Issue link: https://nnumagazine.uberflip.com/i/198093
Books.FINAL:FINAL 2 8/21/08 11:04 PM Page 17 Union which she wrongly identifies as a supporter of the ratios. In fact, SEIU first tried to amend and weaken the ratio law, then tried to persuade legislators to switch to a weaker SEIU bill premised on acuity systems, not ratios, and finally when those efforts failed lobbied against the final bill, including having nursing assistants phone bank legislators on the day of the Senate vote urging its defeat. Even after the ratio bill passed, SEIU tried to undermine the law by encouraging the inclusion of LVNs in the ratio count, and then surreptitiously worked to defeat legislation to strengthen penalties against hospitals that violate the law. While promoting themselves to RNs as an advocate of ratios, SEIU has played a similarly duplicitous role in other states, most recently criticizing an NNOC Ohio ratio proposal, modeled on the California law, with misleading and methodologically unsound data that gives aid and comfort to hospital industry adversaries of ratios. Gordon does, however, provide valuable detail for the reader unaware of the history of the CNA campaign, including the Patient Watch program which brought a spotlight to the pain and suffering of patients in understaffed hospitals, as well as the RN mobilizations, legislative pressure, and media and public awareness drives. And she describes the innovative and extensive research conducted by CNA's research arm, the Institute for Health and Socio-Economic Policy, first to document the need for ratios, then to produce an analytical model for determining the actual unit-specific ratios. She emphasizes the essential importance of RN unions and nurses' collective action, quoting, for example, CNA/NNOC Executive Director Rose Ann DeMoro that "nurses were in motion; there was a drum beat around ratios that was unstoppable." Ratios were made possible in California because of the size, influence, strategy and acumen of CNA, and it will take a strong national movement of direct care RNs to win them elsewhere in the U.S. Overall, Safety in Numbers is a good primer on an issue that is at the heart of every RN's yearning to effectively advocate for their patients and safely practice their profession. While ratios "are not the sole answer," to the crisis facing nurses and patients, Gordon is careful to note, "there can be no solution to the current nursing crisis without them." —charles idelson J U LY | A U G U S T 2 0 0 8 Shopping Our Way To Safety: How We Changed from Protecting The Environment to Protecting Ourselves By Andrew Szasz; University of Minnesota Press, 323 pp. ookstore shelves groan with volumes on how the world is out to get us. Authors tell us that what we eat, drink and breathe are just a slow way to commit suicide. The media is full of crime stories, drug busts, and murders. It's a wonder people get out of bed in the morning. But since hiding in the house is not a serious option, people search for solutions to protect themselves. Chemicals in the water? Drink bottled water or buy a filter. Pesticides in the food? Go organic. Crime worries? Move to a gated community. Those "solutions" are what sociologist Andrew Szasz calls "inverted quarantines," and they are likely to produce exactly the opposite of what people intend. "Act jointly with others?" asks the author. "Try to change things? Make history? No, no. I'll deal with it individually. I'll just shop my way out of trouble." Inverted quarantines—erecting barriers to wall off threat—are hardly new. "Separating and distancing oneself from threatening social conditions" is as old as walled villages, writes Szasz, but what is different about today is that "inverted quarantine has become a mass phenomenon. Millions—many millions—do it." In 1975, the average American consumed a gallon of bottled water a year. By 2005 that figure had grown to 26 gallons. In 1970 there were approximately 2000 gated communities in the U.S. By 1997 that figure had grown to 20,000. Take for instance suburbanization—a subject the book examines in detail. What's the problem with a little peace, quiet, and crabgrass? According to Szasz, plenty. "The suburbs' gains were the cities' losses," argues Szasz. Federal money went toward highway construction instead of mass transit. Industry moved out of the cities because transport costs were reduced, thus depressing urban tax bases. That in turn created underfunded schools, deteriorating infrastructure, and the problems of urban America: poverty, crime, and drugs. It is fairly easy to make an argument that bottled water is a bad idea, even that the sub- B W W W. C A L N U R S E S . O R G urbs create more problems than they solve. But is organic food really a bad idea? Szasz argues it is. It is not that the author is Pollyannaish about the variety of awful things people ingest in their food, or that eating organic food doesn't lower the chemical and toxic load we all carry. But this is a book about social consequences, not how to dodge the latest designer pesticide, and his logic about the downside of organic food is hard to fault. Szasz argues that the combination of growing wealth inequality, with the expense of organic food, means there is "a class dimension" to eating right. Those shut out of the organic food market because of cost represent the bulk of the population, and it is a sector that likely will increase. This will result in "two agricultural systems side by side: a large conventional sector that grows affordable, if slightly contaminated, food stuffs for the majority, and a smaller one producing organic alternatives for a minority, largely made up of affluent health seekers." This two-tier system for what we eat, drink, and breathe creates a kind of "anesthesia" that, according to Szasz, "impedes the development of public sentiment that would support a broader reconsideration of the toxic mode of production in general." Shopping Our Way to Safety will make the reader uncomfortable (although Szasz's dry wit and engaging prose make the book a pleasure to read) precisely because he doesn't give easy answers. But the book is hardly apocalyptic. The author gives a number of historical success stories in which people repudiated the inverted quarantine and sought solutions within a wider social framework. Rejecting the inverted quarantine, he says, is like refusing to make a wrong turn. In and of itself, that choice does "not guarantee anything," but it creates "the possibility that better choices could yet be made." —conn hallinan Barbara Williams is a retired psych RN based in Portland, Ore. Don McCanne, MD, is senior health policy fellow at Physicians for a National Health Program. DeAnn McEwen is an RN at Long Beach Memorial Medical Center and sits on various CNA/NNOC committees. Kathryn Donahue is an ICU/CCU RN at St. Joseph Hospital and a CNA/ NNOC board member. REGISTERED NURSE 17