Guardian of the Discipline
In Memoriam

Claire M. Fagin, notable nurse leader for decades in the U.S. and worldwide, died January 16, 2024, at the age of 97. Dr. Fagin is survived by her son, Charles. Her husband, Samuel Fagin, mathematician and electrical engineer, died in 2019 and son, Joshua, died in 2020.

A guardian is “one who protects, or preserves; a keeper, defender” (Oxford English Dictionary). There is no doubt that Dr. Fagin was a Guardian of the Discipline of Nursing. Yet, over her 74-year career, Dr. Fagin was so much more- a visionary leader and bold, indefatigable, champion for nursing and health care. It is difficult to identify which of her innumerable accomplishments to highlight. However, as a proud 50+ year graduate level alum of the University of Pennsylvania (UPenn) School of Nursing (SON) and a recent beneficiary of the Barbara Bates Center for the Study of the History of Nursing, I am honored to offer some examples. Hopefully others, who knew Dr. Fagin personally, will comment with their perspectives.

Always a nurse: Claire Mintzer (Fagin) was born in 1926 in Bronx, NY. Despite her parents’ strong desire that she study medicine, Dr. Fagin aspired to become a nurse, graduating from Wagner College I948 with a baccalaureate degree in nursing. She articulated nursing as a “renaissance calling… “Healing is an art. You are using science to perform an art” (New York Times, 2024) (NYT)  Dr. Fagin noted that “Citing her other qualifications and jobs she (Dr. Fagin) held, her mother would say she was not “a real nurse”. But Dr. Fagin would reply: “Mama…I’m an R.N. – a Real Nurse” (NYT).

Dr. Fagin “always made it a point of identifying herself as a nurse” (NYT). There is no better example than the credentials section of a 2022 publication by Dr. Linda Aiken and Dr. Fagin (see policy section): “Linda H. Aiken is a registered nurse, a senior fellow at the Leonard Davis Institute of Health Economics, and a professor in the School of Nursing and the Department of Sociology at the University of Pennsylvania. Claire M. Fagin is a registered nurse and a professor and dean emeritus at the University of Pennsylvania’s School of Nursing”.

Advancing psychiatric-mental health (PMH) care and education: Beginning with her first experiences in nursing practice, Dr. Fagin developed a lifelong interest in PMH. Caring for children and adolescents in New York City led Dr. Fagin to pursue a masters’ degree in psychiatric nursing at Columbia University in 1951 which, in turn, led to helping to develop a pediatric PMH unit at the National Institutes of Health in Maryland. Dr. Fagin retuned to New York to pursue a PhD at New York University (NYU) (see policy development). She joined the NYU faculty, developing, in 1965, a masters’ degree program in child adolescent PMH and directing that program as well as the adult PMH graduate program.

Nursing education: In 1969, Dr. Fagin moved to Lehman College as professor and chair of the nursing department and, in 1977, was recruited by the University of Pennsylvania (UPenn) where she served as Dean of the SON (1977-91) and faculty (until 1996). Notably, Dr. Fagin was interim president (1993-94), the second woman interim President of an Ivy League university. A visionary leader in nursing education, Dr. Fagin advocated for baccalaureate-prepared nurses and for graduate education including nurse practitioners and nurse researchers (NYT). Under the leadership of Dr. Fagin the UPenn SON, among many advances ,“tripled enrollment” (NYT), “developed of a new doctoral program in 1978, required all faculty to have doctoral degrees, established some of the early endowed chairs in nursing, had more faculty members in the American Academy of Nursing (AAN) and Institute of Medicine (IOM)… than any other school, and was (and still is) among the top-rated schools in the country” (UPenn).

Nursing scholarship: Dr. Fagin recognized that building nursing’s body of rigorous, scientific knowledge was key to advancing the discipline. To that end, she led innovative, model programs to build and disseminate nursing research. In 1980, UPenn “established the first privately funded center for nursing research in the country”. Dr. Fagin led UPenn to be “among the top-rated schools in the country for research funding” by leading faculty to “secure millions of dollars in external grants, overcome barriers to securing NIH grants, and publishing in highly ranked journals” (UPenn). The school also established the Barbara Bates Center for the Study of the History of Nursing.

