Nurses’ perceptions of in-hospital versus telephone availability of an intensivist at night in an intensive care unit

BACKGROUND: Evidence suggests that in-person management by nighttime intensivists does not change patients’ mortality rates in high-intensity intensive care units.

OBJECTIVE: To better understand domains affected by nighttime intensivist staffing not previously measured.

METHODS: Semistructured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists versus residents with attending intensivists on call remotely. Interviews were done during the final months of a randomized trial comparing the same staffing models. Qualitative analysis was done by using a grounded theory approach. Three investigators independently reviewed interview transcripts to identify key domains.

RESULTS: In addition to 5 themes probed during interviews (efficiency, communication, job place comfort, quality of patient care, and procedures), participants identified 3 other themes (supervision, systems issues, and experience). Most participants thought that nighttime intensivists improved clinical care, procedures, efficiency, communication, and job place comfort. Two thought that the quality of patient care, efficiency, or communication was the same with both arrangements. Three reported no effect on their job place comfort. Twelve mentioned improved supervision of trainees, and all thought systems issues improved.

CONCLUSIONS: Nurses perceive improvements with nighttime intensivists in several domains. Future work is needed to determine whether such perceptions translate into improved outcomes for staff or patients.