1. Herrin, Donna M. MSN, RN, CNAA, CHE

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Nursing Against the Odds: How Healthcare Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care1 presents a view of the nursing profession and particularly the nursing shortage in the context of the healthcare industry. Gordon squarely places blame for the work environment of nurses, the dissatisfaction with the profession, and the class-social issues on the shoulders of the healthcare industry. Cost cutting, restructuring, and funding of healthcare are to blame for what many experts call the greatest healthcare crisis of our time. Gordon writes to the historically dysfunctional relationship between physicians and nurses and to the continuing problems with media portrayal of nurses. Throughout the book, she proposes actions that nurses can take individually and in groups to improve their situations. Nursing Against the Odds is organized into 3 focused sections.


Part 1, "Nurses and Doctors at Work," includes the topics of "Manufacturing the Dominate Doctor," "Designing the Doctor-Nurse Game," "The Disruptive Medical System," "Fatal Synergy," and "Making Matters Worse." This section's theme is that social distance between nurses and doctors is purposefully manufactured through socialization tactics, that nurses have adapted to the applied tactics in the care setting, and that healthcare organizations allow-and even promote-the dysfunction.


In Part 2, "The Media and Nursing," Gordon expands on her prior works regarding nurses and the lack of public awareness of the work of nurses in the topical sections "Dropped from the Picture," "Missing from the News," and "Unavailable for Comment." This section thoroughly highlights the media's misrepresentation of nursing's work, the perpetuation of erroneous depictions of nurses and nursing, the dominant male (physician) figure over the subservient female (nurse) portrayed in television and films, and the fact that nurses have not helped these issues because of decisive silence.


In Part 3, "Hospitals and Nursing," Gordon slices into the heart of the healthcare industry and leaders of the professions as the root causes of the strife of nurses. These chapters are "Mangling Care," a stabbing view of the managed care industry and its dominating position; "The New Nursing Universe," a slanted view of the struggles within healthcare organizations; "Nurses on the Ropes," a discussion of the specifics driving nurses out of their roles and organizations; "No Nurse Left Behind," a pointed review of wide-reaching issues impacting every nurse (executive to staff RN, local to global, acute care to academia); "Management by Churn," an overview of the impact of traveling nurses, transferring nurses, and nurses moving internationally; and finally, "Failure to Rescue," which speaks to the impact and importance of nursing care on the health of human kind.


In the concluding section, Gordon advocates for various solutions to "Changing the Odds." Among those outlined are advocacy for staffing ratios, for incorporating "Magnet" standards into the regulatory framework, for addressing nurse shift length, for elevating nurse pay practices, for reframing the nursing education variances and elevating nursing education, for examining the central role of collective bargaining, addressing the multitude of ways where nurse-physician relations could be mended, and for taking an aggressive approach with the media and the ways that nurses are portrayed, degraded, and silenced.


In Nursing Against the Odds, Gordon presents many brutal facts surrounding the complex nursing profession and the issues at the core of the profession's long-standing struggles. The social-class observations are strikingly outlined and are a call to reform the ways that education and socialization of the health professions occur.


Gordon provides example after example of how the fractured nurse-physician relationship hinders nurses from exercising their full contribution to healthcare delivery systems and thus the well-being of individuals seeking care. The ongoing erroneous portrayal of nurses in the media is disgraceful, where gender prejudice and power-driven interactions based solely on male dominance are inexcusable.


One critical point Gordon makes is that even the best intentions to draw individuals into the profession are based only on the caring aspects of the nursing role and not on the scientific knowledge and contribution to patient outcomes. As an example, the well-intended and widely successful Johnson & Johnson campaign for the future of nursing uses the "high touch" aspects of the profession (caring, compassion, making a difference) without the scientific aspects of the profession (knowledge, improved outcomes, and patient safety) as part of the message. Gordon's exposition about these issues is compelling and worthy of acknowledgement.


Gordon's assessments regarding the professional issues are made from an observer's viewpoint. Many of these observations are supported by fact, including evidence from research, workforce data sources, media history, and industry publications. Almost as many of the assessments stem from incidental data and interpretations from personal observation. Some of Gordon's observations are simply summations of her personal opinions, originating from her personal experience as a physician's daughter. Although not to be discredited, the fact that these observations are based in this "lived experience" is to be noted.


Many aspects of Nursing Against the Odds bring forth negativism based on single examples without recognition of the tremendous works of nurse leaders that has been going on for many years and is occurring in many healthcare organizations today. She writes clearly and bluntly that the state of affairs in the nursing profession have only been exacerbated by consultants and others who have money as the ultimate end, to the sacrifice of nursing and patient care delivery. Limiting the overview to only these examples leads the reader to have an unbalanced view of the impact positive leadership on the nursing profession and healthcare delivery.


The issues surrounding professional nursing and the contributions nurses make to the care of people are extremely complex and multifaceted. Nursing Against the Odds summarizes these issues into a compelling story wrought with accusations and blame. The points made regarding medical education and socialization of physicians, the continuing battle for correct portrayal of nursing in the media, the absence of nursing's voice in the public eye (specifically around the scientific and outcome importance), and the lacking infrastructure to advance professional nursing's rise to actualization within healthcare organizations are important to leaders of the healthcare industry and the nursing profession. The issues brought to light regarding the overall absence of nursing's own voice is a strong message to those young and seasoned in the profession that change from inside is an absolute need.


Criticism is due to Gordon for presenting a slanted view of nursing leadership and the ignoring of the exceptional work being done in many organizations today. There are indeed practice environments that draw professional nurses, where patient outcomes are exceptional, where the professions truly work as colleagues across the disciplines, where nurses not only have a voice, but also use that voice in ways that impact care and community health, and where the profession thrives. Including more of these examples would provide both evidence that change can occur and that there is hope for the profession, for patients, and for the entire healthcare delivery system.


Reviewed by, Donna M. Herrin, MSN, RN, CNAA, CHE


Senior Vice President and Chief Nurse Executive, Methodist LeBonheur Healthcare, Memphis, Tenn, Clinical Associate Professor, The University of Alabama in Huntsville.




1. Gordon S. Nursing Against the Odds: How Healthcare Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care. Ithaca, NY: Cornell University Press; 2005. [Context Link]