If you’re at all interested in what’s going on in the current economy and how to deal — or not deal with it — I suggest you check out Ariel Ducey’s new book Never Good Enough: Health Care Workers and the False Promise of Job Training. It was recently published in the series Sioban Nelson and I edit for Cornell University Press on The Culture and Politics of Health Care Work. Ducey, who is a sociologist, did a thorough study of 1199-SEIU’s job training activities in the state of New York. The union, in cooperation with the health care industry, got enormous amounts of money from the state of New York to implement and manage job training programs for health care workers. In fact, job training activities became a core focus of the union, which could not, or would not, get improvements in wages and working conditions for its members. Instead of trying to make jobs better at every level of the health care hierarchy, the union concentrated on moving workers from one rung of the ladder to the next. So a nurses’ aide was encouraged to become an LPN; an LPN was encouraged to become an RN; a janitor was encouraged to become a clerk and so forth. Universities and colleges in New York City reaped millions for job training programs. So did the union. The problem, as Ducey defines it, is that workers were promised not only better wages but better working conditions and better work. In order to pursue this promise, they were encouraged to fork out money and time to take course after course. Some courses did indeed,give them usseful, new skills, but many simply focused on changing their attitudes so that they would be more productive — not necessarily more satisfied — in the workplace. Many newly trained workers found that they were as poorly utilized in their new job as they were in their old one. Once in that new job, they were confronted with similar problems — understaffing, work intensification, under utilization of their skills, authoritarian management, little authority over their work, little voice in workplace organization and so forth. The solution? According to the relentless job training model — go back to school, take yet another training course and move on to the next rung on the ladder.
Ducey’s title suggests the problem. Workers are told that the problems they encounter in their workplace can only be solved through mobility. And that they are never good enough wherever they land. Above all, don’t stay where you are and fight to make it better, move West young man — or in this case, mostly women of color. This false solution fails to address the problem of how to improve work at the so-called lower rungs of the health care ladder. We need more, not fewer, nursing home aides. Desperately in fact. But rather than improve wages, working conditions and perhaps most of all nursing home management, under the job training model, nursing home aides, who have potential are encouraged to become something else — an LPN, whatever, anything but this. So all we do is reinforce the kind of turn-over, lack of on-site education, and low morale among staff that makes nursing homes so unsafe for residents. The same is true everywhere in health care.
As the editor of this book, I was particularly interested in its subject and analysis because of what I had long observed in nursing. As the problems of the nursing workload and work hours increase, as nurses become more and more frustrated with their inability to give quality care in hospitals and other facilities where they deliver direct care to the sick and vulnerable, many decide not to stay and fight but to leave the bedside to become nurse practitioners or other “advanced practice nurses.” Just the other day, I was talking to a nurse in the South who had had it with dangerously high patient- to -nurse loads and said she’d decided to go back to school and get a masters degree so she could get the Hell out of the hospital. “Would you have stayed at the bedside longer if your workload was more manageable?” I asked her. “Yes, absolutely,” she said. ” I love bedside nursing but I work on a telemetry unit and we take care of 7 to 10 patients in the daytime and 10 or more at night. I’ve tried to change that, but no one listens.” I’ve had it. I’m getting out was her bottom line (she was also fighting for better staffing ratios nationally.) Many nurses are encouraged to get out and move “up” not only by academic institutions but by hospitals or other facilities that provide, as a perk of employment, educational stipends. The problem is, in nursing at least, few of these subsidies go to nurses who want to remain at the bedside because masters degrees in nursing simply aren’t geared to encouraging bedside RNs so stay at the bedside.
Job training as a solution to the crisis in both education and health care has been one unions and health policy experts have frequently championed. Today, SEIU is pursuing that solution to both health care workers’ complaints and the employment crisis. The union and other job training advocates seem to ignore the fact that as one moves up the ladder people are losing their jobs and hospitals and other facilities aren’t interested in spending money on a new crew of newly trained workers to replace them. In fact, even though we still have a nursing shortage, hospitals that feel strapped for cash are laying off RNs or they aren’t filling jobs when someone retires. So training LPNs or aides to become RNs is hardly a solution to either health care workers’ dissatisfaction with their jobs, or the unemployment crisis we are now facing thanks to out of control global cowboy capitalism.
Ariel Ducey’s book is the perfect way to jump start a long over due conversation about how to deal with poor working conditions in health care or for that matter in any other industry. Of course, I am a bit prejudiced, since I edited the book. But I think it’s well worth your attention. To check it out click on the Cornell University Press heading under my picture.