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Midlevels and night shifts

February 2012

Published in the February 2012 issue of Today’s Hospitalist

In response to “Midlevels at night: big help, or more work?” in your December 2011 issue (“Nocturnists: Soaring volumes mean trouble at night“), I am a nurse practitioner in a medium-size community hospital and have worked the night shift for the last five years.

My primary responsibilities are management of ICU patients (12 beds, closed unit), ICU admissions, codes and the rapid assessment team. We also provide cross coverage for the step-down and telemetry floors, with approximately 40 additional patients. I also perform procedures including intubations, central lines, thoracentesis and pneumocaths.

I alternate with another NP and, between the two of us, we have more than 50 years of critical care experience. We take face-to-face signouts from the intensivists and are also supervised during the night by the nocturnist.

I feel the work that we are doing is invaluable. We are not seeing the occasional “easy” patient but the sickest ones in the hospital. These are also the patients who require the most time “and because we are caring for them, that frees up the hospitalist for general admissions.

Are we a big help, or are we more work? At least in our institution, everyone I asked “including the intensivist, ICU staff, ED physicians and specialists “said we were a huge help.

Cori Good, MSN
Redlands, Calif.

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