The Shift: One Nurse, Twelve Hours, Four Patients' Lives

by Theresa Brown

Home is a vaccine against the stresses of nursing.

The older waiter and I both come to work with the hope of doing good, and we share the same wish: for our customers, or patients, not to need us. But until that moment comes we will remain at our posts, ready.

Amid the many uncertainties of the shift there is one thing I know for sure. Am I ready and up to the job? Yes. Today, and every day, for the sake of my patients I have no other option; the answer has to be, and always is, Yes.

The fewer the number of nurses the lower the labor costs for the hospital. But if I give care a numerical value, represented by TLC, while P stands for number of patients and RN for each individual nurse, then: RN/p = TLC The more patients an individual nurse cares for, the smaller the amount of TLC per patient. More significantly, research on staffing levels has made it pretty clear that the more patients a nurse has above a certain number (the number itself depends on the patient population and how sick the patients are), the larger the likelihood a patient will die who wouldn’t have otherwise. In other words, nurse-to-patient ratios aren’t just about patients feeling cared for; they’re also about fragile people staying alive.

It’s not exaggerating to say that Sheila could be dead tomorrow. Today this is the storm we chase: the infinite potential of Sheila’s continuing life, held in the hand of the hospital.

Touch connects the essential humanness of nurse and patient, reminding me that we are two people with a shared mission: healing, if we can.

There must be a weighing of how dire Sheila’s situation is and how tired he and the rest of his team will be. I know from experience that fatigue is a thief of concentration and memory because I lived it when my twins were babies. Peter, I’m sure, also knows how dangerous fatigue is.

“Well,” he says, “If we could know the future our jobs would be a lot easier.”

Where would that be? Spin the globe. Find some place warm, cheap. Could be an island, but the important thing is to be safe, hidden from disease and out of reach of modern medicine because he won’t be needing it. It’s my fantasy, creating for Mr. Hampton a new clean, well-lighted place.

I told him he had said something so wise to me, something that shaped my thinking about the entire project: “If we could know the future our jobs would be a lot easier.” “That was probably something I said half asleep,” he told me, not acting embarrassed or falsely modest, but being scrupulously honest, the way he had been so careful as an intern. He doesn’t remember saying something that changed my life, but I do, and seeing him I felt the import of the entire shift again, for Mr. Hampton and for Sheila, for Candace, Dorothy, and Irving. I felt infinity in the palm of my hand and eternity over the next twelve very busy hours.