Code Green: Money-Driven Hospitals and the Dismantling of Nursing / Edition 1

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Overview

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.

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Editorial Reviews

From the Publisher

"In this thorough investigation into how the nursing profession has changed radically over the last decade, Weinberg cites hospital consolidation and 1997's Balanced Budget Act, which brought cuts to Medicare payments and severely affected hospitals' bottom line, as keys to the problem. The Brandeis University research associate uses the merger of Boston's prestigious Beth Israel Hospital with New England Deaconess as an example of how fiscal problems and consolidation are responsible for the growing shortage of nurses and rampant dissatisfaction in the field. . . . Weinberg's analysis will be important to medical professionals and hospital administrators."—Publishers Weekly, 1 May 2003

"Hospitals frequently devise a system of color codes to convey a message to their personnel succinctly and exclusively. Weinberg chooses 'code green' to refer to the financial crisis that hospitals are facing today, the ensuing trend to merge hospitals, and its implications for the nursing profession. . . . . This thought-provoking book gives a uniquely personal perspective. It is suitable for specialized healthcare collections in academic, larger public, and medical libraries."—Library Journal, 1 May 2003

"Hospital restructuring has fundamentally changed nurses' work and the very meaning of nursing. It has overlooked the therapeutic value of the nurse-patient relationship and the importance of 'knowing the patient.' Is it any wonder, then, that so many nurses are leaving the profession because of frustration and disillusionment? In the end, this hurts nurses as well as patients, physicians, and hospitals. Weinberg concludes that when designers draw up cost-effective plans for hospital restructuring, they must thoughtfully include nurses in their planning. The author is to be congratulated on bringing this important topic into view."—Barbara Mann Wall, Health Affairs, September/October 2003

"Weinberg's book is a powerful description of the issues facing both nurses and hospitals at a time when the entire health care industry is concerned with a growing shortage of nurses. Her portrayal of the impediments faced by nurses in their efforts to continue to provide quality patient care are well-documented, and, in many instances, frightening. The book makes clear nurses' contributions to patient safety and quality-even if the nurses themselves were unable to do so."—Barbara A. Mark, Ph.D., RN, Journal of the American Medical Association, 2003

"The author scrutinizes how and why hospitals, in the era of profit-driven health care, routinely exploit qualities such as empathy, dedication, and professionalism in nurses. Using human science research, she illustrates how nurses really are 'ripe for exploitation,' in part because we internalize responsibility for patient care, patient safety and the caring-healing process."—Virginia Gillispie, Denver's Nursing Star, July 14, 2003.

"Weinberg provides an incredible account of her observations of the state of nursing at the newly merged Beth Israel-Deaconess Medical Center. Her goal was 'to find out why the nurses are crying.' Each chapter thoroughly examines current issues faced by the professional nursing staff as seen through their eyes. These issues are similar to those faced by nurses nationally as financial goals take precedence to quality patient care. . . . An excellent account of challenges faced by nurses today. Summing Up: Essential. "—Choice, December 2003

"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"—Linda H. Aiken, University of Pennsylvania

"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."—Daniel F. Chambliss, Hamilton College, author of Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics

"Beth Israel was an international benchmark hospital which many saw as setting the nursing standards to be achieved elsewhere. This account of its recent history carries important messages about the domination of economics over the need for nursing care, the fragility of even the best nursing leadership during amalgamations, and the ease with which a reputation can be lost."—Tom Keighley, Editor, Nursing Management

"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."—Gordon Schiff, M.D., Director, Clinical Quality Research, Department of Medicine, Cook County Hospital

Publishers Weekly
Bad food is the least of their worries: hospital patients often feel neglected, Weinberg says, and complain that they spend hours without proper medical attention from nurses. In this thorough investigation into how the nursing profession has changed radically over the last decade, she cites hospital consolidation and 1997's Balanced Budget Act, which brought cuts to Medicare payments and severely affected hospitals' bottom line, as keys to the problem. The Brandeis University research associate uses the merger of Boston's prestigious Beth Israel Hospital with New England Deaconess as an example of how fiscal problems and consolidation are responsible for the growing shortage of nurses and rampant dissatisfaction in the field. Before the merger, Beth Israel was famous for its egalitarian policies, while the well-respected New England Deaconess was known for its "restructuring of hospital care" in the name of cost efficiency. The different philosophies behind nursing and the ensuing political struggles involved with the marriage of individual institutions contributed heavily to the drop in nurse retention and, ultimately, to a decline in patient care. Weinberg's analysis will be important to medical professionals and hospital administrators, but outsiders may find it a bit academic and dry. (May) Copyright 2003 Reed Business Information.
Library Journal
Hospitals frequently devise a system of color codes to convey a message to their personnel succinctly and exclusively. Weinberg (senior research associate, Schneider Inst. for Health Policy, Heller Sch. of Social Policy and Management, Brandeis Univ.) chooses "code green" to refer to the financial crisis that hospitals are facing today, the ensuing trend to merge hospitals, and its implications for the nursing profession. The author, whose Ph.D. thesis dealt with this topic, cites the merger of the Beth Israel and Deaconess hospitals in Boston as an example of restructuring. She reviews the problems, power struggles, and disappointments that have disrupted nursing practice and led to nurses' frustration and a shortage of nurses that threatens to worsen. Weinberg calls for professional leadership to guide nursing through the organizational unrest and improve physician-nurse-administrator relationships. More comprehensive literature on nursing leadership is readily available, such as Harriet Feldman's Strategies for Nursing Leadership and the pages of Nursing Leadership Forum. However, this thought-provoking book gives a uniquely personal perspective. It is suitable for specialized healthcare collections in academic, larger public, and medical libraries. (Index not seen.)-Margaret K. Norden, Marymount Univ. Lib., Arlington, VA Copyright 2003 Reed Business Information.
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Product Details

  • ISBN-13: 9780801489198
  • Publisher: Cornell University Press
  • Publication date: 3/28/2004
  • Series: The Culture and Politics of Health Care Work Series
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 240
  • Sales rank: 458,345
  • Product dimensions: 5.42 (w) x 8.42 (h) x 0.57 (d)

Meet the Author

Suzanne Gordon is coeditor of the Cornell University Press series, The Culture and Politics of Health Care Work, and was program leader of the Robert Wood Johnson-funded Nurse Manager in Action Program.

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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 98
5 Doctor-Nurse Relationships 116
6 Not Enough Staff 137
7 Was Quality Affected? 160
Conclusion 175
Appendix Studying Change at BIDMC 193
References 199
Index 207
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