A Day in the Life: Night Float

5:00pm: My alarm clock goes off, but I didn't really need it to, my sleep during the day is always light and on and off! So I hop right out of bed to go surprise Liv who's out in the living room playing with Grammie. We cuddle for a while on the couch and catch up on her day.

5:30: Decide I'm making rice and beans with chicken for dinner (Liv's favorite), so hop into the kitchen and get that started. Liv comes with me in her booster chair (that we have on one of our bar stools) and does some coloring with markers at the island (more like plays the game of drop the markers and make mommy pick them up).

6:15: Dinner is done and the weather outside is perfect, so I turn on our back patio lights for a little ambiance and Liv and I eat dinner out back. N is admitting patients today so he likely won't be home until 8 or 9pm, we definitely aren't waiting for him to eat!

7:00: Bath time for Liv!

7:20: Get Liv into her PJs and then cuddle up on the couch and turn on her constantly-requested all-time favorite movie (The Book of Life). She asks for Manolo and Joaquin every. single. night. And I can't lie, I love the movie too. I'd watch it every night with her if I could.

7:50: Time for me to hop into the shower and get ready. I throw on a comfy tee and my (maternity) scrubs and Danskos and make sure I pack up enough snacks for the night. I make sure I have my trusted fleece and mini survival bag with all my other nighttime/early morning necessities (tums for the heartburn that will come in the middle of the night, toothbrush for the morning, and all the other extra in case I feel like making the effort to feel a little more human at the end of a long shift)!



8:30: I get my hugs and kisses from Liv and leave her with Grammie and hop in the car to drive to the hospital. Thankfully it's only a 15 minute drive!

8:45: Get to the hospital, pick up a small iced coffee before the coffee shop closes at 9, and get my spot situated in our resident workroom. I make sure I've got all my necessities to start the night - ID, pager, a blank piece of paper I fold in half the long way (this will become my "task list" for the night) and my favorite pen. And gum. I am constantly chewing gum as it's the only thing that keeps me from being nauseated all night.

9:00: Time to get sign out. All hospitals and services work differently, but for our medical service, there are multiple different teams taking care of medical patients (about 5 total, plus the CCU - the cardiac unit). On any given night there will be one team that was "long call," meaning they stay until 9pm to give sign out to me - all of the other teams can usually leave by 4 or 5pm when they sign out to the long call team. So I get sign out from the long call intern on all 45 patients all the teams have been taking care. For some of the patients, it's "NTD" (nothing to do), but for many of the patients there are tasks to do or things that are expected to happen - follow up their midnight sodium, follow up the 2am troponin, follow up the head CT read, or if they desat (their oxygen level drops), do xyz. Of course the task list I get at sign out is always much shorter than what ends up happening over night! Although I get a printed sign out with details on every patient, this is usually at least 10+ pages long. I refer to it when I need to, but I make sure to write any actual tasks to be completed on my task list. While getting sign out my pager has already gone off twice.



9:30: I've gotten sign out, now the night begins. I call back the two pages - one was from phlebotomy who needed me to fix an order for a lab, the other from a nurse with a patient who's family is here and wants to speak with the doctor about an update. I quickly fix the order and then look up the patient whose family wants the update - it's always hard being the night coverage (as we aren't the primary team and don't make most of the decisions in their care), but that's why documentation and good sign out is so important. I read the most recent progress notes from the team and have a good idea of what's going on, so I head up to the floor and see the family.

10:00: While on the floor I touch base with the nurses after seeing that patient and his family. I always find it's easier to be present early and available for whatever they need so that I can get most of it done at once instead of being paged multiple different times about it later. It also makes for better community and teamwork (in my opinion of course) to be proactive instead of reactive. Obviously we can't anticipate everything at the beginning of the night but it is nice to check in and take care of what we can early! I put in some orders for nausea medicine, pain medicine, bowel regimens, the usual.

10:30: Now is a good time to eat a snack - Belvita crackers and a cup of peanut butter with lots of water are one of my favorites.

10:40: Glad I decided to snack then, the resident just got paged about a new admission we have coming from the ED. It's a young woman not much older than me with type 1 diabetes coming in with DKA (diabetic ketoacidosis). For night float, the resident sees all the new admissions and writes the notes, but the intern (me) puts in all of the orders and admits them to the floor, and then takes care of anything else that needs to happen with them afterwards (while the resident goes off to see the next admission).

