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

Weinberg, D. B. Ithaca, NY: Cornell University Press, 2003. 240 pp. $17.95 (607) 277-2338 (ext. 251 or 254). http://www.cornellpress.cornell.edu

The United States is on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals in droves, and there are insufficient new recruits entering the profession to meet demand. Hospitals that were once very highly regarded for the quality of their nursing care now struggle to fill vacant positions. What happened? The author argues that hospital restructuring in the 1990s is to blame.

In attempts to retain profit margins or even to stay afloat, hospitals adopted a common set of practices to cut costs and increase revenues that squeezed greater productivity out of nurses and other workers. Nurses' workloads increased to an extent that even the most skilled nurses questioned whether they could provide minimally safe care. As hospitals hemorrhaged money, it seemed that neither hospital administrators nor 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.