Academic journal article Journal of Cultural Diversity

Code Green: Money-Driven Hospitals and the Dismantling of Nursing

Academic journal article Journal of Cultural Diversity

Code Green: Money-Driven Hospitals and the Dismantling of Nursing

Article excerpt

CODE GREEN: MONEY-DRIVEN HOSPITALS AND THE DISMANTLING OF NURSING Edited by Dana Beth Weinberg (2003) Forwarded by Suzanne Gordon (ISBN 0-8014-3980-9, 213 pages, $25 hardcover)

Code Green: Money Driven Hospitals and The Dismantling of Nursing is a scholarly work that examines the impact of hospital cost reduction and restructuring on nursing practice at a merged hospital. The book is written for nurses and their works during the hospital restructuring. The author realistically describes and compares the work on what is happening in nursing care between two competitive hospitals, Beth-Israel and Deaconness in Boston, that have been merged into a giant hospital industry. The book illustrates various aspects of a merger, including comparisons of nursing productivity between primary nursing and other nursing models in relation to physician nurse relationships, quality of patient care, and financial and management issues.

The title, Code Green, is a fantastic way to describe each situation and it signifies the upcoming dangers of changes in hospital environments with the restructuring. With low profit margins and borrowed restructuring strategies from the business sector, many hospitals experience themselves in a code green. The term Code Green is used in hospital industries as a facility failure that requires immediate interventions. In this book, "A code green indicates the dangers of market driven health care systems that emphasize profits over quality patient care" (p. xiv). In response to Code Green, hospitals have adopted the values of business rationality that emphasizes high productivity and low cost, without considering the quality. With the business standards, leaders in the hospital health industries focus their attention on the concept of managed care to increase revenues while reducing costs. The consequences are that of poor quality of care and high stresses of nurses. The author vividly explains about the phenomenon of this cost containment using various research methods; observations, interviews, focus groups, and surveys.

This book clearly analyzes about how the dismantling of nursing occurred in a merged hospital and discusses about quality of care affected by the restructuring processes. The book can be used as a reference for nursing administration, social sciences, health care and hospital administration courses. It also would be a valuable resource for physicians, nurses, and leaders in hospital administrations as well as health care policy makers.

The book is organized into 7 chapters and includes forward statements, introduction and conclusion as separate chapters. Introduction provides the overview of the book. Chapter 1 addresses the roots of a troubled hospital that has been merged from two different hospitals that used different nursing philosophies and models. Chapter 2 identifies problems in nursing models that are not applicable to the merged organization and nurses working without use of the practice model that had served them in the past. Chapter 3 provides the information about how hospital administrators demolished the nursing structure and weakened the power of nurses in the organization. Due to this dismantling of nursing, "Nurses have experienced increased alienation from hospital administration and growing conflict between their roles in patient care and the hospital restructuring plans" (p. 96). Chapter 4 analyzes power conflicts between nurses and physicians as well as other obstacles to providing patient care. Chapter 5 examines the impact of physician nurse relationships that led to lack of teamwork and collaboration. Chapter 6 presents the new flex staffing system that has been applied to the new Code Green financial environment. The flex staffing uses a minimum-staffing ratio and is based on the business models in manufacturing industries. This minimum-staffing ratio of one nurse to many patients has created high levels of stresses for nurses who need to work overtime and/or double shift to provide the safe care. …

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