fulmer j clifford presentation revised
TRANSCRIPT
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.