Book Review: The Shift: One Nurse, Twelve Hours, Four Patients' Lives by Theresa Brown

The Shift takes readers deep into the world of bedside nursing through the eyes of Theresa Brown, a former English professor turned oncology nurse. Set in a teaching hospital in Pennsylvania, this book chronicles one intense 12-hour shift on a bone marrow transplant/medical oncology floor, giving readers—from laypeople to seasoned healthcare professionals—a vivid look at the realities of nursing, including the emotional toll, physical demands, and the quiet courage required to care for some of the sickest and most vulnerable patients.

Brown's story begins not in the hospital but at home, with the alarm clock blaring. For a moment, she contemplates calling in sick—not out of laziness or irresponsibility, but out of fear. Fear of what the day may bring. Fear of losing a patient despite her best efforts, intuition, and knowledge. She describes this fear as "the rock"—a metaphor for the constant uphill struggle of healthcare workers. Sometimes, despite everything, the rock slips, and a patient dies. That weight stays with a nurse forever. Brown's haunting memory of a patient who died seven years prior still lingers, a quiet reminder of how deeply those moments are etched into a nurse's heart.

Any nurse reading this book will find herself somewhere on these pages. Brown doesn't shy away from topics healthcare workers know all too well: short staffing, ethical dilemmas, patient dynamics, and the unrelenting pressure to keep moving. She admits, even briefly, to wanting to avoid the shift—but knows that doing so would leave her colleagues short-staffed and overburdened. This is a feeling many nurses can relate to: the guilt of calling out, knowing it often means more patients per nurse and increased stress for the team.

Brown is assigned three patients as her shift begins—a relatively manageable load on her unit. This gives her time to stay ahead of care plans, coordinate with physicians, and connect meaningfully with each patient. But there's a catch: being the nurse with only three patients means she'll receive the new admission first. And so, a looming sense of dread hovers—she describes it as "a vulture perching on my shoulder, hungry to scavenge my peace of mind" (Brown, 2016, p.19). It's a relatable tension for nurses: balancing the known with the unknown while trying to maintain focus on the here and now.

Brown also tackles the burden of charting in the electronic medical record (EMR), describing how modern documentation demands can sometimes pull attention away from actual patient care. While charting is essential for safety, data tracking, and reimbursement, it often feels like the human element of nursing is being lost behind a screen.

She shares small but meaningful stories, such as one of her patients becoming angry over not receiving her Prilosec on time—a moment that speaks volumes about the need for control when everything else, including one's health, feels uncertain.

Brown also introduces us to a challenging new admission: a patient labeled "difficult," who documents every action in a notebook and seems to be waiting for someone to make a mistake. Brown wisely reflects that the patient's need for control may stem from losing control over the body—a reminder to all caregivers to look beyond behavior and consider the deeper emotional layers.

At times, Brown admits to bending hospital rules—for instance, leaving medications at the bedside instead of watching the patient take them. While this is not advisable for nursing students (and could be considered a clinical jeopardy), Brown is transparent about her choices, illustrating the daily complex decision-making nurses face.

Other daily events covered in the book will spark memories for veteran nurses and offer insights to those just starting their careers: lost dentures, Code Blues, admissions during the worst times, blood transfusions, surgical prep, and delayed discharges. Brown brings each scene to life with detail and empathy, making it easy to visualize—and feel—the pace, tension, heartache, and joy of nursing life.

A Word on Staffing Ratios from The Shift

One crucial point Brown makes is about staffing. She offers a powerful equation: RN/p = TLC

In other words, the more patients assigned to a nurse, the less Tender Loving Care each patient receives (Brown, pg. 19, 2016).

Less tender loving care is not just a philosophical statement but is backed by research. California remains the only U.S. state with legally mandated nurse-to-patient ratios. Studies from Australia, where similar mandates exist, show that hospitals with safe staffing levels report better patient outcomes, including reduced mortality, fewer readmissions, and shorter hospital stays (McHugh et al., 2021). They also show improved job satisfaction among nurses and reduced turnover (Huddad et al., 2023).

Any nurse who has worked in an understaffed unit knows the toll it takes on patients, morale, and mental health. Brown's book is a powerful call to action, reminding us that nurses must advocate for safe staffing, actively participate in policy discussions, and support legislation prioritizing patient care. It's a reminder of our collective power to make a difference in the lives of our patients.

Final Thoughts on The Shift

The Shift is an ideal read for both new graduates and seasoned nurses. For new nurses or students, it offers a real-world glimpse into the daily rhythm of hospital nursing. For experienced nurses, it's a mirror that reflects the profession's pain and pride.

If you're looking for a book that captures the heart, grit, and humanity of nursing, The Shift delivers. And if you've read it, we'd love to hear what resonated most with you. Drop your thoughts in the comments—we're all in this together.

References:

Brown, T. (2016). The shift: One nurse, twelve hours, four patients' lives. Algonquin Books.

Dierkes, A., Do, D., Morin, H., Rochman, M., Sloane, D., & McHugh, M. (2022). The impact of California's staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis. Nursing outlook, 70(2), 219–227. https://doi.org/10.1016/j.outlook.2021.09.007

Kim, Y., Lee, K. & Jung, M.  (2024). Improvement in nurse staffing ratios according to policy changes: a prospective cohort study. BMC Nurs 23, 335. https://doi.org/10.1186/s12912-024-01995-w

Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. Nursing Shortage. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/

McHugh, M.D., Aiken, L.H., Sloane, D.M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. Lancet, 397, 1905–13.