Health Care in Crisis

An inside look into how hospitals, nurses, and patients are faring under the Affordable Care Act

More and more not-for-profit hospitals are becoming financially unstable and being acquired by large hospital systems. The effects range from not having necessary life-saving equipment to losing the most experienced nurses to better jobs at other hospitals. In Health Care in Crisis, Theresa Morris takes an in-depth look at how this unintended consequence of the Affordable Care Act plays out in a non-profit hospital’s obstetrical ward.

Based on ethnographic observations of and in-depth interviews with obstetrical nurses and hospital administrators at a community, not-for-profit hospital in New England, Health Care in Crisis examines how nurses’ care of patients changed over the three-year period in which the Affordable Care Act was implemented, state Medicaid funds to hospitals were slashed, and hospitals were being acquired by a for-profit hospital system. Morris explains how the tumultuous political-economic changes have challenged obstetrical nurses, who are at the front lines of providing care for women during labor and birth.

In the context of a new environment where hospital reimbursements are tied to performance, nursing has come under much scrutiny as documentation of births—already laboriously high—has reached even greater levels. Providing patient-centered care is an organizational challenge that nurses struggle to master in this context. Some nurses become bogged down by new processes and bureaucratic procedures, while others focus on buffering patients from the effects of these changes with little success. Morris maintains that what is most important in delivering quality care to patients is the amount of interaction time spent with patients, yet finding that time is a real challenge in this new environment.

As questions and policies regarding health care are changing rapidly, Health Care in Crisis tells an important story of how these changes affect nurses’ ability to care for their patients.

Theresa Morris is Associate Professor of Sociology at Texas A&M University, where she teaches courses on Organizations, Gender, Reproduction, and Research Methods.She is the author of Cut It Out: The Cesarean Section Epidemic in America (NYU Press, 2013).

Theresa Morris offers a careful analysis of how the intimate interaction between nurse and patient is embedded in the social dynamics of the workplace, in the occasionally tense relations of authority between professions, in the hospital’s budgetary constraints, and in the uncertainties of federal and state healthcare policy in the last decade. Morris’ thoroughly detailed and highly readable ethnography provides a vivid account of how these forces shape nurses’ work lives, with broad political and economic turmoil percolating down to the front lines of patient care.

Wendy Simonds, Author of Hospital Land USA: Sociological Adventures in Medicalization:
In this compelling in-depth ethnography, Morris captures what its like to work as a labor and delivery nurse at a public community hospital in uncertain times. The administrators, reeling from the effects of some penalizing policies of the Affordable Care Act, seek a corporate buyer to relieve the hospitals economic distress. Morris illustrates how interlocking changes in finances and policies result in overworked nurses and negatively impact the care of women and babies. Healthcare in Crisis clearly documents the need for a single-payer system that values patient-centered medical service providers.

Beth Mintz, Author of Lesbians in Academia: Degrees of Freedom:
Theresa Morris's Health Care in Crisis offers an engaging treatment of organizational change. Using a community hospital as her focus, and the Affordable Care Act as the catalyst, she examines the ways in which institutional responses affect the nurse-patient relationship. Studying a maternity unit, and paying particular attention to care delivery, the author demonstrates that the ways in which health care systems are financed really matters.

Jennifer Block, Author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care:
Theresa Morris embeds herself with one hospital's nurses to witness firsthand how financial pressures on the institution impact patients at a particularly vulnerable moment in their lives: when they are giving birth. The news isn't good. Nurses are key here, and policy is driving them away from giving good patient care, in the delivery room and beyond. Healthcare in Crisis is essential reading for anyone wanting to understand how our health system is failing patients, especially women and babies. Too often nurses have been left out of the conversation. Morris puts them in the center.

Morris's detailed focus on hardworking individuals at one hospital shows in microcosm the difficult strains that plague our health care system writ large; as such, this book stands as a cautionary tale.