What is your unit's provider staffing like overnight?

PeakRN · Dec 17, 2018

We don't have ICU fellows and we don't allow residents to care for patients in any critical care areas including the ICU. Our adult ICUs have an in house intensivist overnight, PICU has their own pediatric intensivist, and NICU as a neonatologist as well as multiple NNPs.

core0 · Dec 17, 2018

Overnight we get a 1st year resident and a second year resident, and they're supposed to be supervised by a cardiac fellow, who is often napping or has 'gone home for a few hours'. It's pretty frustrating and scary to have an ICU staffed with a couple of new residents who are afraid to place any orders they have not been directly told by their superior to place. Honestly seems like a bit of a 'let's wait for the code and we'll address the issues there' mentality, rather than a 'let's prevent this patient from coding' mentality, which is obviously what I'd prefer.
Just wondering what other people's MD/NP/PA staffing is like in ICU overnight so I know if I'm being ridiculous when I suggest that we need some legitimate physician supervision overnight .

We have 2 APPs and a resident (PGY 2-4) for 23 beds. All of our ICUs have at least 1 APP depending on the size the larger ones are 2-3 at night.

KeepinitrealCCRN · Dec 17, 2018

We have a PGY2 on the unit overnight. We also have a PGY3 or PGY4 in the building as well as an attending who will round once or twice and come if we have emergencies, otherwise Im sure they are sleeping. The PGY2 does most of the work. They put in orders, put out fires and put lines in pts etc. Most of the nurses have more experience than the residents so they direct a lot of the care.

Cowboyardee · Dec 18, 2018

We have 1 intensivist and 1 PA, covering about 45 beds at night. This would probably be adequate if we had mostly experienced nurses on who knew what orders they needed when they call, but too many of our night shifters are new out of school or a bit under-developed as icu nurses go, and so it can be a problem.

JBMmom, MSN, NP · Dec 18, 2018

We are a small unit in a small hospital. We have two hospitalists overnight covering the whole hospital and an on-call pulmonologist. Sometimes they're in the building because they live far away, but most are home and sleeping if we need to call for something. It's a little unnerving at times because all but one of our night stuff nurses have less than one year in the ICU. But then again we are only a level 3 trauma center and really challenging patients get sent to the city hospital about 30 minutes away.

adventure_rn, MSN, NP · Dec 19, 2018

I work in a 15 bed PICU setting. Our general structure is that every patient is assigned to the 'fellow' team or the 'NP' team (divided evenly), and the fellow or NP is primarily responsible for the patient's plan of care. The intensivist oversees all 15 beds, but doesn't have any patients that they manage on their own; rather, they're present to advise the fellows/NPs, update families, etc. We don't have any residents (praise the lord).

The attendings do 24-hour shifts, so we always have one in the unit. They're around all day and at the beginning of night shift for rounds, then they go to bed in a call room inside of the unit. They carry pagers and get up if a child becomes acutely critical or codes.

Ideally, the NPs and fellows do 12-hour shifts, so the person who is managing the patient should be awake and on the unit for the entirety of the shift. Every so often they'll do a 24 and drag a recliner into their break room/office, but they always have their phones on and are expected to be readily accessible right away. The fellows can make me a little nervous at times (especially the brand new ones), but usually, if they have a question, they'll consult the NP (all of whom have been around much longer than the fellows). Sometimes we'll have two NPs, and very occasionally we'll have two fellows which really does make me nervous (although they will generally put a third-year fellow with a first-year so that at least one of them knows what the heck is going on).

It's a really nice system. This is the first place I've worked where the main overnight providers aren't doing 24s; I'd always feel really guilty calling during the night, and I'd have providers tell me, "Don't wake me up unless somebody is dying." It makes me feel so much more comfortable knowing that I can get their input any time day or night and that I won't feel guilty for waking them up.

The last time I worked with a resident during the night, it went something like this:

https://allnurses.com/nursing-humor-share/fun-with-residents-1083110.html