By Katheren Koehn, MA, RN, who is a member of the AJN editorial board
It was with great regret that I read of the passing of Joyce C. Clifford last week. She was a nurse whose career as a nurse administrator and leader was spent empowering nurses, from the bedside to the boardroom. Much has been written since her passing about her nursing leadership at the administrative level. I would like to take some time to recognize her as a nurse leader who empowered nurses at the bedside.
I first learned of the work of Joyce C. Clifford from a staff nurse who’d moved from Boston to Minneapolis in the late 1980s. The entire time this nurse and I worked together she was in mourning for the hospital and job she’d left behind in Boston. Almost every day she talked about how wonderful Beth Israel was and how great it had been to be a staff nurse there. She talked about primary nursing, nurse autonomy, and interdisciplinary respect. At the time, none of these terms were familiar to me, but I knew she was telling me that “my” hospital, where she now worked, could never measure up to the fabulous BI.
I next learned of the work of Dr. Clifford through the book Code Green: Money-Driven Hospitals and the Dismantling of Nursing by Dana Beth Weinberg. In this book, Ms. Weinberg described the nursing environment that had been created under Dr. Clifford’s leadership:
When Beth Israel Hospital adopted primary nursing on its inpatient floors in the 1970s, the hospital also adopted a host of new organizational arrangements. The architects of Beth Israel’s professional nursing practice argued that by meeting nurses’ needs, the hospital simultaneously met those of patients. Beth Israel organized itself around nurses’ work, supporting and encouraging the work that nurses did with patients.
Organizing a hospital around nurses’ work, encouraging the work that nurses did with patients! Those are sweet words to a staff nurse’s ears. No wonder my nurse colleague was mourning the job she’d left when she moved to Minneapolis!
I was able to meet Dr. Clifford when she and I were participants in the Joint Commission Roundtable that led to the publishing of Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis (2005). Everything I’d heard and read about her I was able to experience firsthand. She truly believed in staff nurses, their professionalism, and their centrality to excellent patient care.
A vision of holistic professional care. Obituaries for Dr. Clifford talk about her pioneering work in primary nursing, but those words don’t do justice to what primary nursing meant to her, the nurses she worked with, and the patients they served. She removed the restraints on staff nurses, which were built on decades of tradition perpetuating a subordinate role. She recognized that nurses don’t merely perform a series of tasks, but provide holistic professional care to patients. She built a nursing model that placed staff nurses at the center of quality patient care and created an administrative culture to support them. She was visionary when she did this in the 1970s. It would still be considered visionary if she were doing it in today’s acute care environment.
I’m extremely grateful for Joyce Clifford and the work she did on behalf of staff nurses. My hope is that as nurses reflect on her work, we will become reenergized to assure the centrality of bedside staff nurses in the provision of quality patient care.