Great book by Suzanne Gordon:Nursing Against The Odds

pickledpepperRN · Apr 18, 2006

American style single payer Medicare for all does not mean the government would be the employer. It means that like medicare no the government would be the insurer.

http://www.calnurses.org/healthcare/

ZASHAGALKA, RN · Apr 18, 2006

American style single payer Medicare for all does not mean the government would be the employer. It means that like medicare no the government would be the insurer.
http://www.calnurses.org/healthcare/

Baby steps

If Medicare is the only payer, then Medicare sets the rates for everything (They have too much control of that, now), and that eventually would include the cost of the 'bed' - and we ARE part of that cost.

Within 10 yrs of single payer Medicare, the primary function of Medicare would be cost containment. And YOU are part of that 'cost'.

Think about it, isn't cost containment the primary reason for advocating for single payer Medicare now? Get rid of all those fatcat insurance companies making a fortune off the health care system?

So, what happens when cost containment of those 'fatcats' aren't enough, and some gov't 'crat decides the real cost containment is in the masses of these 'small fatcat' RNs? I mean, if they really were caring, money wouldn't be the factor? So, either we're caring angels, or moneygrubbing scammers off the back of healthcare.

Well, there's one way to separate the wheat from the chaff. And I have no doubt this would happen. It wouldn't be abrupt, but gradual. First, slowing wages, then wage freezes. And all the while, EVERY hospital has the same, semi-real refrain: "We have to work within the Medicare model; our hands are tied."

Our competitive salaries are the result of competition. The whole purpose of removing the competition away to gov't is to take the profit of competition out of the system. Fine, but your advancing salary is one of those 'profits' such a system is designed to contain.

~faith,

Timothy.

Tweety, BSN, RN · Apr 18, 2006

American style single payer Medicare for all does not mean the government would be the employer. It means that like medicare no the government would be the insurer.
http://www.calnurses.org/healthcare/

I was just going to say that.

Having equal health care for all provided by a system paid for by the government does not mean the government has to own everything. We can keep the providers in private hands, the means for reimbursement would be public.

UM Review RN, ASN, RN · Apr 18, 2006

Baby steps
If Medicare is the only payer, then Medicare sets the rates for everything (They have too much control of that, now), and that eventually would include the cost of the 'bed' - and we ARE part of that cost.
Within 10 yrs of single payer Medicare, the primary function of Medicare would be cost containment. And YOU are part of that 'cost'.
Think about it, isn't cost containment the primary reason for advocating for single payer Medicare now?
~faith,
Timothy.

Exactly.

Never mind that nurses are already the health-care bargain of the century.

Tweety, BSN, RN · Apr 18, 2006

Baby steps
If Medicare is the only payer, then Medicare sets the rates for everything (They have too much control of that, now), and that eventually would include the cost of the 'bed' - and we ARE part of that cost.
Within 10 yrs of single payer Medicare, the primary function of Medicare would be cost containment. And YOU are part of that 'cost'.
Think about it, isn't cost containment the primary reason for advocating for single payer Medicare now?
~faith,
Timothy.

Very good point Timothy. Is this true in countries with long traditions of national health care? That nurses are in worse shape today than in years past? There's no easy answers.

Having the health care for the poor and elderly burdened by the middle class and the working poor who can barely afford premiums for themselves isn't a fair system either. (It's ironic that meany working people pay medicare/medicade taxes only to be uninsured themselves and make too much money to qualify for any assistance for their health care.) We can go off onto a whole other topic about universal health care.

ZASHAGALKA, RN · Apr 18, 2006

We can go off onto a whole other topic about universal health care.

And I didn't mean to spin this thread off topic, but it is sorta on topic because it was one of her points.

Her diagnosis is state of the art and absolutely on point in the book.

Her cure is a folk remedy.

~faith,

Timothy.

Newbie Nurse SMP · Apr 18, 2006

Hi all...

I am a nursing student. Do any of you have any suggestions on books that would be interesting to me? Would this Suzanne Gordon book be appropriate? What other titles does she have?

pickledpepperRN · Apr 18, 2006

I think the book is well worth reading.

That said although I cannot write nearly as well I am compelled to criticize. I've looked over my copy of the book and spent way mor. time than usual on this post.

Guess what? No links.

Ms. Gordon ignores pertinent nursing history.

For years RNs (individually and in some instances collectively) have been engaged in changing the traditional image of being the physician’s and administration’s handmaiden to strong and decisive advocates of their patients and their profession.

