Nurse of America

Remembering nursing pioneer Claire Fagin

In January 2024, U.S. nursing leader Claire Fagin died at the age of 97. Obituaries appeared in many major publications. One of the best was in the Washington Post. That one focused on Fagin’s year leading the University of Pennsylvania, but also on her key role in pushing nursing forward, through her forceful advocacy and emphasis on a stronger academic curriculum. At the Truth About Nursing, we especially appreciated her mentoring and support over the last two decades. 

The wave of the future

The Washington Post headline describes Fagin as a “renowned nurse and researcher,” while the subhead explains that she “helped reshape American nursing” as a clinician, educator, and advocate, which is a pretty good summary. The piece includes the basics of her biography, which convey some sense of the changes in nursing over the course of her life. Claire Mintzer was born in New York City in 1926 and grew up in the Bronx. Her parents, Jewish immigrants from Eastern Europe, “ran a grocery store and told friends that Dr. Fagin would become a doctor like her aunt,” who becme chief of dermatology at Jamaica Hospital in Queens. If that was not enough, Fagin’s father apparently “took to calling her ‘Clarence,’ ostensibly to prepare her for life as a physician surrounded by peers who were men.” But “Clarence” was not having it. She later told an interviewer that being a physician was “not in [her] heart or [her] soul,” because her “natural being [was] to be at a peer level with people,” “collegial” and not “superordinate.” Ouch. [Of course, Fagin knew that nurses are not at a “peer level” with non-nurses in terms of health knowledge, as nurses use their advanced skills to save and improve lives; here she is talking about the importance of interacting respectfully with others.]

The obituary says that at age 17, partly inspired by the “gorgeous women” she saw on posters for the U.S. Army Nurse Corps during World War II, Fagin began studying nursing at a new program at Wagner College on Staten Island. Evidently, a recruiter had convinced her that college programs, not hospital ones, were “the wave of the future.” (See a 2004 interview where she explains how she decided to become a nurse.) She graduated in 1948 and worked at the pioneering Sea View Hospital, caring for children with tuberculosis; the piece does not say this, but at that time her colleagues would have been mainly the Black nurses who were recruited because they were willing to do such risky work. Fagin later worked in the adolescent psychiatry unit at Bellevue Hospital, and she got a master’s in psychiatric nursing from Columbia University in 1951. She then became a researcher at the Clinical Center, the National Institutes of Health’s new research hospital in Washington, DC. In 1952, she married the engineer and mathematician Samuel Fagin, and they had two sons, Charles and Joshua. She returned to New York in 1956 and helped “kick-start” a New York University program in mental health. She got her doctorate in nursing from NYU in 1964, with her dissertation on “rooming in.” The piece does not make clear what Fagin was doing in the late 1960s—in fact, she was directing graduate psychiatric nursing studies at NYU—but she took over as dean of the nursing department at Lehman College, part of the City University of New York, from 1969 to 1977. Then she moved to Penn, serving as dean of its nursing school. After stepping down, she was appointed interim president of the entire university in 1993, serving for one year. After that, Fagin continued to work as a researcher, consultant, and advocate, focusing on geriatrics. 

Tough, canny, powerful, autonomous, and heroic

Understandably, the obituary focuses on Fagin’s leadership of Penn. Evidently the university’s trustees chose her, because of her success at the nursing school, to replace Sheldon Hackney, who had been named as head of the National Endowment for the Humanities. The piece notes that at this time only 12% of U.S. college presidents were women. It also says that although Fagin has often been credited as the first in the Ivy League, Hanna Holborn Gray served as acting president of Yale from 1977-78. In describing Fagin’s one-year term as interim president, the obituary focuses entirely on her efforts to manage a crisis at the campus stemming from a racial harassment case in which a “White student had referred to a group of Black students as ‘water buffalo.’” This incident led to debates and protests. The piece says that Fagin was praised for easing tensions, meeting with students and holding town halls, but her decision to rescind a rule that banned “racially demeaning speech” got a mixed reaction. She noted that the speech code had been ineffective and led to free speech objections, and she set up a committee to create a less formal speech policy. The piece quotes the current interim Penn president J. Larry Jameson as saying that Fagin had “very much served the role of healer,” “seeking broad community input, and implementing many of the recommendations that inform our policies of open expression, respect, and civil discourse today.” These details are helpful, although it would have been good to hear what else Fagin did during the year. The piece might also have had more on Fagin’s other leadership roles, including as president of the National League for Nursing and advisor to the World Health Organization, which it mentions, and her work leading major nursing projects for the John A. Hartford Foundation and the Gordon and Betty Moore Foundation, which it does not. 

Another focus of the obituary is Fagin’s transformative effect on nursing education, primarily through her years as dean of Penn’s nursing school. The piece quotes Fagin herself as saying that when she arrived, she found that the school was a small one at a very big university, “and in a profession that was not highly respected among the students.” Ha ha. But she was on a mission.

As dean, Dr. Fagin oversaw the creation of the first nursing doctorate program in the Ivy League and required all faculty to have a doctorate. She expanded research efforts, launching a privately funded center that drew in millions of dollars in grants. She founded one of the first historical centers for the study of nursing. She created some of the school’s first endowed chairs for nursing. And she started an academic partnership with the university’s health system, in which faculty had dual responsibilities as professors and practicing nurses.

