The Shift by Theresa Brown

In brief: The true story of a nurse’s 12 hour shift in a medical oncology ward.

The good: It’s fascinating and emotional.

The not-so-good: Some of the explanations were a bit basic for me (I have an oncology background) but they are excellent for those who aren’t familiar with the area.

Why I chose it: Thank you to Algonquin Books for the eARC.

Year: 2015

Pages: 272

Publisher: Algonquin Books

Setting: USA

I’m a complete sucker for nursing stories, fictional or real-life. The Shift intrigued me because of its modern setting and that it’s set in a medical oncology ward in the US. Theresa Brown, the author, is also no light weight – she’s a former college professor with a PhD. She writes well, and clearly explains all aspects of a nurse’s day from the lack of break to the continual recording that needs to occur. It’s a book that is well done and gives an excellent insight into the daily life of the nurse.

Interestingly, there’s a few differences between Australian and American care that I was keen to explore. First of all, there’s the difference in payment. The NHS pays for your care in Australia, in the US it’s currently more of a user pays/private health insurance system. You have cancer in Australia and need a $10 000 drug? If the drug is available on the Pharmaceutical Benefits Scheme and you’re eligible (i.e. having the type of cancer for which it’s listed), no worries. You can have it, little to no payment required. I was interested to see the detail and care Theresa put into learning about her patient who was having Rituxan® (rituximab). It seemed like it wasn’t an everyday occurrence – here, we jokingly call it ‘Vitamin R’ because every second person seems to be using it and the potential uses just keep expanding! There’s definitely a lot of nursing care that goes into rituximab administration (it can cause allergic reactions and the patient needs to be monitored closely) and I liked the way Theresa went into it – it felt very caring and like she was treating the patient as an individual. There’s also blood cancers being covered by medical oncology (here they’re covered by haematologists).

To Theresa, the patients weren’t ‘the guy in bed XX’ or ‘the patient with Y cancer’ – they were real people. I think the humanitarian side of nursing – so often forgotten in this world of ‘if you didn’t document it, it didn’t happen’ and medicolegal issues – came through very strongly. I liked the way she explained terms that the average Joe might not be familiar with (it got a little repetitive for me, but I did like the simple explanations – useful for when I’m talking to patients!) but it didn’t seem like she was talking down to the reader. I also think she explained very well the continual competing tasks for a nurse’s time – call bells, telephones, patients coming in and patients going out, sometimes at the detriment of her own personal care (like eating!).

The story of just one shift explains things so well with the different types of patients – the first round of a new chemotherapy medicine (hello, frequent observations), the demanding patient and the patient who is a lot sicker than everyone first thought. It’s a rollercoaster of emotions from joy to frustration to fear. Theresa details well how she feels caught between a rock and a hard place – she simply can’t be everywhere at once and then administration decides she needs a new patient…! Although The Shift doesn’t sugar coat the realities of modern nursing, it offers a hopeful, positive tone. If you’re in hospital, you want someone like Theresa to look after you.

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