Code Green

Beth Weinberg Dana

Description

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.

Sujets

• Médecine
• Nursing
• Industrial relations
• History of the Americas

Informations

• Publié par: Cornell University Press
• Date de parution: 14 novembre 2011
• Nombre de lectures: 0
• EAN13: 9780801464928
• Langue: English

Extrait

Code Green

A volume in the series The Culture and Politics of Health Care Work edited by Suzanne Gordon and Sioban Nelson

Nobody’s Home: Candid Reflections of a Nursing Home Aide by Thomas Edward Gass

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Code Green Money-Driven Hospitals and the Dismantling of Nursing

Dana Beth Weinberg Foreword by Suzanne Gordon

ILR Press an imprint of Cornell University Press

Ithaca and London

Copyright © 2003 by Cornell University

All rights reserved. Except for brief quotations in a review, this book, or parts thereof, must not be reproduced in any form without permission in writing from the publisher. For information, address Cornell University Press, Sage House, 512 East State Street, Ithaca, New York 14850.

First published 2003 by Cornell University Press First printing, Cornell Paperbacks, 2004 Printed in the United States of America

Library of Congress Cataloging-in-Publication Data Weinberg, Dana Beth. Code green : money-driven hospitals and the dismantling of nursing / Dana Beth Weinberg ; foreword by Suzanne Gordon. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-8014-3980-3 (cloth : alk. paper) ISBN-10: 0-8014-3980-9 (cloth : alk. paper) ISBN-13: 978-0-8014-8919-8 (pbk. : alk. paper) ISBN-10: 0-8014-8919-9 (pbk. : alk. paper) 1. Nursing—Massachusetts—Boston. 2. Beth Israel Deaconess Hospital Center— Finance. 3. Hospitals—Massachusetts—Boston —Finance. I. Title. RT5.M4W45 2003 610.730974461— dc21 2003002118

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Cloth printing Paperback printing

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to my parents, Glenda and Alan Weinberg, and to the nurses, for the care they want to give

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Contents

Foreword by Suzanne Gordon Acknowledgments Introduction 1 A Troubled Hospital 2 No Working Model for Nursing Practice 3 Dismantling Nursing 4 Power Contests and Other Obstacles to Providing Patient Care 5 Doctor-Nurse Relationships 6 Not Enough Staff 7 Was Quality Affected? Conclusion Appendix: Studying Change at BIDMC References Index

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ix xv 1 19 43 76

98 116 137 160 175 193 199 207

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Foreword

F or almost thirty years, the Beth Israel hospital in Boston served as an icon for the empowerment of nursing. With its chief nurse execu- tive Joyce Clifford working in a unique partnership with CEO physician Mitchell Rabkin, the BI helped to pioneer an innovative model of nurs- ing care called primary nursing, which assigned one nurse to one patient. That nurse was responsible for that one patient throughout a hospital stay and, when possible, during subsequent hospital stays. The hospital also employed an almost all registered nurse staff, hired only RNs with bach- elor’s degrees, and was committed to enhancing the collaboration between nurses and physicians and giving nurses a greater voice in their institution. The New England Deaconess hospital, situated just across the street from Beth Israel in the heart of Boston’s Longwood Medical area, was also known for a devoted nursing staff that gave excellent care. But it was the BI that shone like a beacon, drawing in nurses from across the globe, who, like weary, sea-battered sailors seeking succor on hospitable shores, yearned for a model of the delivery of nursing services that they could re- produce in their own institutions. For years, the BI served as that model, promising through its strong leadership and committed, satisfied staff to address, and possibly even cure, the many ills that have long made nursing such a difficult and devalued career. It was thus natural for me to visit the BI and study its best practices when I first started to write about nursing. My first full-length article about nursing, “The Crisis in Caring,” written for theBoston Globedur-

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