Assessing for Neonatal Withdrawal and the Nurse's Role

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    A nurse who works in the NICU and was called out to assess a patient. Upon assessment the infant was exhibiting many signs associated with withdrawal. Infant was greater than 24 hours old and less than 48 hours old. Infant was scored using the NAS score with a high result. Parents questioned the infant's symptoms. The nurse discussed at length various causes of why the infant was exhibiting these symptoms and asked the parents about any drug use during pregnancy whether prescribed, OTC, and or street drugs. The parents denied any drug use and seemed appropriate and asked appropriate questions. When the infant's Dr rounded and was notified of symptoms and scoring the Dr became upset because the family had no risk factors for drug abuse and felt the nurse should not have scored the patient. The dr removed the NAS form in the patient chart and told the nurse they were out of bounds by discussing possible drug abuse and withdrawal symptoms with the parents. The dr specifically stated the nurse had no relationship with the parents and no business talking with them. I can understand the Dr wanting to speak with the family first based on the scoring results but am I incorrect in that once you have introduced yourself to the patient or their guardian and received permission to assess the patient then you have established a nurse patient relationship and the above questions would be standard in assessing the family history and risk factors for the patient exhibiting withdrawal symptoms? What are your thoughts on this scenario? Was the nurse out of line?
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    We would have reported the symptoms to the doc and let them take it from there. Was the NICU nurse assigned to the patient? We don't go over to the nursery to look at babies where I work, that would be up to the NP or MD.


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