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(More customer reviews)Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (Suzanne Gordon, ILR/Cornell University Press)is a first rate work of journalism, the beginning of a civilian audit that should have been documented by the profession itself, either in its primary practice venue (hospitals) or by its primary proponents of its own value (academics and the American Nurses Association).
Nursing Against the Odds documents not only the manipulation of nursing by the hospital industry, the medical profession and the media (reinforced by drug and device manufacturer Johnson & Johnson). It documents that nurses themselves think so little of their own contribution that they are unable or afraid to speak up when given the chance.
Nursing Against the Odds also documents the real tragedy of the hospital reengineering movement of the 1990s. This response to the challenge to health providers by the Managed Care companies to show their value in the marketplace was the wrong tactic at the wrong time by the wrong people. Michael Hammer and James Champy made a point to warn (in Reengineering the Corporation: A Manifesto for Business Revolution, 1993) that the chief financial officer should never be tasked to manage the reengineering effort, simply because it was not about cutting costs but raising quality. Since the big accounting firms had the ear of the hospital CFOs this is exactly what happened. So the same folks that brought us Enron messed up hospitals and nursing so thoroughly that neither has yet to recover.
The contribution of Nursing Academia and the American Nurses Association during this cascading iatrogenesis has been less than helpful. Nursing schools teach care planning using a methodology that is largely an intellectual fraud. The Nursing Diagnosis Model demands so many mental gyrations that most students don't get it by the time they graduate. Nursing documentation in the clinical record using this method invites ridicule by other health professionals. Consequently Nursing Diagnosis does not inspire care planning and assist in documenting progress. Nursing care plan documentation is simply ignored or mindless phrases show up in clinical documents ("buffing the chart") that no one reads. Nursing Diagnosis phrases like "situational low self-esteem" or "ineffective coping" are more descriptive of Nursing's present state of affairs and its inability to assert itself as an independent profession.
While many academics look down their noses at union membership by calling it unprofessional, they forget that most professions bill for their time in fractions of an hour and produce quantifiable outcomes for their work. (Not many nursing graduates recognize the SF-36 or the FIM, common health outcome measurements tools.) Most professionals have figured out ways to protect themselves and their families, either by bargaining units or individual, enforceable contracts that protect against the hazards of their work or the vicissitudes of their employer. The fact that Nursing is unable to protect itself, and that this leaves anyone who is subjected to a hospital stay in grave danger, should be enough to give us all some motivation to put Nursing Against the Odds at the top of everyone's reading list.
Michael Newell, RN, MSN
Haddonfield, NJ
Click Here to see more reviews about: Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (Culture and Politics of Health Care Work)
Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals.
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