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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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"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 HospitalAbout the Author:
Dana Beth Weinberg is Assistant Professor of Sociology at Queens College.
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