Suzanne Gordon

A leading health care journalist unravels the complexity of the current nursing shortage while offering possible solutions to the resulting health care crisis.

How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care

Nursing Against the Odds

Bernice Buresh

What Nurses Know and Must Communicate to the Public

From Silence to Voice

To get the resources and respect they need, nurses have long had to be advocates for themselves and their profession, not just for their patients. For a decade, From Silence to Voice has provided nurses with the tools they need to explain the breath and complexity of nursing work. Bernice Buresh and Suzanne Gordon have helped nurses around the world speak up and convey to the public that nursing is more than dedication and caring-it demands specialized knowledge, expertise across a range of medical technologies, and decision-making about life-and-death issues. "Nurses and nursing organizations," they write, "must go out and tell the public what nurses really do so that patients can actually get the benefit of their expert care." The comprehensively revised and updated third edition of From Silence to Voice will help nurses construct messages using a range of traditional and new social media that accurately describe the true nature of their work. Because nurses are busy, the communication techniques in this book are designed to integrate naturally into nurses' everyday lives and to complement nurses' work with patients and families.

US military conflicts abroad have left nine million Americans dependent on the Veterans Health Administration (VHA) for medical care. Their "wounds of war" are treated by the largest hospital system in the country—one that has come under fire from critics in the White House, on Capitol Hill, and in the nation's media. The resulting public debate about the future of veterans' health care has pitted VHA patients and their care-givers against politicians and policy-makers who believe that former military personnel would be better served by private health care providers. This high stakes controversy led Suzanne Gordon, award-winning health care journalist and author, to seek insight from veterans and their families, VHA staff and administrators, advocates for veterans, and proponents of privatization. Gordon spent five years closely observing the VHA's treatment of patients suffering from service related injuries, physical and mental. In Wounds of War, Gordon describes how the VHA-tasked with a challenging patient population- does a better job than private sector institutions offering primary and geriatric care, mental health and home care services, and support for patients nearing the end of life. The VHA, Gordon argues, is an integrated health care system worthy of wider emulation, rather than piece-meal dismantling for the benefit of private contractors. In the unusual culture of solidarity between patients and providers that the VHA has fostered, the author finds a working model for higher quality health care and a much-needed alternative to the practice of for-profit medicine.

How the VA Delivers Health, Healing, and Hope to the Nation's Veterans

Wounds of War

Scott Reeves

Lisa Hayes

Lucian L. Leape

In recent years, there has been growing awareness of the need for interprofessional cooperation in healthcare. Countless studies have shown that genuine teamwork and team intelligence are critical to patient safety. Poor communication among health care personnel is a major factor in hospital errors, even more so than the level of staff competence and experience. This is why many schools for health professionals and major health care employers now promote interprofessional education and cooperation. Bedside Manners is a play about workplace relations among physicians, nurses, others who work in health care, and patients—and how their interaction affects the quality of patient care, for better or worse. The accompanying workbook helps educators, managers, patient safety advocates, administrators, and union representatives to analyze and discuss the issues raised in the play. When presented in hospitals, universities, and health care conferences all over the United States, Bedside Manners invariably sparks a vibrant conversation about patient safety problems and how to solve them, job satisfaction and stress, and the importance of information sharing and mutual respect. As text or script, this play is a unique teaching tool for medical and nursing schools, and other health professional schools and continuing education programs involving health care clinicians and staff of all kinds.

Play and Workbook

Bedside Manners

Lonely in America

Ross Koppel

Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients' hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain, and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects-physicians, safety champions, or high level management-these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.

Confronting the Inconvenient Problems of Patient Safety

First, Do Less Harm

The reassuring bromides of "chicken soup for the soul" provide little solace for nurses—and the people they serve—in real-life hospitals, nursing homes, schools of nursing, and other settings. In the minefield of modern health care, there are myriad obstacles to quality patient care—including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn't easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public. When Chicken Soup Isn't Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad—and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform. Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today—and the role that nurses play as irreplaceable agents of change.

Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession

When Chicken Soup Isn't Enough

John Buchanan

Tanya Bretherton

Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs. Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients—leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation. With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors' history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.

Nurse-to-Patient Ratios and the Future of Health Care

Safety in Numbers

In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, we have a major shortage of nurses. Why are so many RNs dropping out of health care's largest profession? How will the lack of skilled, experienced caregivers affect patients? These are some of the questions addressed by Suzanne Gordon's definitive account of the world's nursing crisis. In Nursing against the Odds, one of North America's leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis. Gordon examines how health care cost cutting and hospital restructuring undermine the working conditions necessary for quality care. She shows how the historically troubled workplace relationships between RNs and physicians become even more dysfunctional in modern hospitals. In Gordon's view, the public image of nurses continues to suffer from negative media stereotyping in medical shows on television and from shoddy press coverage of the important role RNs play in the delivery of health care. Gordon also identifies the class and status divisions within the profession that hinder a much-needed defense of bedside nursing. She explains why some policy panaceas—hiring more temporary workers, importing RNs from less-developed countries—fail to address the forces that drive nurses out of their workplaces. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctors and nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care.

