Nocturnists are hard to find in any industry, but the task of getting someone who wants to work on night shifts seems particularly more difficult in healthcare. Most doctors want to work only days – even moonlighters and fresh residency graduates.
But someone has to work the third shift. After all, patient care never stops and must be available at all hours. As a chief hospitalist, how do you attract nocturnists to your hospital and retain them?
The first thing you should do is think about giving night shift workers better incentives. It can come in the form of more pay and less work or lots of time off. Experiment with benefits until you figure out which one works best for the people working with you.
Try implementing a shorter schedule for nocturnists with the same full-time salary and benefits as daytime hospitalists. For example, a doctor can have a five-on and ten-off night schedule compared to the usual seven-on and seven-off day schedule.
Alternatively, you can offer shorter shifts. The schedule can remain seven-on and seven-off but make shifts shorter. Work can start at 10 PM and end at 7 AM. For someone with a family, this is a favorable arrangement. It gives them enough time to spend with their family every day, especially during the early evening hours when everyone is home.
Another option is to give hospitalists flexibility to choose the number of nights they work in a row. Do not force them to work long stretches, but give them the flexibility to choose a schedule that works best for them. There will be some who will choose to work only three blocks while others will go all the way to seven. The most important thing is giving them the power to decide for themselves. By doing so, you improve the chances that someone will volunteer to doing the third shift. This, in turn, lessens the need for you to force a schedule on an individual or rotate daytime doctors.
Also, it helps to provide enough support to nocturnists. Isolation is often a problem for night workers. Convince some residents to work the night, too, and give hospitalists the added opportunity to learn while doing their admissions and performing the usual duties.
Ensuring Quality of Care
Getting regular nocturnists gives rise to the question: what about measuring performance? It is difficult to gauge the performance of nocturnists because the number of patients they see is variable. So how do you manage productivity tied to compensation bonuses?
First, establish daily tasks for every hospitalist. It can be as simple as doing the night rounds every evening with the charge nurse. Then, track certain metrics. For example, you can track time from team assignment to admission order or track the charge lag, which is the number of days between seeing a patient and charging the bill. Other metrics include teamwork, participating in work groups, leading quality improvement projects, and administering schedule for nights. Of course, these are on top of the usual performance metrics that apply to all doctors regardless of the time they work. The usual metrics include patient satisfaction, referring physician satisfaction, compliance with bridge orders, and so on.
Select the Right Candidate
Ultimately, everything becomes easier when you find the right person for the job. In other words, find a dedicated nocturnist, not just someone who wants to survive the night. A person who voluntarily chooses to work in the third shift is likely to stay on the job compared to someone who feels forced by the schedule.
Be on the lookout for individuals who have been accustomed to working nights in a previous hospital job or a person who engages in important daytime activities. There are people who do well at night naturally. You just have to find them.