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Joyce Clifford, changed how nurses work with patients

Joyce C. Clifford established primary nursing at Beth Israel.
Joyce C. Clifford established primary nursing at Beth Israel.Handout

Years before implementing at Beth Israel Hospital her vision of how nursing could best serve patients, Joyce C. Clifford walked corridors in Connecticut imagining changes that lay ahead.

“From the age of 15,’’ said her husband, Lawrence Clifford of West Roxbury, “she worked as an aide in St. Raphael Hospital in New Haven, watching the care and always questioning, ‘Why can’t the care be better than it is?’ ’’

At Beth Israel Hospital in the mid-1970s, Dr. Clifford established the practice of primary nursing, under which each patient is assigned a nurse who assumes full responsibility for care during the hospital stay and subsequent return visits. Under that model, which spread to hospitals around the world, a physician and a nurse work as coprofessionals, each with primary duties for a patient’s care.


Dr. Clifford, who founded and led the Institute for Nursing Healthcare Leadership in 1999 in Boston, died Oct. 21 at Beth Israel Deaconess Medical Center of complications from kidney failure. She was 76 and had previously spent a quarter-century as vice president and nurse-in-chief at the hospital.

“Obviously she’s an icon in American nursing,’’ said Eileen Sporing, chief of nursing at Children’s Hospital Boston. “She revolutionized modern nursing practice with the creation of her patient-centered care model. That model became widely replicated as a result of Joyce’s advocacy and her contributions to the field and the literature on the effects on patient care.’’

Primary nursing replaced team nursing, under which tasks and responsibilities were divided and no one served as the patient’s principal advocate.

“We did away with a lot of established protocol,’’ Dr. Clifford told the Globe in 1988, and that change allowed nurses to individualize care.

“Because primary nurses can go to physicians, social workers, administrators, and other members of the hospital team, they could begin to participate in decision-making,’’ she said. “So the whole issue of respect and recognition got turned around.’’


Some opposed the departure from team nursing. Dr. Clifford said she often was asked, “How did you get your doctors to agree to this? ‘To agree to what,’ I reply, ‘to give good care?’ They want good care just like nurses want good care. But the thing is, we have always stayed focused on the patient, and because I believe nursing is the fabric that holds the hospital together, if you stay patient-focused, you become nursing-focused as well.’’

Dr. Mitchell T. Rabkin, chief executive emeritus of Beth Israel Deaconess Medical Center, said that “nurses found this very fulfilling. One told me, ‘Now for the first time I can practice nursing the way I was taught in nursing school.’ ’’

Jeanette Ives Erickson, chief nurse at Massachusetts General Hospital, said Dr. Clifford’s “vision was that hospitals and nurse leaders needed to set up organizational structures that enhanced and maintained the integrity of the nurse-patient relationship. She talked about that relationship being a very sacred space.’’

Born Joyce Hoyt in New Haven, she grew up in nearby West Haven, Conn., the third of four sisters, and worked at St. Raphael Hospital before graduating from West Haven High School.

She received a nursing diploma from the hospital and a bachelor’s in nursing from St. Anselm College in Manchester, N.H.

Her first stint working in Boston was cut short when she returned to Connecticut because of a family illness. Back home, an encounter with a recruiter led Dr. Clifford to join the Air Force, which stationed her in Alabama.


“Even as a young officer, because of her experience, her superiors put her in charge of a lot of situations,’’ said her husband of 44 years, who met her when they were in the Air Force.

Dr. Clifford received a master’s in nursing from the University of Alabama Birmingham and a doctorate in health planning and policy analysis from the Heller School at Brandeis University. She was working at Indiana University when Rabkin hired her to join Beth Israel’s administration.

“When she got here, she put forth in more detail this notion of primary nursing,’’ Rabkin said. “Nursing at the time was pretty much team nursing, but no one really knew patients. Originally, physicians objected. It was a short time before they realized this was infinitely superior.’’

Though Dr. Clifford did not originate the concept of primary nursing, “nobody really articulated it the way she did,’’ Erickson said. “She made people realize how important it was.’’

In a 1982 interview with the Globe, Dr. Clifford said that “at Beth Israel, nurses assume full nursing responsibility for between one and four patients, and secondary responsibility for two or three others. As a result, she is clearly in the position to be recognized much more as a professional, first by the patient, and also by other health providers. Physicians, for example, regard this person much more as a colleague.’’

What she established at Beth Israel created a ripple effect, Rabkin said, and “really made major inroads on the status of nursing.’’


“I think what was incredible about Joyce is that she had an impact on the local level, but she also had an influence nationally and globally,’’ said Trish Gibbons, a former administrative director of nursing at Beth Israel Hospital and a former vice president for nursing at Beth Israel Deaconess Medical Center.

“Joyce never stopped at just one hospital, she never stopped at just one country,’’ Gibbons said. “She was a nurse of all time in some ways. Probably there are a handful of nurses who have had as much impact as Joyce has had on the profession.’’

Along with founding the Institute for Nursing Healthcare Leadership, for which she was president and chief executive, Dr. Clifford received many honors, including the award of honor from the American Hospital Association and both the lifetime achievement award and the national nurse executive leadership award from the American Organization of Nurse Executives.

In addition to her husband, Dr. Clifford leaves a sister, Rita Brown, of West Haven.

A funeral Mass will be said at 10 a.m. today in St. Theresa of Avila Church in West Roxbury. Burial will follow in the Massachusetts National Cemetery in Bourne.

“She really was a titan of nursing,’’ Erickson said. “She led with grace and dignity and was a nurse through and through. She really understood the important relationship that nurses have with patients, and the influence a clinical nurse has on a person’s life in illness and in wellness.’’


Bryan Marquard can be reached at bmarquard@globe.com.