We are on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals
in droves, and there are not enough new recruits to the profession to meet demand. Even hospitals that were once
very highly regarded for the quality of their nursing care, such as Boston's Beth Israel Deaconess Medical Center,
now struggle to fill vacant positions. What happened? Dana Beth Weinberg argues that hospital restructuring in
the 1990s is to blame.
In their attempts to retain profit margins or even just to stay afloat, hospitals adopted a common set of practices
to cut costs and increase revenues. Many strategies squeezed greater productivity out of nurses and other hospital
workers. Nurses' workloads increased to the point that even the most skilled nurses questioned whether they could
provide minimal, safe care to patients. As hospitals hemorrhaged money, it seemed that no one--not hospital administrators,
not 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.