Over the years, Dr. Fagin’s research interests centered on system-level change. By example, she studied “hospital visitation (see below), the cost-effectiveness of nursing research and nurse practitioners, and nursing home reform” (UPenn). As Dean Emeritus, Dr. Fagin served as the “first Nurse Scholar-in-Residence at the IOM and being a model for the AAN/IOM program” (UPenn).

Health advocacy, policy, and visibility: Dr. Fagin recognized that to promote change in nursing practice, education, and research, and healthcare more broadly, nurses needed to be visible and engaged in policy development. She was an early model of the current focus on increasing nursing’s influence through leadership roles in private and public organizations and the use of publicity. Her dissertation is a key example of Dr. Fagin’s numerous impacts on policy for nursing and health care. Appalled that she and her husband were not being permitted to stay overnight their ill son, Dr Fagin sought to demonstrate the positive outcomes of parents staying with their ill child. She then advocated for change in visitation policies by disseminating her findings in nursing and healthcare, and through popular media (NYT). Today, “most hospitals will let a parent stay overnight” (The Joint Commission, 2020).

Throughout her “retirement”, Dr. Fagin continued to advocate and gain visibility for “the importance of nursing” and issues in healthcare. For example, she served on four corporate boards, was a member of the WHO Expert Panel on Nursing, was “founding director of the John A. Hartford Foundation’s national program on geriatric nursing, and chairwoman of the advisory board that guided the $100 million endowment and founding of the Betty Irene Moore School of Nursing at the University of California, Davis (NYT).

In 2022, Dr. Linda Aiken and Dr. Fagin (age 95) published an opinion article in STATnews, urging “Changes to Medicare can help solve the otherwise intractable problem of nurse understaffing in hospitals. The U.S. has the nurses. Americans deserve their care”. At the time of her death, Dr. Fagin was working with Dr. Aiken on “better ways to encourage nurses, physicians, and other health care workers to speak as one on matters of public health” (NYT). Speaking of visibility, Dr Fagin would smile to know that, on Sunday, January 21, she was included in the Passages (in memoriam) segment of CBS News Sunday Morning in which “Sunday Morning remembers some of the notable figures who left us this week”.

Dr. Claire Fagin, tireless advocate for nursing and healthcare, was a Living Legend of the American Academy of Nursing, Honorary Fellow of the Royal College of Nursing, recipient of 15 honorary doctoral degrees, and many awards and honors. Dr. Fagin is truly a Guardian of the Discipline and an exemplary role model for all RNs to be “Real Nurses” who advance the profession and discipline of nursing.

References:

Aiken, L. &  and Fagin, C. (2022). Medicare can help fix the nursing shortage in hospitals. STATnews. https://www.statnews.com/2022/02/08/medicare-can-help-fix-the-nurse-shortage in-hospitals/

Dean, C. (2024) Claire M. Fagin, Powerful Advocate for Nurses and Nursing, Dies at 97. New York Times Jan. 17, 2024. https://www.nytimes.com/2024/01/17/health/claire-m-fagin-dead.html

Guardian. (2023). Oxford English Dictionary. Accessed through Case Western Reserve University libraries. https://www.oed.com/dictionary/guardian_n?tab=meaning_and_use

Passages (2024) CBS News Sunday Morning. https://www.cbsnews.com/news/this-week-on-Sunday        morning-january-21-2024/

The Joint Commission. (2020) Speak Up: Prevent Errors in Your Child’s Care. pediatric_safety_brochure-5  15-2020.pdf  

University of Pennsylvania, School of Nursing, Faculty Profiles. Claire M. Fagin, PhD, FAAN, RN.    https://www.nursing.upenn.edu/live/profiles/68-claire-fagin