We are on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals in droves, and there are not enough new recruits to the profession to meet demand. Even hospitals that were once very highly regarded for the quality of their nursing care, such as Boston's Beth Israel Deaconess Medical Center, now struggle to fill vacant positions. What happened? Dana Beth Weinberg argues that hospital restructuring in the 1990s is to blame.
In their attempts to retain profit margins or even just to stay afloat, hospitals adopted a common set of practices to cut costs and increase revenues. Many strategies squeezed greater productivity out of nurses and other hospital workers. Nurses' workloads increased to the point that even the most skilled nurses questioned whether they could provide minimal, safe care to patients. As hospitals hemorrhaged money, it seemed that no one—not hospital administrators, not doctors—felt they could afford to listen to nurses.
Through a careful look at the effects of the restructuring strategies chosen and implemented by Beth Israel Deaconess Medical Center, the author examines management's efforts to balance service and survival. By showing the effects of hospital restructuring on nurses' ability to plan, evaluate, and deliver excellent care, Weinberg provides a stinging indictment of standard industry practices that underestimate the contribution nurses make both to hospitals and to patient care.
Dana Beth Weinberg is Assistant Professor of Sociology at Queens College. Suzanne Gordon is an award-winning journalist, author of Life Support: Three Nurses on the Front Lines, and coauthor of From Silence to Voice, also from Cornell.
Table of Contents
Foreword
ix
Acknowledgments
xv
Introduction
1
1
A Troubled Hospital
19
2
No Working Model for Nursing Practice
43
3
Dismantling Nursing
76
4
Power Contests and Other Obstacles to Providing Patient Care
Physicians need to pay more attention to what is happening to nursing as we and our patients are critically dependent on the underappreciated activities of nurses. A good starting point is to read and heed the alarms sounding in Code Green.
Daniel F. Chambliss
Dana Beth Weinberg's book is right on target, portraying how the relentless financialization of our health care system destroyed one of the finest—if not the finest—hospital nursing service in America. Code Green is a well-written demonstration of how organizational change can disrupt the work of even the most conscientious professionals, and a warning to us all of the human dangers raised by an unthinking spread of business logic.
Linda H. Aiken
Dana Beth Weinberg provides a compelling account of the dismantling of one of the few hospitals in America that specialized in care. This is a 'must read' for all who seek to understand the nurse shortage.
