Nursing at prefix = st1 /BethIsraelHospitalproduces the best patient care possible. If we are to solve the nursing shortage, hospital administration and doctors everywhere would do well to follow Beth Israel's example. At Beth Israel each patient is assigned to primary nurse who visits at length with the patient and constructs a full-scale health account that covers everything from his medical history to his motional state. Then he writes a care plan centered on the patient's illness but which also includes everything else that is necessary. The primary nurse stays with the patient through his hospitalization, keeping  track with his progress and seeking further advice from his doctor. If a patient at Beth Israel is not responding to treatment, it is not uncommon for his nurse to propose another approach to the doctor. What the doctor at Beth Israel has in the primary nurse is a true colleague. Nursing at Beth Israel also involves a decentralized nursing administration; every floor, every unit is a self-contained organization. There are nurse managers instead of head nurses; in addition to their medical duties they do all their own hiring and dismissing, employee advising, and they make salary recommendations. Each unit's nurses decide among themselves who will work what shifts and when.  Beth Israel's nurse-in-chief ranks as an equal with other vice presidents of the hospital. She is also a member of the Medical Executive Committee, which in most hospitals includes only doctors. A primary nurse can propose a different approach of treatment when   _  .
the present one is refused by the patient the patient complains about the service of the hospital the patient is found unwilling to cooperate the present one proves to be ineffective