Nurses know the reality of the night shift.  That nights and weekend hours claim increased rates of medical errors, complications, and patient deaths is neither surprising nor mysterious to them:  there are too few healthcare workers, and those who are on duty are often overworked and exhausted. 

Traditionally, hospital emergencies occurring in the wee hours of the morning have been handled thus - a nurse pages a sleeping on-call physician or, in teaching hospitals, a resident, to address unexpected findings and critical situations.  A myriad of stumbling blocks stymies the delivery of optimal care under this model, contributing to poorer outcomes for patients admitted during off-hours.  Nurses may fear reprisal from fatigued physicians who prefer not be "bothered" for what may seem to be a minor matter.  Residents may fear contacting their attendings for the same reason.  Or, paged on-call clinicians must travel from home in order to address crises, a protocol which can result in problematic time delays.  Further, as already strained nurse-to-patient ratios increase during nights and weekends, nurses are less likely to confirm patient identities or double-check dosages before administering medications.

Several US hospitals are taking a new approach to this problem, instituting a system that they hope will improve the quality of patient care during nights and weekends.  These new specialists, dubbed "nocturnists" work strictly in the off-hours.  Nocturnists, a sub-category of hospitalists, are drawn by incentives of higher salaries and fewer hours per week compared to their daytime colleagues. 

Based in the Intensive Care Unit, these physicians, or combinations of nurses, doctors, and other therapists, attend to emergencies within the ICU or elsewhere in the hospital.  They generally work 12-hour shifts three or four nights a week, a schedule that is particularly attractive to younger healthcare professionals.  Hospitals employing nocturnists include Beth Israel Medical Center in New York City, Overlake Hospital Medical Center in Bellevue, Washington, and Mercy Medical Center in Springfield, Massachusetts.

While hiring nocturnists does increase hospital costs, hospitals are finding that this system improves outcomes and reduces liability concerns.  Not only are nocturnists readily available when back-up is needed, but nocturnist coverage encourages strong communication between swapping patient care teams.  Nocturnists round with the day staff prior to taking over night shift duties, strengthening transmission of relevant information at two points during a twenty-four hour period. 

All of this is good news for nurses.  Nocturnists are on site, they are awake and alert, and they are specifically instituted to respond to unexpected patient events during times when nurses are most strapped.  Perhaps as statistics continue to reflect better care for patients in hospitals that use nocturnist coverage, more institutions will recognize the benefits that this new role promises for both night shift healthcare workers and their patients.

References
Landro, L (28 May 2008). Hospitals move to reduce risk of night shift. The Wall Street Journal Online.

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