An Unvarnished, Behind-the-Scenes Look at the Hospital Nurse

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The Nurses is a mixed bag of high-drama nursing and even some very good critique on our health-care system, from the inside out.


Title: The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital
Author: Alexandra Robbins
Publisher: Workman Publishing Company
Publication date: April 14, 20155
Price: $17.53; hardcover, 368 pages

Florence Nightingale, the most famous and influential figure in the development of modern nursing, began her career tending to the wounded in the Crimean War in 1853. Under her leadership, the role and education of nursing were defined. From war to natural disasters, nurses have played a heroic part in the history of medical care.

Over the decades, nursing has evolved into a multidisciplinary profession of highly educated and trained health-care providers. And perhaps no branch of nursing has a more clearly defined and essential role in patient care than the oncology nurse, regarded as the backbone of the cancer care delivery system.

Television and books have a long history of featuring the medical profession’s dramatic urgencies, most of them overreaching and distorting the reality of hospitals and clinics, creating a hyperfrenetic unspooling of dramatic doctor-patient encounters. Health-care professionals shrug this off: Blood, sex, and hyped up life-and-death events sell.

Best-selling author Alexandra Robbins has made a career of delving into the secret lives of sororities, overachievers, geeks, and so on, so why not nurses? She does just that in her new book titled The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital. The Nurses is a mixed bag of high-drama nursing and even some very good critique on our health-care system, from the inside out. Moreover, one reason that books and television shows about hospitals are successful is because everyone can empathize with being sick, injured, scared, and helpless.

Four Real-Life Stories

The Nurses is told through the real-life stories of four nurses at different hospitals that stand within a 50-mile radius of a major American city. On the surface, they are very different. Pines Memorial Hospital is a pleasant-looking building with a 16-story tower and broad windows overlooking a tree-lined suburban avenue. Pines Memorial’s 190 beds serve a highly educated, wealthy population.

Several miles away, South General Hospital occupies a mostly poor neighborhood; it has 300 beds and a level I trauma center. South General’s ER sees 95,000 patients a year. Then, 45 minutes west, the 425-bed Academy Hospital treats a ritzy demographic of young and middle-aged residents in the nearby million-dollar homes and elite university.

Rounding off the foursome is Citycenter Medical, which has a level I trauma unit that treats most of the city’s gunshot victims, homeless, and drug-seeking addicts. As different as their patient populations are, all four hospitals have one common thread. “In each of these disparate institutions, pale blue curtains shroud pods of frightened people.”

From Silly to Serious

Ms. Robbins organized her book into 10 well-designed chapters with catchy titles, such as “The Stepford Nurse,” “Burnt to a Crisp,” and “When Nurses Bully Nurses.” This serious beach-read format is her literary bailiwick, and it’s made her a steady presence on best-seller lists. Although there is a good deal of serious and informative content in the book, at times—perhaps too often for readers of The ASCO Post—Ms. Robbins plays to what she feels is her built-in audience with overly chatty and silly scenes.

The Nurses is most compelling when it threads value into the narrative, such as in the chapter “Burnt to a Crisp.” Nursing is a physically and mentally demanding career, and Ms. Robbins tackles subjects the oncology community has addressed: burnout and workforce shortage. “Experts estimate that approximately 30% of nurses are burnt out, which has been defined as a loss of caring. Burnout symptoms include irritability, difficulty concentrating, low energy, and sustained thoughts of quitting.”

Ms. Robbins illustrates burnout syndrome with serious anecdotal evidence correlating it with a dangerous uptick in preventable hospital errors. She then wades into the fiscal issue of budget cuts and consolidation, which results in understaffing. Policy is not her strongpoint, but she hits most of the difficult fiscal challenges with authority. To her credit, she gives a balanced overview of these critical issues and ends this well-researched chapter by looking at how hospital administrations across the country are dealing with nurse burnout and understaffing.

Throughout The Nurses, the author treats the reader to compelling nurse-hospital dramas, which not only entertain but also underscore the value that nurses bring to the health-care system. As a value-added section, Ms. Robbins ends with a what you can do chapter, broken into short, subtitled narratives offering sound advice to all those in the business of running a hospital.

Advice for Nurses

For nurses, she gives advice, such as becoming a mentor. When asked about their career choice, most oncologists stress the value of their mentors’ strong advice and guidance. Ms. Robbins offers a thoughtful section on the essential role mentors play in keeping the health-care system fully energized.

However, she seems to drop the ball on one of the most significant issues facing our system: hospital-acquired infections. The Centers for Disease Control and Prevention estimates that hospital-acquired infections kill upward of 100,000 citizens each year. Ms. Robbins’ advice to nurses is shockingly brief: “Bring hand sanitizer and antibacterial wipes. Use them.”

Ms. Robbins is adept at communicating serious issues with accessible and lively writing. People looking for a behind-the-scenes beach read with some serious information threaded into the juicy parts should enjoy The Nurses. Unfortunately, for some readers of The ASCO Post, much of this entertaining book may be considered decidedly lowbrow and filled with clichés and gossipy dialogue. ■