Editor’s Choice

Abstract

Journal of Advanced Nursing still publishes discussion papers as well as empirical research reports and review papers. A scholarly discussion paper on an important issue for nursing can make a real contribution to professional debate. What has gone wrong with clinical chairs in nursing? This is the question that Philip Darbyshire raises in his discussion paper (pp. 2592–2599) in this issue of JAN. Does Darbyshire provide convincing evidence and cogent argument to support his contention that things have gone wrong? The original idea of clinical (or joint) chairs in nursing was to provide positions, usually jointly supported by a university and a hospital or health service, that would ‘straddle the worlds of academia and clinical practice, developing research and scholarship, building research cultures in clinical areas and bridging the notorious theory-practice gap’ (p. 2593). Darbyshire tells us how, 15 years ago, he left Scotland—where I knew him as a PhD student – to take up a clinical chair in Australia, where there already were 20 or so such posts. Clinical chairs have been introduced in other countries, including the UK, and perhaps it is unsurprising that there have been problems in making these positions work satisfactorily in practice. Whether the situation is universally as dire as the picture Darbyshire paints is difficult to assess objectively. He is, however, absolutely right to draw attention to the impossibility of a clinical chair holder being expected to carry a full workload as a university professor and, in addition, to fulfil the demanding and varied expectations attached to a clinical professor’s role in practice. Likewise, that it is untenable to operate these senior posts on the basis of short term, untenured arrangements. No wonder, for these reasons, it might well be proving difficult to fill vacant or new clinical chair posts with suitably qualified candidates. Those with responsibility for these positions, on both sides – academe and service – really must resolve these issues. Darbyshire makes helpful suggestions at the end of his paper (p. 2598) with regard to selection, joint goal-setting, support, review and communication. His proposal that clinical professors should be left in peace to develop their role without the interference of ‘micromanagement’ is rather more controversial, however appealing is the notion of ‘intelligent accountability’ (p. 2598). But where I most disagree with Darbyshire’s analysis is his contention that the shared understandings and consensus between academe and service may be fragmenting (p. 2596). This relationship always will have inherent tension and divergence because the modus operandi, ethos, priorities and timelines are fundamentally different in universities and health services. There are, however, common goals that transcend these tensions, and what most powerfully binds academe and service together is the shared desire that nursing be a research-based profession. While this always has been a key driving force in academic nursing, it is now, I think, an equally well-understood goal in nursing service. At least in the UK, an unprecedented partnership between academe and service is now developing in order to introduce, at last, opportunities for nurses and midwives to pursue a clinical-academic career pathway, with appropriate training at each stage, and with proper employment contracts in and across the two sectors. The goal of this exciting development is to produce a new generation of research-active clinicians and research leaders for our profession. There is a unique opportunity, therefore, in this context, to create a new blueprint for the role of ‘clinical chair’. It needs to be a realistic role, realistically framed in the context of 21st century universities and health services, but with high aspirations as well. Poisoned chalice? Sad if it has come to that. But it need not be so. What do you think? Let’s continue this discussion in JAN Forum.