Nursing against the Odds

Each year, hospital-acquired infections, prescribing and treatment errors, lost documents and test reports, communication failures, and other problems have caused thousands of deaths in the United States, added millions of days to patients’ hospital stays, and cost Americans tens of billions of dollars. Despite (and sometimes because of) new medical information technology and numerous well-intentioned initiatives to address these problems, threats to patient safety remain and in some areas are on the rise. In First, Do Less Harm, twelve health care professionals and researchers plus two former patients look at patient safety from a variety of perspectives, finding many of the proposed solutions to be inadequate or impractical. Several contributors to this book attribute the failure to confront patient safety concerns to the influence of the "market model" on medicine and emphasize the need for hospital-wide teamwork and greater involvement from frontline workers (from janitors and aides to nurses and physicians) in planning, implementing, and evaluating effective safety initiatives. Several chapters in First, Do Less Harm focus on the critical role of interprofessional and occupational practice in patient safety. Rather than focusing on the usual suspects—physicians, safety champions, or high level management—these chapters expand the list of "stakeholders" and patient safety advocates to include nurses, patient care assistants, and other staff, as well as the health care unions that may represent them. First, Do Less Harm also highlights workplace issues that negatively affect safety: including sleeplessness, excessive workloads, outsourcing of hospital cleaning, and lack of teamwork between physicians and other health care staff. In two chapters, experts explain why the promise of health care information technology to fix safety problems remains unrealized, with examples that are at once humorous and frightening. A book that will be required reading for physicians, nurses, hospital administrators, public health officers, quality and risk managers, healthcare educators, economists, and policymakers, First, Do Less Harm concludes with a list of twenty-seven paradoxes and challenges facing everyone interested in making care safe for both patients and those who care for them.

An exploration of the ambitions, sacrifices, personal lives, and day-to-day activities of male and female dancers reveals the sometimes shocking realities of the world of ballet

The Real World of Ballet

Off Balance

"Behind the glitter and illusions of the ballet world lie the poignant, often shocking realities of a dancer's life. A borderline anorexic dances seven hours a day and completes high school through correspondence courses; she is fifteen years old. A New York dancer performs despite agonizing pain in his shins until a doctor tells him he has eight stress fractures; he is twenty-five. After ten years of professional dancing and twelve years of training at a cost of nearly $75,000, a dancer is told that she's too old for the company; she is thirty. They love to dance and have made unimaginable sacrifices to achieve what they have. But after two years of intimate conversations with dozens of dancers like these, Suzanne Gordon wonders whether their sacrifices are really necessary. From New York to San Fransisco, from Houston to Chicago, in Europe and in Scandinavia, Gordon explores the inner lives of dancers, revealing for the first time the dreams and realities of the young men and women ballet audiences so admire. .."--Jacket.

Patrick Mendenhall

Bonnie Blair O'toole

The U.S. healthcare system is now spending many millions of dollars to improve "patient safety" and "inter-professional practice." Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal? Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel. The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, Beyond the Checklist demonstrates how CRM can be adapted, more widely and effectively, to health care delivery. The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills. The coauthors infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O’Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.

What Else Health Care Can Learn from Aviation Teamwork and Safety

Beyond the Checklist

Praise for previous editions— "The book is written by two journalists who have taken on the nursing profession more or less the way we take on patients with a life-threatening condition that is curable but requires both intensive and long-term care. The diagnosis, according to Buresh and Gordon, is silence. By being silent, we miss the opportunity to show ourselves as consequential in the delivery of healthcare. The remedy for silence, according to the authors, is voice—our voices raised in conversation first and foremost with our families, friends, and patients, and also with the general public."—Nursing Spectrum "This is an invaluable book for all nurses, especially those who are proud of being nurses and who have always wanted to make others understand our passion."—Nursing Standard To get the resources and respect they need, nurses have long had to be advocates for themselves and their profession, not just for their patients. For a decade, From Silence to Voice has provided nurses with the tools they need to explain the breath and complexity of nursing work. Bernice Buresh and Suzanne Gordon have helped nurses around the world speak up and convey to the public that nursing is more than dedication and caring—it demands specialized knowledge, expertise across a range of medical technologies, and decision-making about life-and-death issues. "Nurses and nursing organizations," they write, "must go out and tell the public what nurses really do so that patients can actually get the benefit of their expert care." The comprehensively revised and updated third edition of From Silence to Voice will help nurses construct messages using a range of traditional and new social media that accurately describe the true nature of their work. Because nurses are busy, the communication techniques in this book are designed to integrate naturally into nurses' everyday lives and to complement nurses' work with patients and families.

Bonnie Blair O'Connor

The U.S. healthcare system is now spending many millions of dollars to improve "patient safety" and "inter-professional practice." Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal? Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel. The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, this book demonstrates how CRM can be adapted, more widely and effectively, to health care delivery. The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.They infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O'Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.

Suzanne Gordon

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