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Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (Culture and Politics of Health Care Work)

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Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care (Suzanne Gordon, ILR/Cornell University Press)is a first rate work of journalism, the beginning of a civilian audit that should have been documented by the profession itself, either in its primary practice venue (hospitals) or by its primary proponents of its own value (academics and the American Nurses Association).

Nursing Against the Odds documents not only the manipulation of nursing by the hospital industry, the medical profession and the media (reinforced by drug and device manufacturer Johnson & Johnson). It documents that nurses themselves think so little of their own contribution that they are unable or afraid to speak up when given the chance.

Nursing Against the Odds also documents the real tragedy of the hospital reengineering movement of the 1990s. This response to the challenge to health providers by the Managed Care companies to show their value in the marketplace was the wrong tactic at the wrong time by the wrong people. Michael Hammer and James Champy made a point to warn (in Reengineering the Corporation: A Manifesto for Business Revolution, 1993) that the chief financial officer should never be tasked to manage the reengineering effort, simply because it was not about cutting costs but raising quality. Since the big accounting firms had the ear of the hospital CFOs this is exactly what happened. So the same folks that brought us Enron messed up hospitals and nursing so thoroughly that neither has yet to recover.

The contribution of Nursing Academia and the American Nurses Association during this cascading iatrogenesis has been less than helpful. Nursing schools teach care planning using a methodology that is largely an intellectual fraud. The Nursing Diagnosis Model demands so many mental gyrations that most students don't get it by the time they graduate. Nursing documentation in the clinical record using this method invites ridicule by other health professionals. Consequently Nursing Diagnosis does not inspire care planning and assist in documenting progress. Nursing care plan documentation is simply ignored or mindless phrases show up in clinical documents ("buffing the chart") that no one reads. Nursing Diagnosis phrases like "situational low self-esteem" or "ineffective coping" are more descriptive of Nursing's present state of affairs and its inability to assert itself as an independent profession.

While many academics look down their noses at union membership by calling it unprofessional, they forget that most professions bill for their time in fractions of an hour and produce quantifiable outcomes for their work. (Not many nursing graduates recognize the SF-36 or the FIM, common health outcome measurements tools.) Most professionals have figured out ways to protect themselves and their families, either by bargaining units or individual, enforceable contracts that protect against the hazards of their work or the vicissitudes of their employer. The fact that Nursing is unable to protect itself, and that this leaves anyone who is subjected to a hospital stay in grave danger, should be enough to give us all some motivation to put Nursing Against the Odds at the top of everyone's reading list.

Michael Newell, RN, MSN
Haddonfield, NJ

I have become a shameless, devoted Suzanne Gordon "follower" since reading her: "From Silence to Voice".
Suzanne has grabbed the bull by the horns, "put the blame on Mame" for the nursing crisis and offers constructive solutions in order to recruit and retain nurses.
"Nursing against the Odds", is a book that management/administration, government, nurses,student, patients and potential patients/the public - should read in order to understand "what" exactly is going on within the healthcare setting and how to make amends.
"Nursing Against the Odds" was extremely hard for me to read...emotionally. It has taken me months of picking up and putting down the book...especially getting through "Part 3" in such chapters as: "Mangling Care" and "Nurses on the Ropes".
I felt such rage reading what I know is to be so true.
Suzanne details the many players who are " not just supporting good [nursing] practice, they are undermining good practice" and notes that "when nurses believe that exit is their only option, they are really expressing their profound sense of defeat."
And exiting with their feet, they are.
It's deafening and deadly.

While of benefiit to nurses everywhere in just reminding us we are not alone, this book also reminds us how we may be our own worst enemy in promoting change.
Sadly, those who could benefit most from this book, consumers, CEO's and physicians will probably never read it. In light of the JCAHO white paper on the nursing shortage, why isn't JCAHO also implenting and assessing facilities based on their own strategy recommendations? Without nurses at the bedside, medicine is headed for the rocks!
This is a very powerful book on nursing today.
Lisa Jones RN IBCLC

Whether you work in the health care industry, or are a consumer, "Nursing Against the Odds" is a compelling reading. Gordon's writing wryly covers all aspects of the nursing crisis with a thoroughness rarely found in books of current affairs. Gordon has written several books about the nursing profession, and this latest addition is an excellent culmination of many issues covered in previous books.

I read the book and am going to graduate from a nursing program in June of '08. I was so disenchanted as to what went on in the book as I see it going on when I am in clinicals. I probably wouldn't have picked nursing as my number one profession after being in the hospital setting and it should be a read the first quarter of new nursing students. The book is very factual, as to what I have witnessed thus far. It is a shame it has to be the almighty dollar when it comes to health care. This country is so rich and yet it has so many people without coverage. Most of my fellow students are trying to RUN from bedside nursing as the patient ratio is not safe. Schools need to revamp their programs with more hands on experience. We get little to prepare us for the real world. Any nurse will tell you "You will start learning when you get your first job, that is when the real learning begins." It is no wonder there are at least 300,000 med errors a year. Let us shadow a nurse for at least a quarter to see what it's all about. If I wasn't older, I would pursue another degree.

Suzanne Gordon's "Nursing Against the Odds" hits the nail on the head! From her description of present day uniforms to her description of the combat-like nursing duties, she has identified the problems with the nursing profession. I could not put this book down once I started and have promised to loan it to other nurses. It's not often that I comment aloud while reading a book but Ms. Gordon has a literary method of phrasing that evokes the proverbial "Aha" every few minutes. Great reading and thought provoking!

This book is a MUST READ for all hospital administrators and nurses! Gordon does an excellent job objectively putting forth the issues that plague the nursing profession today, including the history of how we got this way, and compelling ideas for solutions. Very thought provoking.

Excellent analysis regarding the troubles that plague the nursing profession. Problem is - how to fix it? I'm not sure we nurses can tolerate the poor working conditions much longer...

I have been a practicing nurse now for 34 years. I have done everything from critical care, medical-surgical, some psychiatric nursing, to now; nursing education. This book accurately presents every thing I have experienced.

This a a very good, and easy to read nursing text book. It flows well because of the real life stories and examples that all of us at the bedside can relate to. It makes you think about what you do, and what you say. How these things can and do impact patient care, and relationships with staff, patients, facilty, etc. We are such a necessary part of the bigger picture, and this book helps support and encourage us to be the best that we can be and to stand up for what it right and good in nursing and health care.