Code Green: Money-Driven Hospitals and the Dismantling of Nursing by Dana Beth Weinberg, Suzanne Gordon (Foreword by)

From the Publisher

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 onenot hospital administrators, not doctorsfelt 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.

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.

Product Details

• Table of Contents

Table of Contents