A New Deal for the Patient at Night

Abstract

Nursing at night is one of the hardest, the least honored, the most neglected, and yet the most important, divisions of the service. In the last two decades many innovations, wise and considered, have been introduced into the nursing program by day. Earnest efforts have been made to provide adequate nursing by the substitution of graduate for student head nurses, by the introduction of more and better supervisors, by the addition of graduate nurses for bedside care, by the adoption of a program of shorter hours and by the use of a much needed supplementary group of ward workers. But in so far as the night is concerned, these improvements seem scarcely to have touched it. Supervision is highly inadequate, insufficient nursing time is provided for patients, in many institutions the medieval practice of keeping students on a 12 hour duty still prevails,' and while the use of a graduate group is becoming more common, there still exist many institutions where the bedside night staff consists entirely of student nurses. In my field observations during this past summer, night nursing was studied in seven different hospitals of varying type and size. Each of these seven night studies covered twelve consecutive hours of observation (from 7:00 P.M. to 7:00 A.M.) of one or more students, depending on the hour schedule in effect. Thus not a partial but a complete detailed picture was obtained from the time night work begins until it ends. The following table is a statistical summary of the results of the study. The services selected for the night analysis were acute medical and surgical on five women's wards and two men's wards. In six of the seven in-