This traditional image dates back to the early 1900 when nursing students were trained and employed in indentured servitude environments by physician owned hospitals.

Graduate nurses were not employed by hospitals (cost), and ended up doing private duty or worked in public health.

In the early 1900s the profession had an opportunity to undo the male dominance in the health care field and be recognized as professional equals of physicians with the right to practice independently. Unfortunately many shortsighted leaders (who were in the majority at the time) ignored the warnings from a small but focal group of nursing leaders regarding the long term effect of women’s subjugation to men. As a result nurses became accomplices of their own subordination. Finally the oppression of nurses was built into the law and the education system through the legalization of paternalism and the institutionalization of apprenticeship.

Nurses owned allegiance to the institution that trained and hired them than rather than the patients and their families.

For decades this image, as viewed by physicians, policymakers, employers and perpetuated by the movie industry and media, became entrenched and permeated every aspect of the RN professional life.

This is no longer the case since the women’s equal rights movement and the demise of hospital based diploma programs. Nurses are now educated in institutes of higher learning (community colleges and universities). Also, don’t tell an OR RN that the “captain of the ship” doctrine still exists. She is responsible for nursing care in the OR.

The not so subtle change took place in the early 1980s with the adoption of the primary nursing care model. In this model for the first time in history the RN direct care and patient advocacy role became intertwined. Because primary nurses collaborate with other nurses and health practitioners about the need of their primary patients, primary nurses became patient advocates within the health care system. In primary nursing the RN plans and provides the care. Many hospitals continued to make extensive use of the LVN and nursing aide. One major reason for its success was the support of nursing, hospital administration and physicians.

The profession does not need the rehashing of the handmaiden image.

In the 80's we came into our own; patient advocates, experts, clinical specialist-independent in our practice; autonomous in our decisions-making, and assertive in demanding the ability to exercise independent professional judgment.

Unfortunately the ANA failed to lead the profession in seeking autonomy in advocacy and recognition in practice settings.

It instead continued to focus on prestige versus real power. Desperately trying to be like the “boys” (MDs) and kowtowing to the employers and politicians, greatful for a little crumb, and being recognized as a stakeholder.

They talk about empowerment which means that someone out there with greater power is willing to share some of it with you, but continues to keep you on a leash.

It is an opportunity lost. Not so however with the CNA; we seized the power.

The book promotes magnet status. In the world of collective patient advocacy magnet status means nothing. It is a money making scheme by the ANA and a marketing tool for the industry; including the individual hospitals who have obtained magnet status. It is now an institutionalized TQM model that also demands the incorporation of shared governance.

The book does not capture the evolution of increasingly more professional models of nursing care, and after several hundred pages of “awfulizing” it peters out- deflates and ends up making a feeble attempt to changing the odds by suggesting generic solutions -- most of which we cannot endorse.

Contrary to her recommendation, there is no need for further experimentation in nursing models; that is like the frog adapting to more and more heat not realizing that he is slowly boiled.

The primary care model was a true professional model with all the trappings of respect and recognition, and it worked. But RNs became more autonomous, demanding greater recognition for their effective contributions to the patient’s therapeutic outcomes. Here is what is written about primary nursing: RN and patient satisfaction high; RN burnout and malpractice low; retention high; cost of recruitment and orientation low; patient length of stay low; and recidivism & readmission low.

For some in the health care industry it meant too much RN independence, therefore too much power and control.

This model got busted with the introduction and implementation of patient-focused-are and the re-engineering of the clinical nursing process.

There is no anatomy of the most incredible achievements of CNA sponsored landmark legislations, like the worldwide first safe staffing ratio legislation. We not only changed the manner in which RNs responded to the patient’s clinical, therapeutic and restorative needs but it also created a social change in the RN culture. We have a lawful weapon to fight for our patients and our profession including our own wellbeing. From isolation to elegant militancy.

This whole focus on the RN being weak, being a victim and being burned out is inaccurate.

The strategy to deal with these factors can be rather simple if there is a professional and political will. How does one deal with stress? Very simple, by changing the stress factors. What are the stress factors? On the clinical side – having the responsibility and accountability of too many patients (oppressive workloads) without the authority. What is the solution? Representation by a progressive professional and labor organization fighting for better working conditions and achieving safe patient ratio standards, including the requirement to staff-up based on the patient’s individual acuity; as determined (assessed and classified) by the direct care RN.

Even when she recognizes the public’s appreciation of the work the RN does, she throws in the altruism and self-effacing factors. The nursing profession has always ranked #1 or #2 when it comes to the public trust. So what is this trust? How about – I trust you with my life, and that you will make the right decisions on my behalf; protect me from harm by others and help me get back my health. Is there any higher standing?

