1) The document summarizes a seminar honoring Joyce Clifford and her scholarly contributions to the nursing field over several decades. 2) It discusses Clifford's early scholarly works that outlined the need for nursing autonomy, accountability, and authority as well as the mandate for primary nursing and reimagining the nurse manager role. 3) Clifford's work anticipated key messages of the 2010 IOM report on the future of nursing, including nurses practicing to the full extent of their education and achieving higher levels of education.

1. Joyce C. Clifford Seminar in Nursing
Terry Fulmer, PhD, RN FAAN
Bouvé College of health Sciences
Northeastern University
November 30, 2011

2. With our deepest
thanks to Larry Clifford
and her wonderful
family who shared her
with us all of these
years…

3. Joyce Clifford: The Scholar
In her own words

4. 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

5. 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

6. 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

7. 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?

8. Our conversation tonight
• How we carry forward
her vision…
• Conduct the much
needed research
• Publish the papers
• And keep the legacy
vibrant

9. 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

10. 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…

11. 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.

12. 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

13. And she put us on the map…
December 26, 1983

14. 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

15. 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.

16. 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..”

17. 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.

18. 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.

19. 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

20. 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…”

21. 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

22. 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

23. 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-

24. 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.

25. 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.

26. Contemporary nursing…
• Downsizing?
• Shortages?
• Adequate preparation?
She expects us to lead
through the cycles, be
courageous and set an
example

27. Thank you, Joyce.