This is all great. The piece notes that when Fagin stepped down, “enrollment had tripled and the school sat atop the rankings of the nation’s best, according to the New York Times.” More importantly, the piece credits Fagin as a primary force in a broader “transformation in nursing education,” pioneering “landmark baccalaureate and doctoral programs to educate the next generation of clinicians.” It cites Linda Aiken for the idea that by pushing for nurses to have college educations, rather than what the piece calls “technical” hospital-based diploma programs, Fagin helped create a new world in which bachelor’s degrees are (in the piece’s words) “standard,” and many nurses have graduate degrees. Aiken says that “moved nursing into the mainstream of health-care leadership, and created nursing as an autonomous profession with its own expanded scope of practice.” This discussion may understate somewhat the prior level of nursing skill and autonomy. But it surely is correct that when Fagin “began her education as a nurse in the ’40s and ’50s, a lot of physicians viewed nurses as their handmaidens,” as the piece quotes Dominique Tobbell, a historian of nursing at the University of Virginia, as saying. Now, a nursing leader receives a Post obituary that identifies her throughout as “Dr. Fagin.” The obituary might have also noted that Aiken, herself a prominent nursing scholar, is now the Claire M. Fagin Leadership Professor of Nursing Science, a title that speaks to Fagin’s influence.

The obituary could have had a lot more on Fagin’s substantive nursing work. It does have a good amount on her dissertation, which it says was on rooming in, “the clinical practice in which parents are allowed to stay with their hospitalized children.” The piece explains that in the 1960s, “draconian” hospital rules generally kept child inpatients separated from their parents. In fact, they kept Fagin from spending time with her son Joshua after he had hernia surgery. 

Her research found a stark difference between hospitalized toddlers who were granted unlimited parental visits and those who, under traditional hospital rules, were isolated from their families. Written up in newspapers and featured on the “Today” show, her findings were credited with spurring rule changes nationwide. By 1978, more than 60 percent of hospitals allowed 24-hour visiting in pediatric wings, according to a University of Pennsylvania biography. The practice is now ubiquitous in American hospitals.

This too is all great. However, the piece could have had much more on Fagin’s work in psychiatric nursing in the following years, both at NIH and in New York, as well as on her later work in geriatric nursing, particularly with the Hartford Foundation. 

The obituary does give a fairly good sense of Fagin’s public advocacy for nursing, which is also a critical part of her legacy. 

She was an eloquent and persuasive voice for nurses and nursing research, arguing in newspaper and television interviews that nurses were not silent partners to doctors but instead were in the mold of Florence Nightingale: “tough, canny, powerful, autonomous and heroic.”

The obituary also quotes Tobbell as noting that Fagin was part of a group of nurses making clear “that nurses were expert in their own right, full members of the health-care team with their own distinctive and valuable contributions.” And the piece has a couple good examples of her advocacy. It links to a priceless (and sadly prescient) 1996 letter to the editor of the New York Times. In that letter, Fagin argued that reported plans to replace nurses with “barely trained” patient care assistants were profit-driven cutbacks that “defy thoughtful planning and reflect the views of high-priced consultants or administrators who understand little about the primary aim of the health delivery system — care and cure of people.” And the obituary notes that in 2022, “at age 95,” Fagin and Aiken wrote a column for the health news site Stat “arguing that the federal government could use Medicare funding to fix a nurse shortage in hospitals.” The obituary closes with a short quote from that column: “The U.S. has the nurses. Americans deserve their care.”

Of course, Fagin had been advocating for nursing in the media for many decades. Although we did not see any obituary mention this, in the 1980s she founded the group Nurses of America with fellow nursing leader Pam Maraldo. The group worked to improve nursing’s media representation, and among its notable achievements was getting the abysmal 1989 naughty nurse television show Nightingales off the air. In a more recent interview, Fagin explained her philosophy on advocacy:

That’s my philosophy: you’re not silent and you make sure you use your voice every place that it counts–and even when it doesn’t count–because you’re not always sure when it counts.

Claire Fagin and The Truth About Nursing

And finally, on a more personal note, we wanted to say that Fagin’s advocacy for the profession also included two decades of mentorship and support for us at the Truth About Nursing. She met with us in 2003, shortly after we started the Truth’s predecessor organization, the Center for Nursing Advocacy, and she was on our advisory panel and was there for us from then on. She gave useful advice. She introduced us to other nursing leaders who could help us. She sent us a paper she wrote in 2001 about how important it is for nurses to increase public awareness of their work, and she shared the slides she used when she spoke to a group about nursing in the media. In 2004, she co-wrote an op-ed with nursing leaders Diana Mason and Pam Maraldo in the American Journal of Nursing entitled “A Gift to Yourself,” explaining how our work overlapped with hers and encouraging nurses to support our work. She co-wrote articles with us, including “The Nursing Shortage,” published in two 2005 issues of Kango Jissen no Kagaku, the Japanese Journal of Nursing Science. In 2007, Fagin wrote a review of the A.R. Gurney play Crazy Mary when it appeared in New York so we could post it on our website. In 2008, she gave us a great quote for the back cover of our book Saving Lives. She launched fundraising initiatives on our behalf. More recently, in 2019, she wrote a companion piece to one we published in the New York Daily News Nurses Week supplement. She made time to join our advocacy campaigns, writing letters to media creators with the same blunt authority as she displayed in the 1996 Times letter discussed above.

Just this past summer, in 2023, we discussed her enthusiasm for the overall vision of nursing in Sarah DiGregorio’s recent book Taking Care and the best ways to spread the word about that (we will have more on this book in the future). 

In all this, Claire Fagin was powerful, persuasive, funny, accessible, full of ideas, and always supportive. In her emails to us, she was enthusiastic but concise, occasionally to the point of being a bit inscrutable. Of course, since she could be seen as a sort of oracle of nursing, that is not really surprising. We will miss her.

 See Harrison Smith’s obituary: “Claire Fagin, renowned nurse and researcher who led UPenn, dies at 97: As a clinician, educator and advocate, she helped reshape American nursing. She was also one of the first women to lead an Ivy League school, serving as interim president at Penn,” which appeared on January 18, 2024 in The Washington Post.