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Monday, November 29, 2021  

Number crunch and the nursing processPublished 11/4/2003


Here I go, agitating about yet another rehash of the nursing crisis! I wish I could just have positive things to say, but protest and critical analysis feel healthy at this point. I set out to review "Code Green: Money-Driven Hospitals and the Dismantling of Nursing" by sociologist Dana Beth Weinberg, and it set the old blood boiling.

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" (p. 156), in part because we internalize responsibility for patient care, patient safety and the caring-healing process.

This sense of duty manifests in standard nursing behavior such as going hours without using the bathroom, skipping meals as a matter of course, routinely picking up extra shifts and staying late to compensate for lack of staff. Ultimately exhaustion sets in, leading to burnout, work-related stress and injuries, and risks to patient safety.

Weinberg’s analysis of the merger of Beth Israel and New England Deaconess Hospital provides a thumbnail sketch of what has happened with restructuring in hospitals across the U.S.

In her study, hospital decision-makers often perceived and treated the nurses like whining, complaining children who just couldn’t accept or adjust to the changes that came with the merger’s "workplace redesign."

As is often the case, the restructuring involved decreased licensed nursing staff at the bedside. The changes were presented as inevitable in the hospitals’ struggle for fiscal solvency, and staff nurses had little to no input into the redesign. Staff complaints and concerns about questionable patient care conditions were dealt with as if they were anything but symptoms of a real problem.

Tragically, the realization that nurses were in fact accurate in their warnings has come too little and too late. Indeed, the "dis-ease" that is chaotic, rushed, assembly line patient care has resulted in patient complications and unnecessary deaths.

Locally, scenarios similar to what happened in Code Green continue to play out. In a recent article in Denver Westword, Stuart Steers examined issues related to the Denver Health nurses’ drive to unionize ("Critical Condition," June 12-18, 2003).

He also considered what happened at another local hospital a few years ago when nurses there tried to form a union: The hospital introduced union-busting tactics and thwarted the effort.

More recently, the use of insidious customer service scripts has been mandated at this hospital. Threatened with job loss or the perennial "write-up" if the scripts are not followed, or if the proper "positive attitude" is not conveyed, nurses are strong-armed into conforming to employer expectations no matter how unreasonable or exploitative.

As quoted in the Westword, nurses were advised that they "should sense people’s needs before they ask, take the initiative to put customers’ needs first, and go the extra mile to satisfy them."

However well intended, these expectations read like a codependent’s how-to manual for enabling dysfunction. Such a heavy-handed approach to extracting the lifeblood of employees enables organizations with unrestrained power to ignore underlying systemic issues.

The "shame and blame game" protects the status quo, which is at best unhealthy and at worst downright dangerous.

Similarly in Code Green, systems issues were routinely blamed on individual nurses, a classic symptom of dysfunction. When the system fails the customer/patient, the employee with little or no input into company decisions should not take the hit for it.

Nursing leaders, such as Ginette Pepper, PhD, RN, FAAN, contend that hospital culture and nursing’s educational system foster the above dynamic.

Dr. Pepper was recently at the University of Colorado School of Nursing giving a presentation about medical errors for the annual Lola Fehr Lecture in Nursing Ethics. Mirroring the analysis presented in Code Green. She stressed the imperative that a "culture of safety" be fostered as opposed to a "culture of secrecy."

She, too, identified the pervasiveness of the "shame and blame game," and called for the development of a new system and culture, similar to what is already in place in the aviation, military and chemical manufacturing industries (School of Nursing News, June, 2003).

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