working night shift in a hospital with no house MD

wildtime88 · Dec 26, 2001

I have worked at many hospitals where there was not a house doc. The ER doc was resposible to go to all codes and emergencies. If we had a code or emergency in the ER while they were tied up on the floor then we would run the code or deal with the emergency until they returned.

Does your hospital have an ER? Most of the ER docs are very good about reading x-rays like this if you bring them to them.

If you call a code you will see them show up for it pretty quickly.

grouchy · Dec 26, 2001

This is blowing my mind! How big are these hospitals with no MD at night? I work in a 4 or 500 bed teaching hospital, so we always have interns and residents at night plus "Hospitalists" on some floors. I've been meaning to respond to the recent night pharmacy hours thread too. We always have at least one pharmacist, plus a pharmacy tech on at night. I always thought that hospitals, by definition, were 24 hour a day institutions. I guess I never realized how good we have it here.

oramar · Dec 26, 2001

I also have worked at small hospitals where House Officers were scarce. It is true that ER MDs will deal with emergencies. However, there are many things of a serious matter that are not emergencies that they do not deal with. Also, sometimes a ER can be very bad and the ER MD can't respond. It is a serious situation and it seem to me that managment was crossing their fingers hoping that nothing happened. Technically speaking, a patient in the hospitals attending MD is required to cover in house emergencies if the ER MD is not availiable but we all know that does not happen either. This and the lack of 24 hour coverage by pharmacist are my main complaints.

wildtime88 · Dec 26, 2001

You are right to be concerned about this issue.

I should have given you an overview of what happens in the ER.

In the case of a code, it is not uncommon for a doc if he is the only one working to drop everything he is doing and run to the floor or the unit. They are usually shouting out orders for the patients in the ER or just basically saying deal with things as you see fit as they leave the ER.

In case of potential life threatening emergencies it is much the same way. They would rather intervene before a code has to be called.

Now here is a typical summary of a patient who is starting to go bad.

The nurse on the floor or in the unit calls the attending or who ever is covering and reports the problem. They receive orders via the telephone. That doc then decides if he needs or wants to come in personally. In many cases that doc then calls the ER doc and discusses the patient with him. The ER doc then decides if he can actually manage the patient's condition if things go bad while at the same time providing effective coverage in the ER. Sometimes an argument peruses during the phone call.

In more hospitals than you probably think the ER doc assumes the house doc role. I have worked at small and medium sized hospitals where this was the case. If an ER doc shows up for a code in the middle of the night, then this is the case.

kaycee · Dec 26, 2001

Grouchy, there are far more hospitals of the non teaching variety and most do not have 24hr anything but nurses. Our Pharmacists quit at 9pm weekdays and 7:30pm weekends and holidays. Cafeteria closes at 6pm and doesn't open till morning. Central supply is gone by 5pm, cardiology closed by 4pm, adm office closed by 4:30pm(everything after that goes through the ER). The evening and nite supervisors are nothing but gophers. All they do is run for "stuff" cause everything is closed.

We do have house officers but they don't come in until 6:30pm and they don't work any holidays. The ER docs cover any house emergencies when the house officer is not there.

Most teaching hospitals at similar bed size have more services available 24hrs like yours.

The majority of hospitals (community sized) do not.

nur20 · Dec 26, 2001

I dislike sounding ignorant but is there a circumstance whereas the nurse cannot check placement for NG feedings? Is that a special order?

EXOTIC NURSE, RN · Dec 27, 2001

This ng tube has a mercury bulb on the end of it and we as nurses are not allowed to just check for placement like we would do a regular NG tube there has to be an xray to confirm placement and that is hospital policy.

JillR · Dec 27, 2001

Interesting subject. I am always amazed at the number of people who do not understand how it is in small hospitals.

Our pharmacy is out of the building by 4:30, along with purchacing, medical records, and anyone else who does not have to be there. We NEVER have a doc in house to cover the people on the floor, just the ER doc, and they tend to not be there either, if nothing is going on, which is not often, but it does happen.

What do the ER nurses do when a critical patient comes in and the ER Doc is not there. we treat the patient, getting orders by phone if the patient needs meds STAT, if not, we get the labs and xrays done that are needed. In our ER we have One RN, one Doc and a tech from 7am to 11pm, after that it is the RN and Doctor. The charge nurse is responsible for everything, there is one charge for the whole hospital. I work weekends and got the luck of being charge, so now, I am in the ER, the nurses call me for any meds they need from pharmacy, help if a patient is going bad, and get the fun job of supervising the CNA's, which is a chore in itself.

Wildtime pretty much summed it up when he decribed how it is in very small hospitals.

As a nurse you either become very independant fast or can't handle it and quit fast. It is a tough situation for new grads. You do have to be very confident in your assessment skills.

If someone codes on my shift and the doc is not there, I run the code until the doctor gets there. Never had to do that yet, but it will happen. The only time I ever ran a code is when the doc went to talk to the family in the middle of the code.

thisnurse · Dec 27, 2001

i work at a 500 bed teaching hospital. we have someone from nearly every department on call.

it is a 24 hour operation.

ive also worked in a small hospital where the er doc is the house md. never had a problem with that, but once i had to draw a stat blood for glucose level and nobody was in the lab. he was drawing blood at a nearby nursing home. it was daylight shift. had to wait for him to get back.

grouchy · Dec 27, 2001

Wow! This is an education! I thought we had it bad because due to cost-cutting, our hospital recently closed linen and central supply on the night shift, and closed the cafeteria after 7 pm. We have a small community hospital in my town, and they have a hospitalist at night in addition to the ER doc.

dawngloves, BSN, RN · Dec 27, 2001

Wow! :eek: I have a lot of admiration for you nurses that have to work like this. I like autonomy, but Geezz! I am very lucky to work in a big city hospital!