I have worked in many areas of nursing throughout my career. I’m not perfect, I am still learning. Every situation and client are different; there isn’t one “recipe” that we can use to address them all. We have to listen, summarize, and try to figure out what is best for the client in that specific situation. We need to facilitate that process. In my case, I can work with people from the beginning of their terminal diseases (from diagnosis) until they die.
Despite the fact that I have retired from teaching, I am still very much involved with nursing. I still do clinical work every week with people who are terminally ill. When we leave people alone to make decisions about a situation that they do not understand, they are confused. We need to guide them through the decision process. Having open discussions is very important; when we have open discussions, people feel relieved. Furthermore, their understanding is part of their informed consent.
What is the most rewarding aspect of your job and what is the most challenging?
The most rewarding aspect is the satisfaction that I can see in people’s eyes when I know that I have helped them. We have meaningful discussions that will help them move forward. I provide answers that they may not have had previously. Individuals are in charge of their own body, so how can I help them manage their own care or disease? They need to understand what is going on.
The challenge for me is the myth that health care can cure anything. This is not true, we cannot cure everything. We can help with medications and treatments, which can improve your quality of life. Even still, there is so much knowledge, research, treatments and nursing expertise that people are not using. We need to address this. We need to work with people to help them deal with their own situation. We cannot give medication and walk away; this is not proper care. We need to use the entire nursing process.
More about Paul-André:
Right now I am a CNS consultant. I moved into a new position a few years ago as the president of the Clinical Nurse Specialist Association of Ontario (CNS-ON), where we are increasing the visibility of the CNS. We also want title protection for the CNS designation. The CNS should be someone who has a graduate degree in nursing with a master’s that includes advanced clinical experience. And now we are talking of a minimum of 500 hours for future CNSs.
Paul-André has done regular interviews with the media since 2003, with over 300 official interviews that have been published or aired. In 2012, he was awarded the Queen Elizabeth II Diamond Jubilee Medal. In 2014, he was awarded the June Callwood Circle of Outstanding Volunteers Award for hospice/palliative care. In April 2015, he received a Lifetime Achievement Award from RNAO and became an honorary life member. He even received an international award, the Ordre de la Pléiade, for his involvement in the Francophonie. All of these recognitions are related to his volunteer work with the community. Paul-André remains involved in nursing because he loves it and he is still learning — and he wants to keep contributing to the community and to society.