In Focus: A Nurse in the House
She ended up running the University of Pennsylvania, but Claire Fagin’s heart has always been by the patient’s side
By Joe Levine
W hen Claire Fagin (M.A., ’51) was growing up in New York in the 1930s, her parents—European Jewish immigrants—told everyone
she would be a doctor. Her father even called her “Clarence” to prime her for what was then almost exclusively a man’s career. • Fagin had other ideas. “It was not in my soul or my heart to be a physician,” she recalled recently. “Later, when I could explain it to myself psychiatrically, I realized that my natural being is to be at a peer level with people. I don’t see myself as super-ordinate. I see myself as collegial, and I believe in Erich Fromm’s notion of rational authority by way of skill or knowledge.” • That kind of authority propelled Fagin to a career of “super-ordination” that has included service as the first female president of an Ivy League College, the presidencies of the National League of Nursing and the American Orthopsychiatric Association, and a place at the forefront of seemingly every major advance in her field during the past 50 years. • The doctoral dissertation Fagin wrote at NYU, on the importance of allowing parents to stay with young children who are hospitalized, made national news and overturned practice at medical centers across the country. • The undergraduate baccalaureate program she founded at Lehman College was the nation’s first to equip nurses as “primary practitioners” who conducted initial patient workups. A letter she published in The New York Times in 1996, and
a subsequent paper, “When Care Becomes a Burden,” focused national attention on a changing health care system that forces families to act as caregivers for recently discharged patients.
Fagin has been lionized as a “Living Legend” by the American Academy of Nursing, had a building and a professorship named after her at the University of Pennsylvania, and received a slew of awards and honorary degrees. Yet collegiality has figured equally in her success. A striking woman with a brilliant smile, Fagin is the kind of person who will take your arm minutes after meeting you, and who winds up at the center of talking, laughing people wherever she goes. Time and again, she seems to have met someone who mentored her, suggested a new professional direction, picked up the phone on her behalf, or simply dropped everything to come join her team.
There was the day in 1943, when Fagin, then 17, and a friend spotted a sign on Lexington Avenue for something called the Nursing Council for War Service. They had already decided to become nurses so they could serve in World War II, and were trying to decide which hospital to seek out for training.
“A woman there, Dorothy Wheeler, spent just half an hour with us, but she probably had as much influence on me as anyone I’ve ever met,” Fagin recalls. “She said ‘You are not going to a hospital school. The future of nursing is a college program, you have got to go to college.’”
College programs were considered suspect by many in the profession who assumed they would provide insufficient clinical experience. But Fagin heeded Wheeler’s advice and went to Wagner, a small private Lutheran college with a new nursing program, and took courses in anatomy, physiology and chemistry. It was the beginning of an ongoing and fruitful tension in her career between clinical work and nursing education.
“I had no intention of being in education, because I loved the clinical work, every single minute of it, and I do to this day,” she says. “When I have my dear friends or my sister in the hospital, and I’m there as their nurse, so to speak, I leave and I feel, ‘Oh, my God, I love nursing. It’s me, it’s who I am.”
But in 1950, working as a clinical instructor in the adolescent psychiatric unit at Bellevue Hospital, Fagin discovered other dimensions to her calling. During meetings, when the chief psychiatrist asked nurses for their opinions of patients, Fagin noticed that a young Teachers College student, Gertrude Stokes, never began her assessments with the words I feel.
“She’d start with the intellectual part—‘Well, you know he actually seems to fit a description from Erich Fromm or Harry Stack Sullivan,’” Fagin says. “She’d bring in the literature and then go to her perception of the patient. And I would sit there with my mouth hanging open, thinking, ‘I want to be like that.’”