10:50: I get paged about a patient whose oxygen just dropped into the 80's and hasn't come up with 2L oxygen. I let the resident know to page me when he's done seeing our new, and I'll get the orders in asap, but for now I have to rush up to the floor. The patient has been sitting in the hallway most of the night so the nurses could monitor him since he keeps trying to get out of bed (he's a little delirious at baseline). I listen to his lungs and he definitely has crackles bilaterally, I don't remember them telling me that at sign out so I'm assuming it's new. I have the nurses increase his oxygen to 4L, which doesn't do much, so we switch from nasal cannula to face mask. His blood pressure has been on the higher side and with what sounds like fluid on his lungs I don't hesitate to give him some lasix. I also get an ABG (arterial blood gas) and order for a stat chest x-ray. But he still didn't look good and he was still in the 80's. I had the nurse page my resident, as well as the respiratory team. They gave him a nebulizer treatment that didn't help much and my resident arrived soon after. Our ABG had already returned and didn't look good. We called a rapid response on the patient and the ICU team came to the floor as well, and we ended up transferring him out. Once I make sure he's gotten over to ICU alright and I've got all of his orders in I write up an event note documenting all that occurred.

12:00: I get a page from the nurse that the new admit arrived to the floor so I go ahead and put in her orders.

12:30-4: I'll spare you all the details, but we can just say that throughout the night we got another 4 admissions that required order entry, pages about labs, etc. that keeps us busy until things finally started settling down around 4. I eat some oatmeal to settle down my stomach and then lay my head down at my workstation.

Me getting a quick "escape" to the bathroom on a particularly hectic night // Some of my nightly "task lists," basically tons of checkboxes! Writing has been blurred to protect my patients.

5:40: I'm awoken to the sound of my pager and am actually amazed that I got a break for that long and actually slept a bit. I call the number back - it's phlebotomy letting me know that a patient refused their AM labs. Since I'm up I scroll through my task list and make sure nothing got left unchecked. I begin updating sign out with all of the events of the night. I make a quick trip to the bathroom to splash my face and brush my teeth.

6:00: My pager goes off again. This time a patient's blood sugar was 400. The nurse covered it with the sliding scale insulin as per protocol, but they still have to "notify MD." I still sometimes think it's funny when I read the note later that says "MD notified, or MD made aware," knowing it was me. It still feels weird to be the MD.

6:30: I print out admission notes for all of the new patients we had overnight and follow up their labs while I eat some greek yogurt with blueberries and granola. And water. Lots and lots of water. (Which also means lots and lots of peeing that I've left out of this diary of my night, but I pee whenever I can lol)! Eventually I even check my email, but I usually only have time to read the emails, without responding, a horrible habit that I need to break out of!

6:50: The first of the five interns that are on today arrives. I sit down with him and update him on what his patients did overnight and about the new patient that's coming to his team. As the rest of the interns stroll in they come and sit at the table one at a time and get sign out from me.

7:45am: Finally done! I turn off my pager and get to my car, turn on the radio and head home.

8:00: Home sweet home. Liv is just waking up so I quickly change out of my scrubs and get into shorts and a tank. I eat breakfast with her (more like a night snack for me) and we later cuddle up on the couch, her still sleepy from just waking up and me still sleepy from never sleeping at all!

8:40: Grammie is up and has had her coffee and mommy officially calls it a night. I head into my room, set my alarm, put my earplugs in and eye mask on and pass out.

12:00: It's like clockwork - I always wake up around noon, so I hang out with Liv if she's still home and take out meat from the freezer for unthawing if I've already thought of what I want to make for dinner later. I retreat back to the bedroom for a couple more hours of sleep that is always a bit more fragmented than the first chunk I get in the morning.

5:00pm: My alarm clock goes off, time to get ready for another night!

Hope you guys enjoyed this post! I've since done night float at another hospital (the state/prison hospital I just worked at for the last month) and now in the ICU, where the schedules are all a little different (at the state hospital I had to be there for 6pm and left around 8am, in the ICU I come in for 9pm but stay until after morning attending rounds, which can sometimes not be until 10am or later). It all varies! But hopefully this gave you a little taste of what night float is like! 

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