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Contemporary debates on health care have given relatively little attention to the effects of recent changes on health care workers. When such questions are raised, debates have centered on the effect of corporatization and state intervention on the medical profession rather than on the much larger work force of less esteemed, gender-segregated occupations that constitute the majority of health care workers.
Intensifying Care contributes to overcoming this disparity by focusing on nurses and the reorganization of the nursing labor process during the cost containment era. In the expansionary decades of the 1950s and 1960s, nursing labor in hospitals was organized around a stratified work force performing differentiated tasks. Beginning in the 1970s, this system of labor was transformed by a trend toward RN-predominant staffing, the displacement of less-credentialed workers, and the reunification of nursing tasks. Nursing leaders promoted task reunification as a form of professional practice reminiscent of nursing before the widespread employment of a stratified work force in postwar hospitals.
To understand the reorganization of nursing labor as well as its significance, the author begins by discussing changes in the political economy of health care, the corporatization of hospitals, and the effects on health care workers. Major chapters then examine the changing forms of nursing labor, uniquely combining the use of prior studies of nursing and the author's participant observations at a metropolitan hospital undergoing both corporatization and the reorganization of work.
In focusing on the labor process in one of the largest service industries in the United States, the study contributes to theoretical debates regarding workers' stratification and empowerment, the role of managerial and occupational interests in organizing work, and the professionalization and/or proletarianization of services labor.
PART ONE: Political Economy, Corporatization, and Subordinate Workers
The Changing Political Economy of Health Care
Corporatization and the Reorganization of Community Hospitals
PART TWO: Reorganizing Nursing Labor
Before the Postwar Period: Hospital Apprenticeship and Private Duty
Stratified Workers, Subdivided Work: Team Nursing
Reunified Tasks: Primary Nursing and the Trend to an All-RN Work Force
Conclusion and Epilogue