That same fall, Fagin enrolled at TC in a new psychiatric nursing master’s degree program led by Hildegard Peplau, who would become known as “the mother of psychiatric nursing.” Fagin quickly fell under Peplau’s spell—in part because Peplau did, in fact, attach great importance to the use of feelings combined with one’s scientific knowledge. In her seminal text, Interpersonal Relations in Nursing, Peplau argued for the creation of a shared experience between nurse and patient, and she believed strongly in psychoanalysis. (Fagin herself underwent Freudian therapy, and later drew on it to articulate her view of the damage caused by separating young patients from their mothers: as a child she herself had twice gone to live with relatives when her own mother was ill.)
But Peplau also sprinkled her lectures with references to famous thinkers and practitioners, sending her students literally racing to the library to be the first to look them up. Fagin also took a “mind-blowing” seminar taught led by Goodwin Watson, founder of The Journal of Applied Behavioral Science, and struck up a lifelong friendship with a fellow student, Gwen Tudor, who later headed the psychiatric nursing department of the new clinical center at the National Institutes of Health and became the first nurse to publish a paper in The Journal
“It was an atmosphere of intellectualism that I had never experienced before,” Fagin says. “I came out of it with a different view of myself. I felt truly educated.”
Instead of returning to Bellevue, Fagin took on a research consultancy assignment Peplau had arranged with the National League of Nursing. She served as Gwen Tudor’s deputy at NIH, where Bruno Bettelheim and other “names” dropped in for visits, and where there was freedom to implement cutting-edge theories from around the world. And at the Children’s Hospital in Washington, D.C., working under the famous psychiatrist Reginald Lourie, she became the nation’s first psychiatric liaison.
Along the way she married Sam Fagin, an engineer. They moved back to New York in 1956—and for the first time in years, Claire found herself scrambling for work. Again, her interests were clinical—but the job that materialized was helping to create a master’s degree program at NYU in psychiatric nursing. By the time she left, 14 years later, she’d gotten her doctorate and built a nationally recognized program that was among the first to include a community mental health component and a formal mechanism for minority recruitment. She’d also adopted two sons and come to a new understanding of the connection between education and practice.
“I see nursing as the application of science in an artistic way,” she says. “To do that, you have to be very knowledgeable—about science, about humanity, about patient care. You have to able to put it together and know it so well that you can focus it all on the patient.”
With her subsequent success at Lehman, the NYU experience transformed Fagin—in others’ eyes and her own —from a perennial “second banana” to leader material. In 1977, Penn came knocking with a nursing deanship, and Fagin took it, building the school into the nation’s top-ranked program. She recruited star faculty and administrators, created a board of overseers, built a relationship with Penn’s medical center and assiduously cultivated the media.
“I did everything I could to make us visible,” she says, laughing. “I went to benefits wherever there was someone we wanted on our board, and I always went over to Ruth Seltzer, who wrote the society column for the Inquirer, and said ‘Hi, I’m Claire Fagin, dean of the school of nursing,’ and she’d put my picture in the paper. Well, there were a lot of nurses married to wealthy people who weren’t even admitting they were nurses, and they started coming out of the closet.”
Fagin was so successful, and came to be regarded as such an adroit institutional politician, that a year after she left the deanship Penn’s board asked her to serve as the University’s interim president, with a defined one-year term. She enjoyed it so much that she has since wondered whether she didn’t come late to her true calling.
Since leaving Penn, Fagin has worked for two foundations, creating scholarships for nurse educators to conduct research. She believes the profession desperately needs more people with doctorates who can build the discipline and weigh in on research on national policy issues. Yet a story she tells makes it clear that she’s still the clinician whose real love is working with patients:
“My husband and I were at this big meeting a while back, and someone shouted, ‘Is there a doctor in the house?’ Nobody in this huge audience got up, and Sam looked at me and said, ‘So what are you going to do?’ So I stood up and said, ‘I’m a nurse.’ And I got down on the floor with this woman, and I held her hand, and that was what she needed. I focused on her and she focused on me. I wasn’t going to give her some big diagnosis. But, you know, so many doctors and nurses don’t even look at you when you come into a room. And if someone doesn’t look at you, then in my opinion, that person isn’t a caregiver.”