What do you think about the following thought on night shifts on hospitals?

I’m guessing even in the best hospitals daytime is when most of all the patient’s urgent needs are met by all the doctors in charge including lab tests, x-rays or MRIs.

Daytime is when they review the care plans they initiated and they do adjustments accordingly.

At night in the best hospitals, I can only assume they have enough personnel to attend to patients in case of emergencies.

But yes, I do think that in all hospitals a patient can still “fall into a crack” especially if that patient is incapable of advocating for himself and there is no family or friend who knows how to properly advocate for that patient.

Based on my experience back in 2007, many corners are cut on the night shift.

That is why you hope you have family who can crash at the hospital.

I don’t understand the dichotomy family vs fewer personnel.

Nurses do most of the care anyway.

True if you have something acute happen you might not get the best, most experienced doctor to come to your aide in the middle of the night, but as far as being tended to in a routing way, I think overall that is ok morning or night.

You want family there to speak for you when you can’t speak for yourself, or to watch that everything is getting done that should be. Mistakes are made at hospitals to often, and patients are ignored too often.

I think there are many gaps or flaws in your logic. As @JLeslie pointed out, nurses do most of the care. Physicians don’t NEED to be there around the clock for the VAST MAJORITY of patients. Do you realize that most patients in the hospital have far more chronic health issues than acute health issues? The doctor writes orders, the nurse tends to the ongoing care and follows the orders. The nurse notifies the doctor (usually starting with the doctor on-call with the lowest level of experience and authority) if there is a change in status or emergency.

There are always doctors in the emergency department and emergency staff in other parts of the hospital or on-call who need to be able to be in their role within a certain amount of time (for me it was 30 minutes from being paged).

Most patients in the hospital are lower acuity, relatively stable and sleeping at night. Why would hospitals staff more doctors for that?? You said it yourself, hospitals need to be efficient. That would not be an efficient system. An efficient system uses lower cost labor to fill in the bulk of the work, supervised by higher paid individuals with more experience.

The family vs. fewer personnel “dichotomy” is largely based on systems from outside of the US, usually in developing countries, where families feed (meaning provide ALL food for) patients and tend to them (provide comfort, blankets, help them go to the bathroom, walk with them, etc.). In some systems, families purchase medication at the pharmacy and bring it back to the hospital (which does not provide medication to patients directly).

The US system is not based on family labor or provision of food/supplies. However, there is an expectation that when able, the family will help with care. For example, pediatric units are built (newer ones, anyway) to accommodate families to stay with the child to provide comfort and basic care. Parents are expected to tend to their newborn during the delivery hospital stay. These are ways in which our system does informally rely on parent/family caregiving in a way that may alleviate some staffing needs. In this way, newborn units are NOT staffed to care for all newborns in the nursery overnight. There is an expectation that most of them will room-in with parents. If that were to change overnight, extra staff would need to be called in from home.