Nursing Against the Odds

Nursing Book Club

Nursing Against the Odds

How cost-cutting, media stereotypes and medical hubris undermine nurses and patient care

By Suzanne Gordon; Cornell University Press, 2005
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Reviewed By Christine Contillo, RN, BSN

Book ReviewSuzanne Gordon is a health journalist who has been following changes in both the culture and business of nursing for several decades. Not a nurse herself, but the daughter of a physician, she nevertheless understands the subtleties of how nursing is portrayed by the media, and how it is used and misused by hospital administrators.

Ms. Gordon begins the book with a concrete example. She transports a single neighbor who has had arthroscopic knee surgery home from the hospital. When she realizes that her neighbor is already familiar with crutches, the discharge nurse dispenses with instruction in their use. Only after leaving her car does Ms. Gordon understand that her “patient” is heavier and more sedated than she anticipated.

Any nurse reading the anecdote knows what will happen next — the patient falls, the author is unable to get her up alone, and she has to call for help from landscapers passing by. Soon she realizes that the neighbor is in no position to navigate her own home alone and is afraid to leave her. Such is the plight of many patients today, being discharged sooner and sicker with no support system in place. The situation is equally frightening for the nurses who are unable to care for their patients in the way that they’ve been taught.

Ms. Gordon uses this story to lead into how nursing has been maneuvered into its latest crisis. Some of the material has been covered in her previous book, From Silence to Voice. We learn that nurses are submissive, and that the medical model predominates because doctors bring in the patients while nurses remain interchangeable hospital personnel with only a first name. Nurses have largely been dropped by the media, except as naughty or as handmaidens; they are reluctant to speak with journalists except upon guarantee of anonymity because they fear the wrath of hospital administrators if they voice their complaints. The work they do is not billed as a service but is wrapped into the room charge. It was the emergence of feminism that initiated change in the profession, but it seems to be the nature of the nurses themselves that has made this change so turtle-paced.

New in this volume is a concrete understanding of the relationship between hospitals, insurance payers and Medicaid, and how concentration on the financial bottom line has led to early discharges, high nurse-patient ratios, an increase in errors, and a decrease in adequate patient care.

Frustration with the inability to practice the art of nursing correctly, and the corresponding stress involved, has led to nurses leaving the profession. This forces those nurses left to deal with even higher patient loads that have more acute illness. Chapter builds upon chapter and leaves the reader with a crystal-clear understanding of where nursing stands now and how it got there.

The final chapter offers suggestions to improve the plight of nursing, including making efforts to improve the image of nurses that the public holds and using collective action for demanding better pay, flexible work schedules and safer nurse-patient ratios. Ms. Gordon recommends an increase in the minimum education for an RN, but also a prolonged internship period during which nurses are introduced to acute care settings. She feels that implementing nurse-doctor patient rounds will develop a more collaborative effort and help restructure patient care.
Without implementing at least a few of her suggestions, there will most certainly be far fewer nurses caring for an increasingly elderly and ailing population.

Written By Christine Contillo, RN, BSN, has worked as a nurse since 1979, and has written extensively for various nursing publications as well as The New York Times.

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