Frustrated

[purplena19]

I'm in my first year as a nurse working nights on a telemetry/neuro floor. I learn so much everyday, but it gets so annoying and frustrating at times. I had a patient who had been extubated a little less than a week prior to when I had him. When I was doing my assessment on him I noticed he coughed when he sipped on water. So I did a bed side swallow eval on him. He ended up failing. When I put in in the computer the patient automatically becomes NPO and speech therapy is consulted. He had surgery on consult, so I called the surgery resident to let her know what happened and she said ok. So I gave my morning report to the on coming nurse and told her what happened and she agreed.

I came into work that night and the nurse told me that the surgeon was so mad that the patient was made NPO. He wanted to speak to the manager and said, "So now nurses can put in orders and have the ability to increase my patients' length of stay?" I was blown away...here I was thinking I had caught something. I understand that the patient had some irritation when being intubated and extubated, but I was only doing what I thought was right to prevent this patient from aspirating. To make matters worse the nurse told me the charge nurse suggested to the surgeon that I could have waited to see how the patient did during the day before charting my bedside swallow assessment. Anyhow the speech therapist did come to see the patient and recommended a dysphagia diet with thickened liquids. The patient ended up refusing...the nurse told me she was giving him his pills and he was swallowing fine, so I just felt really dumb

I just can't believe the surgeon said what he said and no one really backed me up. I felt that during my assessment at the time I did it this patient was having difficulty swallowing. It's just really discouraging when you work really hard and people say negative things. Anyways thanks for reading to me rant!

[itsnowornever, BSN, RN]

I would have done the same as you. If he can't pass a swallow eval, I'm not making him swallow during my shift! He's not aspirating on my license! You charted your assessment, and you CYA...and the speech therapist agreed with you! The surgeon was being a bully, and you said you even called the surgery consult and they said ok right? As long as you charted it, be ok with the fact that you did what was right by your patient. If he is your patient again, and still has the same issues, I'd do the same thing. If the patient refuses, chart it. Its your license. If you are being safe, then that's all you can do. I"m sorry they made you feel bad for doing something that IS right. I mean, that's a basic NCLEX question right there.