Code Green: Money-Driven Hospitals and the Dismantling of Nursing (The Culture and Politics of Health Care Work)

Beth Israel was an international benchmark hospital which many saw as setting the nursing standards to be achieved elsewhere. This account of its recent history carries important messages about the domination of economics over the need for nursing care, the fragility of even the best nursing leadership during amalgamations, and the ease with which a reputation can be lost.

Hospital restructuring has fundamentally changed nurses' work and the very meaning of nursing. It has overlooked the therapeutic value of the nurse-patient relationship and the importance of 'knowing the patient.' Is it any wonder, then, that so many nurses are leaving the profession because of frustration and disillusionment? In the end, this hurts nurses as well as patients, physicians, and hospitals. Weinberg concludes that when designers draw up cost-effective plans for hospital restructuring, they must thoughtfully include nurses in their planning. The author is to be congratulated on bringing this important topic into view.

Hospitals frequently devise a system of color codes to convey a message to their personnel succinctly and exclusively. Weinberg chooses 'code green' to refer to the financial crisis that hospitals are facing today, the ensuing trend to merge hospitals, and its implications for the nursing profession..... This thought-provoking book gives a uniquely personal perspective. It is suitable for specialized healthcare collections in academic, larger public, and medical libraries.

In this thorough investigation into how the nursing profession has changed radically over the last decade, Weinberg cites hospital consolidation and 1997's Balanced Budget Act, which brought cuts to Medicare payments and severely affected hospitals' bottom line, as keys to the problem. The Brandeis University research associate uses the merger of Boston's prestigious Beth Israel Hospital with New England Deaconess as an example of how fiscal problems and consolidation are responsible for the growing shortage of nurses and rampant dissatisfaction in the field.... Weinberg's analysis will be important to medical professionals and hospital administrators.

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,' in part because we internalize responsibility for patient care, patient safety and the caring-healing process.

Weinberg provides an incredible account of her observations of the state of nursing at the newly merged Beth Israel-Deaconess Medical Center. Her goal was 'to find out why the nurses are crying.' Each chapter thoroughly examines current issues faced by the professional nursing staff as seen through their eyes. These issues are similar to those faced by nurses nationally as financial goals take precedence to quality patient care.... An excellent account of challenges faced by nurses today. Summing Up: Essential.

Weinberg's book is a powerful description of the issues facing both nurses and hospitals at a time when the entire health care industry is concerned with a growing shortage of nurses. Her portrayal of the impediments faced by nurses in their efforts to continue to provide quality patient care are well-documented, and, in many instances, frightening. The book makes clear nurses' contributions to patient safety and quality-even if the nurses themselves were unable to do so.

Dana Beth Weinberg provides a compelling account of the dismantling of one of the few hospitals in America that specialized in care. This is a 'must read' for all who seek to understand the nurse shortage.

Dana Beth Weinberg's book is right on target, portraying how the relentless financialization of our health care system destroyed one of the finest-if not the finest-hospital nursing service in America. Code Green is a well-written demonstration of how organizational change can disrupt the work of even the most conscientious professionals, and a warning to us all of the human dangers raised by an unthinking spread of business logic.

Physicians need to pay more attention to what is happening to nursing as we and our patients are critically dependent on the underappreciated activities of nurses. A good starting point is to read and heed the alarms sounding in Code Green.