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.
Reviews
"In this thorough investigation into how the nursing profession has changed radically over the last decade, [Weinberg] 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. . . . Weinberg's analysis will be important to medical professionals and hospital administrators."—Publishers Weekly, 1 May 2003
"Hospitals frequently devise a system of color codes to convey a message to their personnel succinctly and exclusively. Weinberg 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. . . . . [T]his thought-provoking book gives a uniquely personal perspective. It is suitable for specialized healthcare collections in academic, larger public, and medical libraries."—Library Journal, 1 May 2003
"Hospital restructuring has fundamentally changed nurses' work and the very meaning of nursing. It has overlooked the therapeutic value of the nurse-patient relationship and the importance of ‘knowing the patient.’ Is it any wonder, then, that so many nurses are leaving the profession because of frustration and disillusionment? In the end, this hurts nurses as well as patients, physicians, and hospitals. Weinberg concludes that when designers draw up cost-effective plans for hospital restructuring, they must thoughtfully include nurses in their planning. The author is to be congratulated on bringing this important topic into view."—Barbara Mann Wall, Health Affairs, September/October 2003
"Weinberg's book is a powerful description of the issues facing both nurses and hospitals at a time when the entire health care industry is concerned with a growing shortage of nurses. Her portrayal of the impediments faced by nurses in their efforts to continue to provide quality patient care are well-documented, and, in many instances, frightening. The book makes clear nurses' contributions to patient safety and quality-even if the nurses themselves were unable to do so."—Barbara A. Mark, Ph.D., RN, Journal of the American Medical Association, 2003
"The author scrutinizes how and why hospitals, in the era of profit-driven health care, routinely exploit qualities such as empathy, dedication, and professionalism in nurses. Using human science research, she illustrates how nurses really are 'ripe for exploitation' (156), in part because we internalize responsibility for patient care, patient safety and the caring-healing process." --Virginia Gillispie, Denver's Nursing Star, July 14, 2003.
"Weinberg (Brandeis Univ.) provides an incredible account of her observations of the state of nursing at the newly merged Beth Israel-Deaconess Medical Center. Her goal was 'to find out why the nurses are crying.' Each chapter thoroughly examines current issues faced by the professional nursing staff as seen through their eyes. These issues are similar to those faced by nurses nationally as financial goals take precedence to quality patient care. . . . An excellent account of challenges faced by nurses today. Summing Up: Essential. All levels." --M. A. Volino, Elmira College, Choice Magazine, Dec. 2003.
"The writing style, the narrative reporting of nurses' experiences, the observations and perspectives of nurse managers and administrators, all capture the reader's interest. In fact, the first few chapters of this book read like a 'whodunit,' causing the reader to ask, 'How could this have happened?' . . . Code Green is a thought-provoking work that graduate students and experienced administrators should read, discuss, and reflect upon."—Margaret N. Miller, University of North Carolina, Nursing Education Perspectives, May–June, 2004
"Offers a vivid snapshot of one episode in the recent history of the US health care system, and what it meant for the nurses involved. . . . For anyone interested in the management of nursing, or in the working of the US health care system, the book is informative and readable."—Stephen Wilmot, University of Derby, Nursing Ethics 11:2, 2004
"Brandeis University sociologist Dana Beth Weinberg couldn't believe her good luck when the influential group that evaluates the nation's hospitals asked her to lead a conference about the nursing crisis. Weinberg . . . would get a chance to make her case about the plight of nurses directly to executives who could reverse the tide. But, within 24 hours of advertising the by-phone conference, the Joint Commission on Accreditation of Healthcare Organizations pulled the plug on her April 15 appearance after hospital officials complained about Weinberg's perceived bias. Commission spokeswoman Charlene Hill said the title of Weinberg's book dismayed some callers because it 'cast kind of a disparaging light on hospitals.'"—Boston Globe, March 30, 2004
"One of the best analyses you will read of the causes of the nursing shortage is written in the introduction to Dana Beth Weinberg's fine book, Code Green. Here is a case study of the merging of two medical institutions, Beth Israel Hospital and New England Deaconess Hospital in Boston. By dissecting in detail what happened to both these institutions, especially in respect to the nursing department, Weinberg shows how the pressures of a national health care system in crisis drove the decline in nursing care in a newly merged medical center."—John O'Connor, New York State Nurses Association, Labor Studies Journal Summer 2004
“For an audience of working nurses, this book is likely to be welcomed as an empathetic portrait of their challenging work experiences, especially in the managed-care era, when organizational restructuring and job redesign have taken center stage. For physicians and other health care professionals and executives, the book may prompt a greater understanding of how nurses view their work and a greater recognition of the interdependent professional relationships that enable nurses to perform at their best. The book also could serve as a lesson for organizational leaders in any industry, through its story of the perils of restructuring without detailed forethought about the impact of job redesign on the recruiting, staffing, training, and productivity of key employees. . . . Weinberg admits her study was like trying to paint a still life during an earthquake; she does an admirable job of keeping the paintbrush steady.”—Kathleen Montgomery, University of California, Riverside, ASQ, March 2004
“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’s ability to plan, evaluate, and deliver excellent care, Weinberg provides a standard industry practices that underestimate the contribution nurses make both to hospitals and to patient care.”—Home Healthcare Nurse, vol. 23, no. 2, February 2005
“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 Hospital
