Being in a hospital at night or over a weekend can be hazardous to your health, and even has a name: “the weekend effect.” A raft of studies has documented higher rates of death, complications and medical errors affecting patients treated at night or on weekends. “After normal working hours it’s mostly maintenance,” said Jessie Gruman, 56, director of the Washington-based Center for Advancing Health, a nonprofit health-policy group.
“There’s a real sense of vulnerability you have at night when you know things are not happening at full speed. There’s less nursing care, less access to a doctor and more demands on doctors,” added Gruman, a veteran of more than 35 years of hospitalizations to treat cancer-related illnesses. To bridge the chasm between the day and night shifts, hospitals from Syracuse to Seattle are hiring a new breed of subspecialist called a “nocturnist” — an experienced doctor who works overnight taking care of patients outside the emergency room.
Other requirements to bolster patient safety have also led to increased staffing at night. Standards issued by the Joint Commission, which accredits hospitals, have led to the development of rapid response teams led by doctors to care for patients whose condition worsens. Beginning next year, the new health-care law requires that Medicare payments to hospitals reflect patient satisfaction scores.
“There are consequences to bad care that didn’t exist before,” said Robert Wachter, associate chairman of the department of medicine at the University of California at San Francisco and an expert in hospital medicine. “And there is an increased level of expectation that patients have for quality and safety.”
Not the graveyard shift
When internist Terance Millan agreed to work the night shift at North Florida Regional Medical Center in Gainesville in 1997, he thought it would be only temporary. “But here I am 14 years later,” said Millan, 51. Working nights enabled him to spend time caring for his children, now 20 and 22, and offered flexibility that his wife, also a doctor, needed.
Millan is one of three staff nocturnists; each works 15 days per month from 4 p.m. to midnight or 7 p.m. to 7 a.m. He said he likes the autonomy, the esprit among the night staff and the fact that “when I’m off, I’m off.”
Nights were slow at the beginning, but that has changed dramatically. “We’re very busy,” said Millan, who sometimes admits 22 patients during his shift, many of whom are very sick.
Hopkins’s Washburn, 47, said her workload has escalated since 2006, when she began working part time. Her schedule — every Friday from 8 p.m. to 8 a.m. and the same shift every other Saturday — has given her the flexibility to home-school her three children. She has trained herself to fall asleep when she gets home, relying on earplugs, a darkened room and her family’s cooperation.
Working nights, Washburn said, “is not difficult for me. I think some people can tolerate it. There are fewer interrruptions and distractions at night.” Although she does not officially supervise residents, they consult her about patients and she evaluates ICU admissions and confers with nurses and other staff when problems arise.
Gruman says that as both a patient and an advocate, she regards the use of nocturnists as “long overdue. The need for night coverage has always been there,” she said. “It’s so hard for me to believe that it’s taken this long.”