Why did you decide to become a clinical nurse specialist?
I have had many jobs and roles over the years as a nurse, working in everything from direct care to management. I have not necessarily always aspired to be a CNS, and it wasn’t the ultimate goal after doing my master’s. My primary desire was to learn ways to evolve in my nursing career. This came from my curiosity to expand my presence and effectiveness in my job — I wanted to change my lens of care in nursing to look at things differently and doing my master’s in Nursing (rather than a master’s in education, for example) seemed to be the best way to accomplish my long-term career goals. Holding a CNS role in a team-based palliative care setting, I help patients make choices and I help my team with assessments and problem-solving. These roles are something I have always strived to do and I have always promoted.
Some of my curiosity to become a CNS came from working with amazing CNS’s in the past who have inspired me to take on new challenges. The first CNS was a nurse from a health science centre working in a multiple sclerosis clinic. She was a model of how to use the CNS role to make changes in a clinical setting, to move intervention forward, to implement a program, to push nursing practice forward and ultimately achieve care that is better for patients.
How do you feel you help patients the most?
I help my patients most by being able to use my many past career experiences and education to expose patients to the best evidence available to ensure they make the most informed decisions possible. I also think that I help patients’ perspectives and voices be heard, especially when working with people whose choices about their goals of care may be challenged due to the end of life situations they and their families may be facing. Situations change over time and this can be hard to face. In my role as a consultant for the Winnipeg Regional Health Authority palliative care program I have opportunities to collaborate with nurses, physicians and other health professionals develop the skills to communicate with patients and their families.
What is the most rewarding aspect of your job and what is the most challenging?
This is a hard question because so much of my job I absolutely love. It has been the most fulfilling position I have ever had in my life. There are three things I would mention as the most rewarding aspects of my work:
- I really appreciate working with our program’s community visiting nurses in challenging home situations with end-of-life care to help come up with creative solutions that work best for each individual patient and family.
- Being a wound care consultant, I help cover region to help with palliative care wound management. I integrate literature and best practice guidelines to focus them on a palliative population where healing wounds isn’t necessarily the goal but maintaining them is. This involves focusing on the patient’s goals instead of what the health-care professionals’ sometimes want (i.e., healing the wound completely). This can involve a lot of creativity in developing solutions.
- Working in the motor and neuron disease clinic — specifically with ALS — has been an incredible learning opportunity. It is quite humbling when you see how incredible the team is with this population; they are an excellent example of effective team-based collaborative care.
One of the most challenging aspects of my work is to balance the “Strong model” (what we are taught in our CNS education) with competing work demands. (This model, which was developed at Strong Memorial Hospital in New York state, is an organizational model of the five domains of advanced nursing practice.) There are so many great opportunities to work with teams or promote education but you need to find a way to fit everything in. Picking and choosing which path to follow can be difficult at times.
More about Tamara
Having the chance to become a wound care consultant for the palliative program and taking the interprofessional wound care course was very motivating and stimulating. Taking on this role has helped me to work to my full scope of practice and take my work in different and expanding directions. This role is another example of how team work and collaboration can work for patients and their families.