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Ordered to Care Chapter 10: Great Transformation, Small Change

Ordered to Care Chapter 10: Great Transformation, Small Change. Sara Tresler Mary Hanks. Everything old is new again. Great Depression 1929-1940 Hospitals Patients Nurses Nurses Private duty Hospital staff. The hospital in transition. Big Business in American Economy

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Ordered to Care Chapter 10: Great Transformation, Small Change

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  1. Ordered to CareChapter 10: Great Transformation, Small Change Sara Tresler Mary Hanks

  2. Everything old is new again Great Depression 1929-1940 • Hospitals • Patients • Nurses • Nurses • Private duty • Hospital staff

  3. The hospital in transition • Big Business in American Economy • 6,719 hospitals • 955,869 beds • 3 billion dollar investment in plants, equipment • Medical specialization/specialty clinics • Extended lengths of stay (1-3 months) • Increased technical medical procedures “too busy”

  4. Changing times • Costs, Costs, Costs, • Hospital closings common • Lower costs, increase income • Encourage occupancy • Regularizing income source • Public relation consultants • Third-party payments (Blue Cross) • “old days of not worrying about costs because of availability of charitable gifts had gone” (p. 183)

  5. Tinkering with change • Re-examining nursing practice • Student nurses • Graduate nurses • Private-duty specialty nurses “Specials” • 24 or 12 or 8 hour days, which is better? • 54 hour work weeks common until post World War II

  6. The reluctant staff nurse • Sixty percent of all hospitals contain nursing schools • Of these, 73 % no graduate staff • Of these only 15% had 4 or more graduates • So many graduate nurses • Not enough work • Task- versus patient- oriented • Hospitals to the rescue: minimal wages; room and board

  7. Employment and control at a cost • Graduate Staff nurses • Cheapness, hard work, loyalty • Work split shifts, long hours • Heavy patient loads • Move between wards • Eat within walls of hospital • Increasing absenteeism; high turnover • Better working conditions, more control over pt care

  8. Salary and price comparison 1946 Nurse’s Salary Comparable Salaries and Prices in 1946 Typist $0.97 Bookkeeper $1.11 Gasoline: 21 cents/galHouse: $12,500Bread: 10 cents/loafMilk: 70 cents/galAvgAnnual Salary: $3,150Minimum Wage: 40 cents per hour • $0.75 to $0.87 cents • Annual Salary: $1,810

  9. Us versus them Graduate and Student Nurses Versus Nursing Aides

  10. Bedside or bargaining • Moving from the bedside • New technical skills • Supervisory Role • Unionization versus Professional Organizations • The right to care

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