National Nurses United

Books:1 copy 9/2/09 3:35 PM Page 15 We come to understand how the U.S. desire for scans reflects anxieties about the quality of healthcare, physician skills, and increased incidence of cancer, MS, and other chronic illnesses. The reader is drawn into the pressure cooker of imaging units, where radiologists and technologists are under constant demand to accelerate their work practices. least trained workers and suggesting problems in the workplace could be surmounted with the right attitude." Ducey asserts that both the content of many training programs and the commitment of time they require put pressure on individual healthcare workers who remained at the mercy of their employers' policies and their union's partnership agreements. She makes the case that caring labor has been devalued and asserts that the relentless creation of underpaid service jobs helps sustain the inequities inherent in America's healthcare system. There may be considerable disagreement with Ducey's point of view, but her opinions are well supported and reflect a healthy respect for academic integrity and fairness. She notes that 1199 may have lost its footing on healthcare policy, leading to the eventual separation from what she describes as its formative political ideals: "The so-called pragmatic way in which 1199 uses its now considerable political might in the arena of health care policy has reinforced precisely those aspects of the U.S. health care system that siphon off resources and revenue that might otherwise go to workers' wages and patient care." Where the book falls short, in my opinion, may be in Ducey's apparent buy-in of the industry's claim that there is underuse of the knowledge and skills in our contemporary market economy. Ducey conducted multiple interviews with workers who described their concern about being compelled to work outside of their job description in healthcare organizations. My interpretation from the reading is that these concerns also have to do with their employer's policydriven encroachment on scope of practice as well. While she notes that "tasks are not always assigned to those who are best equipped to perform them," she fails to identify that there are important legal distinctions, regulatory requirements, and accountabilities that must be J U LY | A U G U S T 2 0 0 9 considered when comparing and contrasting roles, tasks, and skill sets of health team members. To illustrate her point, she discusses an LVN who argues that her day-to-day work is "identical to that of a registered nurse," though Ducey acknowledges that the LVN may have underestimated the extent of the education and insight that an RN possesses. She describes the concept of wasted ability of the workforce as talent and performance gaps that refer to the ability of workers to use their "achieved level of skill and knowledge on the job." Ducey alludes to the sociological phenomenon of turf battles among competing occupational or professional groups in the healthcare field about performance of a given task, again without due consideration of which professional is ultimately held legally accountable for the competent performance of the task and the evaluation of the outcome for the patient. Tucked away in Chapter 9, I found the most fascinating and compelling part of Ducey's book. She discusses single-payer universal healthcare in the United States and why it's not yet a fact of life for people living in this country. She attributes this in large part to a historical union provincialism, a lack of vision, and the failure of organized labor to use its collective power to mobilize members to engage in this struggle when they had the opportunity to do so after the Wagner Act was passed in 1935. She weaves in fascinating details of labor history, labor law, and human interest portraits of significant union leaders during that time. In the final chapter of this refreshingly readable book, Ducey calls our attention to the lessons that can be learned from fragmentation, lack of vision, and unity among labor unions with regards to healthcare and the history that we'll doomed to repeat if we don't take note of them. Ducey notes the historically recent efforts of the state to divest itself of direct responsibility for education. Education has not only become depoliticized, vocationalized, and privatized seminars, but it is becoming routinized. The author concludes that multiskilling initiatives, communication skills training, and individual "upgrading" proposes that self-discipline is the realistic alternative to the misallocation of wealth and resources in the healthcare industry. She states, "If this is a result of the "pragmatic" responses to economic restructuring and the dismantling of universal health and social security, how much better might we do with a dose of idealism." —deann mcewen, rn W W W. C A L N U R S E S . O R G REGISTERED NURSE 15

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