Finally, just looking at the depressing cover picture alone; an extremely defeated, burned-out looking RN in a slumped, victim position.

Which planet did this one come from?

Sorry she is not doing our profession any favors.

gr8rnpjt, RN · Apr 18, 2006

I liked the book: it was an engrossing read.
I think it explains the problems of nursing and how we got here quite well.
But her solutions are all wrong. Nationalizing healthcare would make us no better off than teachers: our salaries would be artificially kept low because the gov't would have a monopoly on those salaries.
~faith,
Timothy.

:yeah: :yeah: :yeah: :yeah: :yeahthat: :yeahthat: :yeahthat:

Tweety, BSN, RN · Apr 18, 2006

And I didn't mean to spin this thread off topic, but it is sorta on topic because it was one of her points.
Her diagnosis is state of the art and absolutely on point in the book.
Her cure is a folk remedy.
~faith,
Timothy.

Feel free to spin it any direction it goes, I'm all about going off topic and letting a topic have it's own life. Didn't mean to stifle that.

I haven't read her book, so I shouldn't even be participating in this thread. I realize that universal health care may not advance the nursing profession and to say it will is indeed naive, and it's a nearly monumental impossible task with tons of roadblocks, issues, costs, losses, etc.

Still at the end of the day, it just fits in with my idea at what nurses should be about - advocates for the health of not just those in their care, but the community, equally and fairly. I feel whatever the cost in the end it's worth it in the end.

ZASHAGALKA, RN · Apr 18, 2006

Feel free to spin it any direction it goes, I'm all about going off topic and letting a topic have it's own life. Didn't mean to stifle that.
I haven't read her book, so I shouldn't even be participating in this thread. I realize that universal health care may not advance the nursing profession and to say it will is indeed naive, and it's a nearly monumental impossible task with tons of roadblocks, issues, costs, losses, etc.
Still at the end of the day, it just fits in with my idea at what nurses should be about - advocates for the health of not just those in their care, but the community, equally and fairly. I feel whatever the cost in the end it's worth it in the end.

The poorest of poor can walk into any ER in this country and get care. The old saying is that a single tylenol (acetaminophen) costs 2 dollars in a hospital because you are paying for the person that orders it, the one that stocks it, the one that dispenses it, the person that gives and evaluates it, the person that files the insurance claim for it, and the 3 people that didn't pay for theirs. . .

We don't have a health care crisis as much as we have a health finance crisis. It is true that, as a result, we are losing a real battle with preventative medicine. But socializing medicine will have other, equally dire drawbacks - and those drawbacks will effect everyone.

Cost containment is a scary thing if YOU need a procedure and the result of the last 5 yrs of shunting docs from one specialty to another means there is a 6 month wait for open heart surgery. In a real way, the Canadian system works because they have an overflow outlet - US. Who will we use as an outlet? Mexico?

If your relatively active 66 yr old mom needs dialysis and the rules deny starting dialysis to anybody over 65, too bad.

If that miracle drug that would have saved your life in 5 yrs doesn't get developed for 15 more years because research is now at the gov't's whim, well, you didn't really need the 30 more yrs of life that med would have provided you, did you?

I could go on. Look, I think fighting national healthcare is without a doubt NURSE advocacy. It's not in our best interest to be part of a gov't monopoly instituted for the very purpose of cost containment. We are one of those costs.

But, I also happen to think that fighting national healthcare is PATIENT advocacy. The gov't has a knack for bogging down any and everything it touches. In healthcare, that's just not safe. I think national healthcare could improve the lives of a few, but only by bringing down the healthcare of the many. And when it comes to healthcare, I'm just not willing to standardize care by lowering it for all.

It's the same argument for price controls for gas. We tried that in '72 and got huge gas lines as a result. I may not like 3.00/gal gas, but I'd much rather pay 3 bucks and drive right up to the pump and pump away than I would pay 1.75/gal and can't find a gas station to get it from - or if it's there, the wait is 6 hrs. . . (and then only if it's my 'odd' or 'even' day to pump.)

And spacenurse, I don't think your point is the whole picture but one perspective. But, it is a completely valid perspective.

~faith,

Timothy.

Marie_LPN, RN, LPN, RN · Apr 18, 2006

While the book brings up several issues within nursing, it only mentioned LPNs twice; leaving out some of the nurse population, an obvious snubbing.

Sorry she is not doing our profession any favors.

My sentiments as well.