Never Good Enough: Health Care Workers and the False Promise of Job Training

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Ithaca 2008 Hard cover Good. Glued binding. Paper over boards. 300 p. Contains: Tables, black & white. Culture and Politics of Health Care Work.

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Frontline health care workers have always been especially vulnerable to the perpetual tides of health care 'reform,' but in the mid-1990s in New York City, they bore the brunt of change in a new way. They were obliged to take on additional work, take lessons in recalibrating their attitudes, and, when those steps failed to bring about the desired improvements, take advantage of training programs that would ostensibly lead to better jobs. Such health care workers not only became targets of pro-market and restructuring policies but also were blamed for many of the problems created by those policies, from the deteriorating conditions of patient care to the financial vulnerability of entire institutions.

In Never Good Enough, Ariel Ducey describes some of the most heavily funded training programs, arguing that both the content of many training and education programs and the sheer commitment of time they require pressure individual health care workers to compensate for the irrationalities of America's health care system, for the fact that caring labor is devalued, and for the inequities of an economy driven by the relentless creation of underpaid service jobs. In so doing, the book also analyzes the roles that unions—particularly SEIU 1199 in New York—and the city's academic institutions have played in this problematic phenomenon.

In her thoughtful and provocative critique of job training in the health care sector, Ariel Ducey explores the history and the extent of job training initiatives for health care workers and lays out the political and economic significance of these programs beyond the obvious goal of career advancement. Questioning whether job training improves either the lives of workers or the quality of health care, she explains why such training persists, focusing in particular on the wide scope of its "emotional" benefits. The book is based on Ducey's three years as an ethnographer in several hospitals and in-depth interviews with key players in health care training. It argues that training and education cannot be a panacea for restructuring—whether in the health care sector or the economy as a whole.

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Editorial Reviews

From the Publisher
"To overcome the hazards of constant health care restructuring efforts, one union strategy has been the development of programs to make allied health workers multiskilled and cross-trained. However, these expensive training programs have provided neither more meaningful work not better paying jobs. . . . This book features interviews with allied health workers about their educational, occupational, and personal histories. The interviews certainly speak to the humor and creativity health care workers employ in light of these constant training programs."—B. A. D'Anna, Choice, September 2009

"In her book, Never Good Enough, Ariel Ducey explores the ideology of the market and healthcare restructuring in considerable historical detail. She takes aim at the major values of individualism, competitiveness, and the pursuit of self-interest underlying U.S. health policy during the mid-1990s and the mantra of the inevitability of market-based reform. As a healthcare ethnographer and sociologist Ducey's perspective comes from the study of the healthcare workforce training industry in New York City. In particular, she closely examines SEIU's New York City-based Local 1199, and its strategy of labor-management partnerships and embrace of work-force retaining programs in response to healthcare restructuring and the threat of hospital layoffs in the early to mid-1990s. There may be considerable disagreement with Ducey's point of view, but her opinions are well supported and reflect a healthy respect for academic integrity and fairness."—Registered Nurse

"Ariel Ducey's Never Good Enough takes a hard look at how unions can best aid the job enrichment and career development of their members. Job training is a field with as many pitfalls as promises—and Ducey examines them all. Her book is an invaluable guide to what works and what doesn't, in health care and other industries where labor-management training initiatives are supposed to cushion the impact of corporate restructuring and provide more meaningful employment for American workers."—Larry Cohen, President, Communications Workers of America

"Whether you find yourself agreeing or arguing with Ariel Ducey, Never Good Enough will spark fresh thought about the way we define knowledge and skill, the purpose of worker education, and the distortions wrought by ever-present rhetoric of the 'new economy.' This is a stimulating book."—Mike Rose, author of The Mind at Work: Valuing the Intelligence of the American Worker

"Ariel Ducey illuminates the structure of the health care industry by not only following legislative and funding trails but also observing the lives of working people themselves. Ducey takes seriously the aspirations, feelings, and thoughts of these health care workers-primarily immigrants of color and African American women. These workers provide an organic critique of hospital reengineering, including the transformation of nursing from hands-on patient care to the filling out of forms."—Eileen Boris, Hull Chair of Women's Studies, University of California, Santa Barbara

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Product Details

Table of Contents

Acknowledgments ix

Introduction: Health Care and Getting By in America 1

1 The Pull and Perils of Health Care Work 21

2 Restructuring the New York Way 59

3 The Promise of Training 75

4 Too Skilled to Care: Multiskilling 89

5 "It All Comes Down to You": Self-Help and Soft Skills 111

6 Training without End: Upgrading 139

7 From Skills to Meaning 159

8 A Common Cause 180

9 Education as a Benefit 208

Conclusion: A Dose of Idealism 233

Appendix: A Note on Methods 245

Notes 253

Bibliography 279

Index 291

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