Joyce C. Clifford Seminar in Nursing

Terry Fulmer, PhD, RN FAANBouvé College of health Sciences

Northeastern University

November 30, 2011

With our deepest thanks to Larry Clifford

and her wonderful family who shared her

with us all of these years…

Joyce Clifford: The ScholarIn her own words

Many of us have had the privilege to know her personally

• As a devoted friend • A passionate advocate• A comic when needed• A “mother warrior”

also as needed

This evening

• Joyce Clifford as scholar – Her early papers outlining the mandate for

nursing autonomy, accountability & authority– The mandate for primary nursing – The necessity for reimagining the role of the head

nurse ˃ nurse manager– The full partnership of the discipline in practice

The Future of Nursing The four key messages:

1. Nurses should practice to the full extent of their education and training

2. Nurses should achieve higher levels of education…seamless progression

3. Nurses should be full partners with physicians and other health professionals in redesigning healthcare in the United States

4. Effective workforce planning and policymaking require better data collection and improved information infrastructure

But she knew that

• I would argue that it was Joyce Clifford’s scholarly work that led us to this moment we think of as The Future of Nursing

• prescient?

Our conversation tonight• How we carry forward

her vision…• Conduct the much

needed research• Publish the papers• And keep the legacy

vibrant

The early years• 4+ decades ago-

emphasis on direct patient care

• No notion of leadership; only supervision

• Concerns related to patients receiving treatments as ordered with procedures completed

• A time when interaction between staff and head nurses was very limited

Joyce knew that leadership was a crucial part of the equation and began her journey. Five years of teaching at the Hospital of St. Raphael, followed by U.S. Air force Nurse Corps, Alabama, Indiana, Boston…

We are so fortunate she published...

She left us a roadmap…• Clifford, J.C. (1979). The potential of primary

nursing. Health Care in the 1980s: Who provides? Who plans? Who pays? New York, NY: National League for Nursing.

• Clifford, J.C. (1978). A reaction to Donna McCarthy and Marita MacKinnon Schifalacqua: Primary Nursing: Its implementation and six month outcome. Journal of Nursing Administration, 54.

• Clifford, J.C. (1974). Review of Supervisory Management for Health Institutions. Journal of Nursing Administration.

Clifford, J.C. (1978). A reaction to Donna McCarthy and Marita MacKinnon Schifalacqua: Primary Nursing: Its implementation and six

month outcome. Journal of Nursing Administration, 54.• Here Joyce argued that the limitation of the head nurse

role is a serious problem for advancing the accountability of the profession.

• The imperative for decentralized decision making• Caregiver to caregiver communication• Head nurse no longer simply coordinator, but leader

with authority for decision making• The serious limitations of geographic areas and districts

And she put us on the map…

December 26, 1983

Clifford, J.C.(1981) Managerial control versus professional autonomy: A paradox. Journal of Nursing Administration, 9, 19-21.

• “THE 2 HATS… NURSING ADMINISTRATOR’S HAT AND THE NURSES CAP”

• THE DILEMMA OF MANAGERIAL ACCOUNTABILITY & PROFESSIONAL ACCOUNTIBILTY

• JOYCE TAUGHT US HOW TO WEAR BOTH

And distinguished lectures• Shaping the Results: A Case Study View –

Beth Israel Hospital, Boston, MA USA. Speaker for The Institute of Nursing Science of the University of Basel Conference, Switzerland. 28 September 2005

• Expert Nurse Forum. The American Health

Care System: Current Priorities and Implications for Nursing Practice and Nursing Roles. Japan. 11 August 2002

• Expert Nurse Forum. Career Development

for Professional Nurses Concepts and Case Example. Japan. 4 August 2002 .

• "Leadership Through Clinical Excellence". Keynote speaker for The First Anna Reynvaan Lecture in Amsterdam, Netherlands, 9 June 1999.

Clifford, J.C. (1983). Nurse-physician communication: Competition or cooperation? Fourth

Annual Dean's Distinguished Lecture. Philadelphia, PA: University of Pennsylvania.

She took on the hard topics.. And with Dr. Rabkin, she gave voice to what so many of us wanted to discuss. “… a review of the literature over the past 2 decades indicates the need for the 2 groups to form more effective communication patterns..”“the social structure of the hospital contributes to the breakdown…”“I am interested in better understanding organizational barriers..”

Middle years: exploration of the nurse executive role

• Clifford, J.C. (1985). Improving Hospital Management and Information Systems: The nurse executive in the institution's leadership team. World Hospitals XXI (4) 28-30.

• Clifford, J.C. (1984). Determination of the nurse shortage (United States). In R.S. Tonks (Ed.), Determinants of Change in Health Care, proceedings of the Fourth Northeast Canadian/American Health Conference (pp. 54-63). Burlington, Vermont.

• Clifford, J.C. (1984). Nursing research and policy formulation: The case of prospective payment. American Academy of Nursing Papers of the 1983 Scientific Session. Kansas City, MO: American Nurses Association.

Era of the DRGs, cost containment– advent of product lines…

• Clifford, J.C. (1988). The nurse executive: Will the professional practice model survive? Journal of Professional Nursing, 4, 76-77, 141.

• Clifford, J. C. (1988). What

DRGs Mean to the Patient and the Provider. Journal of Geriatric Psychiatry, 22, (2), 201-210.

Clifford, J.C. (1988). The nurse executive: Will the professional practice model survive?

Journal of Professional Nursing, 4, 76-77, 141.• “Primary nursing is dead,” declared the keynote speaker• She asked “who said so?” and questioned the role of the non nurse

futurist• She noted the declaration did not come out of the experience of nurse

executives across the country• However she was brave enough to say that none of us could assert that

primary nursing is alive and well• Challenged the abdication of responsibility for critical decision making in

difficult times• Her usual courage

She stayed evidence based…“Our data do not suggest that we are more costly, When I compare Beth Israel’s nursing hours per patient day with my colleagues in this community we have stayed at the mean…”

And her dissertation and PhD were underway

• Brandeis University 1991-1997

• Published her dissertation in 1998

• Her leading acknowledgment in her book was, of course, to Larry

When did she have the time?• She used an expert panel,

collected original data- 3 hospitals (case studies) in 3 different states

• Data were collected from multiple sources, (interviews, observation, organizational documents)

• Unit of analysis: CNO

Papers were increasingly focused on what restructuring meant to professional practice

•EDITORIAL ADVISORY BOARDS•Health Management Quarterly, 1993 – 1994•Nursing Administration Quarterly, 1981 - •Nursing Management, 1982 - 2001•Journal of Nursing Administration, 1978 - 1984•Nursing Spectrum, Regional Advisory Board, 1998-

while always coming back to relationships and behavior..

Clifford, J.C. and Wandel, J.C. (1993). Creating a Supportive Work Environment. In D.J. Mason, S.W. Talbot and J.K. Leavitt (Eds.), Policy and Politics for

Nurses: Action and Change in the Workplace, Government, Organizations and Community. W.B.

Saunders Co., Philadelphia, PA.

And her vision for the profession..• Clifford, J.C. (1990). The future of nursing

practice. In N.L. Chaska, (Ed.), The Nursing Profession: Turning Points (pp. 617-723). St. Louis: C.V. Mosby.

• The Future of Nursing in Massachusetts.

Randolph, MA: Panel member at Tri-Council Program sponsored by Nursing Spectrum. 3 June 1998.

Contemporary nursing…

• Downsizing?• Shortages?• Adequate preparation? She expects us to lead

through the cycles, be courageous and set an example

Thank you, Joyce.