Appeasing nurses vs patient care
I’m training at a highly rated academic center. I had an issue this week where the nurses and the respiratory therapist decided it was appropriate to extubate a patient at midnight and were hell bent on doing so. I was called to the bedside to evaluate the patient and he had no purposeful movements. He was unable to follow commands or lift his head off the bed. His wife was in the room for all of this and he did not even open his eyes with her calling his name. The nurses and RT were still adamant that he should be extubated. I explained to them that his mental status was not appropriate for completing this. They proceeded to tell me that mental status was not a part of criteria to extubate. I informed them that this was inappropriate and we would not be extubating him. Even if we wanted to do a pull and pray, this patient is 80 with a pulmonary embolism. They wrote me up because they felt that I was delaying patient care. After our encounter, they proceeded to stand outside of the Resident room and shit talk to me for almost an hour. They turned it into a personal thing and that I was just disagreeing with them because they were not doctors. the next day three different attendings evaluated the patient and ultimately agreed that he was not appropriate for extubation. I made the decision based off of the patient not on anything else. I don’t like working in an environment where the nurses/RTs act like they’re the only ones trying to do what’s best for the patient. I now feel uncomfortable saying anything because it’s going to turn into another dispute. i’ve been on shift a couple days since the encounter and it already feels hostile at every turn. I consider myself a reasonable human and I always encourage my team to question my decisions because if I can’t explain why I am doing something we probably should not do it, but this feels like more than that.