Advocate of ‘Primary Nursing’ Approach Died at 76

On Oct. 21, Joyce C. Clifford, a professional nurse who supported a relationship of equals among doctors and nurses when it comes to the treatment of patients, and her ideas were taken in by some of the country’s leading hospitals for the reason that they minimized medical errors and at the same time helped improve survival rates, died in Boston at the age of 76, the reason being kidney failure and heart disease, according to her spouse Lawrence.

Dr. Clifford (she acquired a Ph.D. in health planning in Brandeis University) was among the primary line of registered nurses who endeavored to have bachelor’s degree the last amount of requirement in an area where a majority had associate degrees. It was a prerequisite she placed for every nurse that she employed at Beth Israel Hospital in Boston where she was employed starting 1974 until 1999, acting as the nursing administrator and eventually the vice president. This hospital, by the way, is a Harvard teaching hospital.

Beneath the “primary nursing” model that she began at Beth Israel in 1975, nurses were given primary responsibility for every four to five clients – providing care for each one as they were on duty, remaining on call whenever off duty, and serving as advocate as well as the go-between for every client’s doctors.

The thought was to bring back the continuity and responsibility that were thought to be losses of the nursing system that was then used widely, recognized as team nursing. Within the team system, every nurse was given a specialized duty, such as dressing wounds or handling medication, but not a single nurse was able to see the big picture.

According to Margaret Grey, Yale School of Nursing Dean, in an interview following Dr. Clifford’s demise, doctors come and see their clients for a few minutes per day, but nurses are present all day, seven days a week. Dr. Clifford composed a system that allowed the primary nurse the advantage of that gathered 24-hour nursing information, she continued.

Although Dr. Clifford was not the author of the primary nursing model, she was at least the first who applied it into practice within a big teaching hospital, stated the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania Linda Aiken, who put into printing research regarding the works of Dr. Clifford.

Research revealed that the system was beneficial for both patients and hospitals alike, added Professor Aiken. The improved responsibilities as well as the advanced education it required were connected to a decrease in patient mortality and at the same time, a lesser staff nurse turnover. Professor Aiken continued to say that Beth Israel had waitlisted applicants despite the nurse shortage elsewhere.

Never being the standard, primary nursing is used, in one form or another, in only around 10% of the country’s hospitals. With cost-cutting and corporate mergers, hospitals that used to practice this system have long since adjusted or removed it completely in order to make room for more systems that are decentralized, including Beth Israel, which is now called the Beth Israel Deaconess Medical Center.

Dr. Clifford’s accomplishment was in presenting how primary nursing could be effective, stated Queens College assistant sociology professor Dana Beth Weinberg. Her Harvard dissertation, a book printed back in 2003, the “Code Green: Money-Driven Hospitals and the Dismantling of Nursing”, recorded how the primary nursing was dismantled in Beth Israel, following its merger with Deaconess Medical Center back in 1999 and after Dr. Clifford left.

Dr. Clifford also continued to set up and head the Institute for Nursing Healthcare Leadership. This supports research as well as higher level of education in nursing and also the primary nurse system.

Born Joyce Catherine Hoyt on September 12, 1935 in New Haven, she is one among the four daughters of ironworker Raymond Hoyt and his spouse, Helen. She obtained her nursing diploma in St. Raphael Hospital New Haven while her Bachelor of Science degree was acquired in Anselm College in New Hampshire in 1959.

She entered the Air Force around the early part of the 1960s and got a master’s degree in nursing administration from the University of Alabama in Birmingham back in 1968, where she was assigned. She met her spouse at the university.

Dr. Clifford was employed as chief nurse at Beth Israel by Dr. Mitchell T. Rabkin, the president and chief executive, who is also an associate of the Harvard Medical School faculty.

During an interview on Monday, Dr. Rabkin stated that on the first day of his internship, he became conscious that nurses were a lot more knowledgeable than he was. He allowed Dr. Clifford complete freedom to assemble a nursing staff that would labor together with physicians. At first, it met resistance with medical doctors who protested that instead of just a single nurse that they had to communicate with in part of a ward, they had to do a lot of individual contacts for every patient’s primary nurse. Dr. Rabkin continued that the resistance was short-lived for the reason that the physicians soon understood that they were receiving significantly better details, and the clients were receiving considerably better care.

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