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16 J U L Y / A U G U S T 2 0 0 5 C A L I F O R N I A N U R S E tell an OR RN that the "captain of the ship" doc- trine still exists. She'll eat you for breakfast. We took this road in the '80s and never looked back. But Suzanne Gordon spends too much time rehashing the handmaiden image. She should have used CNA's revolution as an ex- ample of what needs to occur in our profession in order to protect and promote our profession, patient safety, and patient advocacy. The American Nurses Association failed to lead the profession in seeking autonomy in advocacy and recognition in practice settings, choosing instead to focus on prestige versus real power. No so with CNA. We seized the power. Yet Gordon's book provides no anatomy of the most incredible achievements of CNA- sponsored landmark legislation, like the na- tion's first safe staffing ratio law. These accomplishments not only changed the manner in which RNs responded to the patient's clinical, therapeutic, and restorative needs, but also created so- cial change in the RN culture, e.g. acting as lawful weapons to fight for our patients, our profession, and our well-being. Gordon supports the BSN degree as the entry into practice and differentiation of practice. She also promotes the "magnet" hospital status, which is really just a money-making scheme by ANA and a marketing tool for the industry. Also, contrary to her recommendation, there is no need for further experimentation in nursing models. That's like the frog adapting to more and more heat, not realizing that he is being slowly boiled. Finally, her focus on the RN being weak, a victim, and burned out is misplaced.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 re- sponsibility and accountability of too many patients without the authority. What is the solution? Representation by a progressive professional and labor organization fighting for better working conditions/benefits and achieving safe patient ratio standards, in- cluding the requirement to staff up based on patients' individual acuity as determined by the direct-care RN. —Hedy Dumpel, RN, JD NURSING AMERICA: ONE YEAR BEHIND THE NURSING STATIONS OF AN INNER- CITY HOSPITAL, by Sandy Balfour, 212 pp., $23.95 B ritish television journalist Sandy Balfour promises to take readers to the front lines in Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital. To do so, he spent a year hanging out with nurses in the various specialty wards of Regional Med- ical Center in Memphis, Tenn., a county hospi- tal known by all around simply as "The Med." Balfour does a good job of taking readers close to the action, whether it's riding high above the city in a helicopter with flight RNs Tonya March and Cindi Bailey, or sitting through a 24-hour operation to reconstruct the face of a young woman shot by her boyfriend with a sawed-off shotgun. Some of the best parts of the book are his eyewitness accounts of what's happening and his observations of nursing culture—how nurs- ing personalities and floor atmosphere differ among various specialties. The RNs in trauma, for example, get a rush out of anonymously fix- ing the "bent, broke, or bleeding" under high pressure, whereas the RNs in burn understand they are in for the long haul, helping their pa- tients through extremely long recoveries. But the book remains largely a stringing to- gether of anecdotes as he floats from unit to unit. The Med is a financially starved public hospital serving a huge number of poor and uninsured Tennesseans of color, and though unpleasantries like annual budget crises and substandard staffing surface now and again through various characters, Balfour never explores these problems and possible solutions—such as col- lective nurse action or single payer healthcare—fully. At one point, Dr. Sheldon Korones, who runs the Med's New- born Center, gives a fabulous monologue about the basic fallacy of the U.S. healthcare system: "Medical care is not a product. It is not something you should buy and sell. It is a right, not a priv- ilege. If you want me to be grand about it, I'd put it like this: it is a moral and constitutional right, part of our guaranteed right to life, liberty and the pursuit of happiness. You can't be happy if you're sick." But Balfour presents Dr. Korones' deep beliefs as just another viewpoint. Later, Balfour reports that "almost all the complaints I heard [from nurses] were about staffing levels," adding that patients often complained there weren't enough nurses and that nurses frequently did not get meal breaks. Then he drops the issue, mov- ing onto the next story. Only when a union organizing drive by SEIU Local 205 got underway did the hospital feel it needed to address its nurses' wages and staffing levels. The hospital suc- cessfully union busted the effort. Again, Balfour does not explore what the nurses could have done collectively, but just moves on. In the end, you're left rather depressed. There's a somewhat fatalistic strain that runs among the book's characters. They just accept that the state of affairs is terrible and do their best. Yes, he clearly admires the nurses and portrays them as heroes, but not as people who, acting to- gether, can transform the situation for the bet- ter. —Lucia Hwang ONE NATION UNINSURED: WHY THE U.S. HAS NO NATIONAL HEALTH INSURANCE, by Jill Quadagno, 274 pp., $28 N ot many years ago, the U.S. healthcare system was generally labeled the best in the world by its foremost champions. With the U.S. now falling to 72nd among nations in health efficiencies, measured in quality, ac- cess, affordability, and other barometers, ac- cording to the World Health Organization, that commendation is not heard as much anymore. What does everyone else have that we