A reply to 'why nursing has not embraced the clinician-scientist role' by Martha MacKay: nursing science and the postmodern menace.

I read with interest the recent prize-winning postgraduate essay by Martha Mackay on why nursing has not embraced the clinician-scientist role (Mackay, 2009). This is an important issue for nursing, and the paper posed some valid questions about the nature of nursing knowledge and the relationship between theory, research, and practice. Although there is limited scope for Mackay to present a full and thorough examination of all the issues in a journal paper of this length, I was somewhat disappointed in the way that certain lines of inquiry were rapidly shut down or simply not addressed. The primary assumption running throughout her paper appears to be an acceptance that nursing practice and research share an agenda with medicine, and that the clinicianscientist role developed in medicine of a 75–25 split between research and practice/education is the only viable model. The premise, then, is that the medical model of the ‘career scientist with portions of time also devoted to clinical practice and education . . . offers a unique perspective from which good nursing science can proceed’ (Mackay, 2009, p. 288), and the aim of Mackay’s paper was therefore to explore the factors ‘that might help to explain the limited uptake within nursing of the clinician-scientist role’ (p. 288). This assumption effectively blocks other, perhaps more fundamental questions, such as whether nursing would actually benefit from such a role, and if so, whether other models of the ‘clinician-scientist’ might be more appropriate. However, to cut a long story short, Mackay’s conclusion is that resistance to the uptake of the clinician-scientist role is due to a lack of consensus regarding what kind of science nursing is and a confusion about the relative status of different types of nursing knowledge. Furthermore, it would appear that ‘post-modern thought may be at least partly responsible for the impasse in naming and agreeing upon nursing approach(es) to science and knowledge’ (Mackay, 2009, p. 294). The last third of Mackay’s paper is therefore devoted to a one-sided and overwhelmingly negative critique of this ‘postmodern thought’. I suppose that I should have seen this coming. Postmodernism has become a bête noire in nursing and other disciplines as a cause for the failure of modernism to deliver on its promise. The argument, which is repeated here by Mackay, is that certain ‘postmodernist’ writers have introduced doubts in the minds of good people about the modernist promise of inexorable progress through science. When the promise is not delivered, rather than question the relevance or efficacy of the scientific method, the blame is located with those who do ask questions of science for weakening the resolve of the faithful. Thus, postmodernism has led ‘practitioners in general and nurses in clinical practice in particular to mistrust theory and the research enterprise’ (Mackay, 2009, p. 294). It is perhaps worth noting that, as well as implicating my own writing in inciting practitioners to mistrust theory and research, Mackay cites a paper by Donna Perry in support of this view. Strangely, there is no mention in Perry’s paper of postmodernism or of any writers who might be seen as postmodernists, and while Perry does indeed identify the problem of the mistrust by practitioners of ‘academic’ nurses, she concludes that while nursing theory contributes to the problem, the solution lies in how ‘philosophy might be used to reconcile nursing science, theory and practice into a coherent whole’ (Perry, 2004, p. 68). C om m en ta ry