Can someone please explain night float and how it relates to the call systems they have seen out there...
thanks.
thanks.
please explain what your def of night float and the basic call structures avail.
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Night float is where you work just nights for multiple nights in a row. Eg if you work Sunday through Friday overnights from 5 pm to 6 am x eg 4 weeks. You go home and sleep during the days. You often don't get access to the call room because it's understood you are sleeping during the days. This is in contrast to the call shifts where you work, say, 24 hours every 3rd or 4th day, and have a post call day off. For instance you come in Monday morning, go home Tuesday morning and have off Tuesday. Then normal work day Wednesday. Then another 24 hour shift on Thursday to Friday, and so on.
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Where I work as an intern, you do 4-5 months of floors through the year. During this time you will spend 2-3 weeks total during the course of the year in night float. While on night float, you admit for the team admitting that day up to their maximum number of patients they can admit for the day (cap). You also take care of any problems that arise for teaching service patients.
When you are on standard floors you admit every 4th day, picking up new patients on that day until ~7PM when night float takes over. When it's your turn for night float, you arrive at 7PM, call the day service residents (who are already home), and get sign out over the phone from each of them (with printouts from the electronic signout system). You spend the night taking care of any problems or doing any admissions. I don't know about Law2Doc's examples of very malignant sounding programs (wtf no call room), but we do have access to call rooms and we do sleep here and there. In the morning at ~7AM you sign out to the day team and go home.
The night float "week" is one where we typically do 3 nights of float, 1 night off, 3 nights of float, then 24 hour period off and resume floors that following day. It's nice because you still get another 3 days off that month. Overall I think it's great, and I love being able to sleep 8 hours a day, every day. My problem was never staying up all night, but rather adjusting to being awake during the day when I came back from float. Still, I'd much rather have that than being sleep deprived every fourth day!
When you are on standard floors you admit every 4th day, picking up new patients on that day until ~7PM when night float takes over. When it's your turn for night float, you arrive at 7PM, call the day service residents (who are already home), and get sign out over the phone from each of them (with printouts from the electronic signout system). You spend the night taking care of any problems or doing any admissions. I don't know about Law2Doc's examples of very malignant sounding programs (wtf no call room), but we do have access to call rooms and we do sleep here and there. In the morning at ~7AM you sign out to the day team and go home.
The night float "week" is one where we typically do 3 nights of float, 1 night off, 3 nights of float, then 24 hour period off and resume floors that following day. It's nice because you still get another 3 days off that month. Overall I think it's great, and I love being able to sleep 8 hours a day, every day. My problem was never staying up all night, but rather adjusting to being awake during the day when I came back from float. Still, I'd much rather have that than being sleep deprived every fourth day!
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At my (peds) program, our breakdown is this:
Night float is a 1 month rotation, you're on nights from 7pm -7am for 5 or 6 nights in a row, have 2 or 3 "days" off and then back on for 5 or 6 nights. We have two "teams" each comprised of one upper level and one intern on each night - one team does all the admits, the other cross covers the floors. However because we have aged based teams (0-3, 4-10ish, 10+) for our general peds teams and then certain specialties assigned to specific teams, we don't have a rotating admit schedule which seems more common in IM programs.
Our "call" schedule on wards then is every third day you stay 'til 7pm to check out to the night float cross cover. Our hospital administration, with the new work hour rules, really pushed to eliminate cross cover during short call, so every team has one team member on short call each day.
In our ICU's (neonatal/peds), nights are covered with a rotating schedule of residents on that service. You work nights for 6 nights in a row, rotate back to days and wait until it's your time to flip back on to nights (this is my #1 beef with the new work hour rules - in the past, sleep was much more conducive to doing 10 or 12 nights in a row and being done with your time rather than having to switch back and forth).
Night float is a 1 month rotation, you're on nights from 7pm -7am for 5 or 6 nights in a row, have 2 or 3 "days" off and then back on for 5 or 6 nights. We have two "teams" each comprised of one upper level and one intern on each night - one team does all the admits, the other cross covers the floors. However because we have aged based teams (0-3, 4-10ish, 10+) for our general peds teams and then certain specialties assigned to specific teams, we don't have a rotating admit schedule which seems more common in IM programs.
Our "call" schedule on wards then is every third day you stay 'til 7pm to check out to the night float cross cover. Our hospital administration, with the new work hour rules, really pushed to eliminate cross cover during short call, so every team has one team member on short call each day.
In our ICU's (neonatal/peds), nights are covered with a rotating schedule of residents on that service. You work nights for 6 nights in a row, rotate back to days and wait until it's your time to flip back on to nights (this is my #1 beef with the new work hour rules - in the past, sleep was much more conducive to doing 10 or 12 nights in a row and being done with your time rather than having to switch back and forth).
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I think saying someone doesn't get a call room if they are only in the hospital for 13 hours is hardly malignant. Do you get to nap during a 13 hour day shift? Use of the term malignant for stuff like this kind of marginalizes those in actual malignant situations.
When I was an intern we had 30 hour call shifts where you could sleep in the call room if you got a chance (rarely), and in other rotations we had 13 hour night float months, where you were expected to work those 13 hours as if that was your day job, and thus not use a call room. You stayed under the 80 hour ceiling more easily with night float, and the workload at night was often a bit slower paced than during the day so it wasn't too bad.
My situation was the exact opposite of what I would define as malignant. Everyone was always smiling, goofing around, ribbing each other. People generally helped each other, watched each others back, made sure things didn't slip through the cracks. Lots of mutual respect, nobody getting blamed. Generally a very positive experience for an intern year. But yes the hours were long. I'd still rather have long hours in a very benign setting than the alternative, which does exist.
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It's at night, the time when you normally sleep. I wouldn't nap during the day because I'm not tired. If you're on at night, you should have a place where you can sleep. Certainly on my night float, I would typically have several hours of downtime. An acceptable place not to have a call room would be the ED. Though of course the ED staff work far less overall hours than IM/surg.
I remember on my med school OB/GYN rotation, the residents would catch naps in a standard chair with their heads on a desk behind a nurse's station overnight because they had no call room. To me, that is a feature of a malignant program.
As I mentioned in a previous thread on this topic, I have never seen, nor even heard a discrete example of a malignant, low hour internship. The only situation that seems to come up with some frequency is when applicants apply somewhere thinking the hours aren't bad, but then the actual hours after matching are much worse.
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nah, they exist in abundance. At the hospital where I did intern year, there were a couple of specialties I would probably consider malignant, even though they worked fewer hours than the one I was in. I wouldn't trade my situation for theirs in a million years, because although they came in later and went home earlier than I did most days, they got treated like crap by their seniors and attendings most days, while my setup was a very positive respectful experience of collegiality and teamwork. Malignancy is more of a culture than a number of hours. It stems from the top down, so if your chairman or PD is a SOB, it will trickle down. Obviously if you are in a bad situation and have to do it more hours that's worse, and because someone who is an SOB isn't going to care as much about how many hours you work this can go hand in hand, but the hours themselves are never the problem, just a very nonspecific symptom.
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when you are only on for 12-13 hours each day, some people take the position that the other 11-12 hours a day is when you get to sleep. And as such, they load up the night float person with stuff to do such that he's not generally going to have "several hours of downtime" like he would on a 30 hour call. In such a situation, the move from on call to night float allows for the elimination of the call room. It becomes a "shift", no different than ED. That it's a different philosophy than the one your program used hardly makes it malignant. Only being allowed to sleep 11 hours between shifts is malignant? Please. When you say stuff like this it marginalizes all those folks in truly bad situations, who would kill to be in a situation where the worst they were subjected to is sleeping during the day.
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