Staff Nurses at the Center: Joyce C. Clifford’s Still Radical Notion

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.


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2016-11-21T13:11:32+00:00 November 4th, 2011|career, nursing perspective|7 Comments

About the Author:

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.

7 Comments

  1. Leah Ann Megan October 5, 2012 at 12:50 pm

    I passed my boards in July. After a couple months enjoying my children and settling them into their new school year, I am ready to find a job and begin my exciting journey as a nurse! Thank you “Aunt” Joyce, without you none of this would be possible.

    Leah

  2. Shawn Kennedy November 11, 2011 at 5:16 pm

    Leah,

    what a great legacy to your “Aunt Joyce”. I met her a few times in connection with AJN. I had just started working at AJN – Thelma Schorr was president of the compnay and Joyce was the president of the board. I recall a very gracious and warm person with a keen ability to zero in on issues. I’m sure Joyce will ‘watch’ your career with interest.

  3. Leah Megan November 8, 2011 at 10:20 am

    “Aunt Joyce” was how I was first introduced to this wonderful lady. She was my husbands surrogate aunt, My mother-in-law and Joyce were friends from their days at St. Anselms nursing school. I did not really get to know Joyce well until 1992 when my mother became ill. Unsure of what was causing my mothers, short term memory loss, I talked to Joyce, unaware of her numerous high positions in the nursing field. She immediatley directed me to the top Neurologist at BI. A diagnosis of lung ca was given and about six months for her to live. Through the advancements in oncology, and having the best Dr.’s possible, because of Joyce, she lived a good quality life for three years. Cancer took my mothers life in 1995, but it led me to Joyce. She was an amazing person on a personal level, but what I learned about her professional life, left me in AWE. I was the mother of 3 young children with little faith that I would have the ability to go back to school. Joyce, through the years, bolstered my confidence and pointed out the qualities in me that would make me a great nurse. After my 4th child, I decided, that there was never going to be a perfect time, so therefore I went ahead and enrolled in a four year full time BSN program, with the most wonderful letter of recomendation from Joyce. It has been the hardest challenge of my life, but Joyce had confidence in me. I am now in my senior year and it greatly saddens me that Joyce will not be here when I walk across that stage in the spring. I can honor her though, by being the best nurse when I graduate that I can be!!!!!!

  4. Vernon Dutton, R.N. (@nursingpins) November 7, 2011 at 8:51 am

    Nurses at the bedside suffered a loss with the passing of Joyce C. Clifford. Unfortunately neither healthcare or bedside nursing as a profession will advance as long as hospitals are in charge of how nurses at the bedside are utilized.

  5. Monicca2654 November 7, 2011 at 4:00 am

    Well written commentary on the work of Joyce Clifford. I met Joyce at my first AONE meeting when I was a new nursing administrator. She was my beacon as I struggled to convince hospital administration to change our environment to one in which staff nurses thrived. I give her complete credit for my ongoing quest to convince not only hospital and nurse executives of the importance of this model, but to convince nurses of the part that empowered nurses would play in creating a ‘healthy’ workplace environment. Joyce will be missed, for sure. She will also be revered for her important place in nursing history as a champion of professional nursing at the bedside.
    +1

  6. Sheila Englebardt November 6, 2011 at 11:17 am

    Well written commentary on the work of Joyce Clifford. I met Joyce at my first AONE meeting when I was a new nursing administrator. She was my beacon as I struggled to convince hospital administration to change our environment to one in which staff nurses thrived. I give her complete credit for my ongoing quest to convince not only hospital and nurse executives of the importance of this model, but to convince nurses of the part that empowered nurses would play in creating a ‘healthy’ workplace environment. Joyce will be missed, for sure. She will also be revered for her important place in nursing history as a champion of professional nursing at the bedside.

  7. Peggy November 4, 2011 at 9:49 pm

    As I’ve written in a previous post, my years at a hospital with a strong primary nursing model stand out in my memory as some of my very best. We also used a collaborative practice model that gave nurses much more autonomy. I thank this thought leader for her innovation and courage to think outside the box.

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