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Tears and Rage deals with issues of primary concern to nurses—flagging self-esteem, "restructuring,"health care reform, non-hospital nursing roles, etc. It also addresses how patient care is compromised due to the changes inaugurated by managed care. The information addressed in Tears and Rage is topical and controversial. It is a no-nonsense book that strives to empower nurses so that they can cut through the garbage in medicine and do their jobs. There is no other book like it on the market today. The issues have not been softened with pithy sayings nor have they been clouded with precious adjectives and adverbs.

This is not a book for the faint of heart. If you are looking for something to make you feel good, you'd better shuffle over to the fiction section of the bookstore. This book is, in many ways a gripefest. In nursing there's a lot to gripe about as well as a lot of griping.

The purpose here is to lay it on the line. All those whisperings in the locker room, the utility room, and the bathroom are shouted out in the following pages.

Most of what is discussed is not new, but here it is out in the open. This in itself is somewhat of a novelty. It's time to speak loudly and clearly about the problems in a very decent profession. There are no pat resolutions to all our gripes. However, my hope is that through this book we can all realize that our complaints are not unique and we are not alone. We are all in this together, for better or worse, whether we like it or not.

For far too long, nurses have been casting off in individual ships, reluctant to be part of our profession's fleet. Now we are changing our solitary courses to a united one as we realize the power of the fleet. Solidarity among nurses is the result of understanding ourselves, our relationship with administrators, managers, doctors, and each other. Perhaps the strongest catalyst for our coalition is the effect that restructuring has on our relationship with patients. The potential dangers of mediocre care have compelled us as nurses to reassert our role as primary caregivers and to reassess our perception of ourselves.

At the same time, it's essential to discuss the changes that nurses face as the workplace shifts from the hospital to the community. It is now our task to work with the entire patient to prevent illness. This is a major adjustment. For so long, our focus was directed to the individual who was already ill. We are now moving into a more preparatory phase, which is both challenging and frightening. Just the same, change is here and we are here, so let's see how we can make the new ideas work for our benefit and the benefit of our patients.

Threads of commonality weave through our lives. The thread that pulls us together can also be the thread that pulls us apart. In nursing, image is that thread.

Image is a commanding essence that can empower as well as destroy. It involves not only how we are perceived by others in the medical world—administrators, physicians, coworkers, patients, etc.—but also how we are portrayed to non-medical people in books, newspapers, movies, television and even in songs. Image also includes how we regard ourselves, an aspect that is particularly destructive and painful to nurses.

Image, which has brought us to our present state of anger and frustration, can also help us resolve the negatives of our profession and move into a new era of self-awareness and self-confidence It is up to us to untie the knots in this tangled web of our discontent so that we can find the taut lifeline to our future.

It was an image of ourselves as helpers, comforters of the sick and wounded that brought us to nursing. Ours was a noble fantasy that brought out the best in us. We saw ourselves bathed in the positive light of respect and high esteem. We would be thought of in the highest manner--by our superiors, by our peers and by ourselves.

That image was indeed a fantasy. Here is the reality. We struggle in the muck of hospital politics, staggering and stumbling through the swamp of demeaning, destructive relationships with doctors, management and, worst of all, with each other. We are lost in trickle-down waste management, headed for the garbage dump. We must renew ourselves by recycling this waste into something usable. For nurses, this means converting discontent to empowerment.

Through empowerment, we can change our own image and that of our profession. The key to empowerment is understanding--who we are, how we got to this point, why we act the way we do. Coalition, hopefully, will be the outcome of understanding.

Before understanding, unity, and improved self-image can be attained, it is necessary to identify the problems, gripe about them, and set about eliminating these negatives. At the same time, we must identify and accentuate the positives.

Tears and Rage: The Nursing Crisis in America is available for $18.95, plus $5.00 s/h. Sales tax is added for CA residents.

To order see link above. VISA, M/C, and AMEX accepted. Or, send a check, made out to Adams-Blake Publishing, to 8041 Sierra Street, Suite 101, Fair Oaks, CA 95628.