"Nursing Against the Odds" scores OK in New York Times

May 17, 2005 -- Suzanne Gordon's new book, Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care, has now been released. The book's subtitle extends its influence by supplying a nice 15-word executive summary even to those too busy to read it. Yesterday the New York Times posted a significant review of the book by science writer Cornelia Dean. The well-written review seems mildly positive and it presents a good, if somewhat rambling, description of some of the book's key points. However, it offers no critical analysis and seems to underplay the book's criticisms of health care players other than nurses themselves, ignoring, for instance, the book's lengthy discussion of the role of physicians in the crisis. Ms. Dean and the Times do deserve credit for giving the book such wide exposure.

Ms. Dean's review, headlined "Nursing in America: A Portrait of a Profession in Critical Condition," describes some of the major themes in Ms. Gordon's "gloomy assessment of American nursing." Actually, the book also spends significant time on nursing in other industrialized nations, many of which are facing comparable problems, showing that the crisis is truly global. The review runs through some of Gordon's main points as to the nature and extent of the nursing shortage, including the faculty shortage; the managed care cost-cutting and short staffing that have driven the shortage; the importance of nurses to patient outcomes; the profession's widespread public image problems; and the various internal nursing dysfunctions that have helped to bring the profession to its current crisis. The review also mentions some of the book's many proposed solutions for nurses, including making the bachelor's degree the minimum professional educational requirement, demanding better working conditions and pay, and rejecting the "language of virtue" that has reinforced stereotypes of nurses as scut work saints. She also rightly stresses Gordon's point that spending money on adequate nurse staffing is cost-effective, since it reduces serious complications.

We saw a few issues. The review doesn't really say whether the book is well done or interesting. Nor does it convey how controversial parts of it may be in the health care community, including among the categories of non-bedside nurses for whom Gordon seems to have little use. Since the book is essentially an extensive opinion piece that uses reporting and research as supporting evidence, there is plenty of room to challenge its reasoning, focus and balance. The review does not do that. The review notes Gordon's focus on nurses' own reluctance to speak up about their work and tendency to embrace patterned scrubs, then implies that Gordon suggests that this "culture of nursing" has led to the general absence of nurses from the news media and the abundance of inaccurate stereotypes in the entertainment media. This is a bit misleading: Gordon does indict nursing's role in its own poor image, but she also makes clear that the media, hospitals and society at large bear responsibility as well. More broadly, the review certainly conveys Gordon's focus on nurses' own responsibility for their problems, but it gives little sense of just how trenchant the author's criticisms of managed care and its key players are, especially hospitals, consultants and physicians. Indeed, the review virtually ignores physicians, even though almost a third of the book is about the pernicious power imbalance between medicine and nursing. And the review's comments on Gordon's indictment of the virtue script seem oddly wistful--perhaps an unwitting illustration of just how hard it is to let go.

The review does take the time to repeat Gordon's suggestion that "[l]iberal arts graduates" who become advanced practice nurses (APRNs) tend to have poor bedside skills and contempt for bedside RNs, which without any context presents an even more wildly distorted vision of APRNs than Gordon does. In case there is any confusion, there is no evidence that most APRNs are inept liberal arts graduates with contempt for bedside nurses.

The review closes by reminding readers of nurses' potentially life-saving bedside monitoring role, and noting mildly that people interested in health care should "pay attention to the issues" Gordon raises, though nurses "especially" should read it, since its message is in many ways directed at them. That's a start, but we might have pumped this up just a bit: anyone interested in staying alive for the next 10, 20 or 30 years should read the book, since the issues it explores are central to global public health. In this respect, the review does not quite capture the book's larger significance: the nursing crisis is everyone's problem.

We commend Ms. Dean and the New York Times for the fairly prominent review of the book, and for their attention to these vitally important issues.

See the review "Nursing in America: A Portrait of a Profession in Critical Condition" by Cornelia Dean in the May 17, 2005 edition of the New York Times.

Correction

In our original analysis of this piece, we mistakenly indicated that all MSN programs either require a prior BSN degree or include one as part of the program, and that all prospective APRNs undergo at least two years of undergraduate education entirely in nursing before pursuing their graduate nursing work. However, we have been advised that some bachelor's-to-MSN programs do not award the BSN degree, and some include only one intense year of undergraduate education solely in nursing, following certain prerequisites. We understand that such programs do require that students fulfill all requirements for taking and actually take the NCLEX-RN licensing exam before completing their graduate nursing study, as is the case with the UCSF and Yale programs. We have removed the original text from our above review, and we regret the error.