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I just finished Night Float for this weekend. I'm posting as a curiosity although there will be some gripey-ness to it. Cuz I am wondering aside from putting a body in the hospital, is there an actual learning purpose to night float? Theoretically/ideally speaking.
Giving an intern the Ancom phone and getting signed off 64 patients from the many teaching services to receive multiple phone calls from nurses at all three nursing shifts (their 3-11, 11-7, 7-3) w/ 3 different sets of eyes on their patients. Night Float for us is 8pm to 10am and I found ZERO value to it.
Things I learned.
~ You have no time to assess any patient complaining of pain and if you try to be conservative w/ PRN narcotics, the patient/nurse will fight you about it till you give in and you pretty much become a glorified drug deal. I feel like I pushed probably a sum total of 1gm of IV dilaudid by the end of the shift.
~ If one nurse signs off a completely irrelevant symptom (i.e. a COPD exacerbation patient w/ R ear pain), that will continually be signed off on remaining shifts and 3 separate phone calls will be made.
~ So I DID learn to somehow be in these nursing sign-outs. Not literally, but unless you finally tell one nurse, "please only call me if the patient is febrile, tachypneic, or desats" that irrelevant symptom persists. And they make their snippy little notes in their notes, "Pt still complaining of ear pain. MD does no new assessment."
~ You sign off on more things than you have time to think about sometimes. Which is scary but somewhat necessary when your Ancom is going crazy. Those veteran nurses know what to do, but they Jedi mind trick you. "I have a patient w/ [this], can we order [that]? I can put it in for you. Spell your last name. Thanks doc!"
~ You are a "fire fighter" of the wards. Get a "fire" put it out. Move on. Which is not all that great. As much as you do want to be a "better doctor" you can't. If COPD patient were my daytime patient I'd want to fully "work up"/treat her ear pain. But you literally have an Ancom ringing in your pocket every 3 minutes and my census is 64. It's ONLY the "big stuff" otherwise it would be insanity. You sign it off to the relieving intern at the end of the shift, go home and sleep.
~ You can become quite delirious 8 hrs into it which is potentially where medical errors can be made. Fortunately none of mine were serious. For example, I needed to renew a mitts and wrist restraint order, which I completely did, not knowing I was in the WRONG patient's EMR. So the requesting nurse calls me back 30 mins later and asks why I didn't renew it. I explain I did. Only to see I did for another patient who's EMR I was in while talking to the nurse.
Point of all of it is (before I keep adding to that list which I could) to illustrate how medical learning is completely NOT happening when an intern (3 days into residency) is suddenly given a 64 patient census for 14 grueling hours overnight.
I anticipate a response like: "Well, you are learning how to acutely manage patients" so...that I can teach MY intern next year on Night Float which will eventually insulate me from it, if I decide to become a hospitalist w/ an overnight at a teaching hospital or actually an internist who does mostly OP.
If you read this or respond to it thanks lol
Giving an intern the Ancom phone and getting signed off 64 patients from the many teaching services to receive multiple phone calls from nurses at all three nursing shifts (their 3-11, 11-7, 7-3) w/ 3 different sets of eyes on their patients. Night Float for us is 8pm to 10am and I found ZERO value to it.
Things I learned.
~ You have no time to assess any patient complaining of pain and if you try to be conservative w/ PRN narcotics, the patient/nurse will fight you about it till you give in and you pretty much become a glorified drug deal. I feel like I pushed probably a sum total of 1gm of IV dilaudid by the end of the shift.
~ If one nurse signs off a completely irrelevant symptom (i.e. a COPD exacerbation patient w/ R ear pain), that will continually be signed off on remaining shifts and 3 separate phone calls will be made.
~ So I DID learn to somehow be in these nursing sign-outs. Not literally, but unless you finally tell one nurse, "please only call me if the patient is febrile, tachypneic, or desats" that irrelevant symptom persists. And they make their snippy little notes in their notes, "Pt still complaining of ear pain. MD does no new assessment."
~ You sign off on more things than you have time to think about sometimes. Which is scary but somewhat necessary when your Ancom is going crazy. Those veteran nurses know what to do, but they Jedi mind trick you. "I have a patient w/ [this], can we order [that]? I can put it in for you. Spell your last name. Thanks doc!"
~ You are a "fire fighter" of the wards. Get a "fire" put it out. Move on. Which is not all that great. As much as you do want to be a "better doctor" you can't. If COPD patient were my daytime patient I'd want to fully "work up"/treat her ear pain. But you literally have an Ancom ringing in your pocket every 3 minutes and my census is 64. It's ONLY the "big stuff" otherwise it would be insanity. You sign it off to the relieving intern at the end of the shift, go home and sleep.
~ You can become quite delirious 8 hrs into it which is potentially where medical errors can be made. Fortunately none of mine were serious. For example, I needed to renew a mitts and wrist restraint order, which I completely did, not knowing I was in the WRONG patient's EMR. So the requesting nurse calls me back 30 mins later and asks why I didn't renew it. I explain I did. Only to see I did for another patient who's EMR I was in while talking to the nurse.
Point of all of it is (before I keep adding to that list which I could) to illustrate how medical learning is completely NOT happening when an intern (3 days into residency) is suddenly given a 64 patient census for 14 grueling hours overnight.
I anticipate a response like: "Well, you are learning how to acutely manage patients" so...that I can teach MY intern next year on Night Float which will eventually insulate me from it, if I decide to become a hospitalist w/ an overnight at a teaching hospital or actually an internist who does mostly OP.
If you read this or respond to it thanks lol