Arizona Nurse Has License Threatened By Doctor After Providing Patient Education

Already know Amanda Trujillo’s story, and want to quickly find out how to help? Go here for support, donation, and media details.

arizonanurseThere are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win.

The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on  Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing  on January 24th, 2012.

Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.

Success in healthcare is not defined by how many treatments and tests you can perform on a patient. Success is defined by the ability to help a patient make informed decisions on their path in health an life. If that path includes surgery, then so be it. If that path does not, and we have informed the patient of all the options and they are capable of making an informed and rational decision, then we have been successful.

I’m really disgusted that a healthcare organization would bow to the tantrum of one very arrogant and immature physician. If there was one example of a surgeon with a God-Complex, this is one.

I encourage you to read the email and case below and to reach out to Amanda Trujillo ( @NurseInterupted on twitter) to show her your support. We need patient advocates like her to take care of us. Do you want your loved ones to have the right of choice in their healthcare stripped away from them by a detached physician?

You can also email the Arizona State Board of Nursing and let them know you are following Ms. Trujillo’s case: arizona@azbn.gov

 

The Email and Arizona State Board of Nursing Case

This is a (must read) e-mail that was passed to me from Echo Heron.  @EchoHeronAuthor


Hello Ms. Heron,

My name is Amanda Trujillo. I’m a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. Back in April of this year I was caring for a dying patient whom I had discovered had no clue about what they were about to participate in when they agreed to get a major invasive surgery. When I properly educated the patient using the allowed materials by my employer they became upset that the physician never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). The patient also had no idea that they had a choice about whether they had to get the surgery or not or that there were other options. They asked about hospice and comfort care and I educated the patient within my nursing license and the nursing code of ethics. The patient requested a case management consult to visit with hospice to explore this option further in order to make a better decision for their course of care. I documented extensively for the doctor to read the next day and I also passed the info on to the next nurse taking over, emphasizing the importance of speaking with the doctor about the gross misunderstanding they had about the surgery. The doctor became enraged, threw a well witnessed tantrum in the nursing station, refused to let the patient visit with hospice, and insisted I be fired and my license taken. He was successful on all counts.

     Instead of initiating the hospital policy of consulting with an ethics committee to sort out the situation the hospital fired me instead. The doctor was angry that the patient had changed their mind about the surgery and my nurse manager was angry that I “messed up all the doctors’ hard work and planning for the surgery.” Since then, my career has been destroyed, no one will hire me because of the complaint on my license. Despite almost three nursing degrees after my name, my education and experience–at this time–is considered “null and void.” I’m a single Hispanic mother who fought hard to get off of welfare and to make it through school into a career I love. I never dreamed a complete stranger could strip our lives away, and under such a circumstance in which I was doing my job and protecting the patient’s rights to full disclosure about the surgery and their right to choose their course of care. Today, we are back on welfare, we can barely keep food in the house, have almost lost our house 4 times, and I cant get health insurance for my daughter who has severe asthma. This situation can happen to any nurse and any patient–and it is happening with more frequency throughout the United States. Nurses are afraid to speak up when they see unsafe or unethical practice taking place with their patients’ lives. The nurses at the hospital I worked at have told me they don’t teach their patients anything anymore and they don’t report things that concern them for fear of losing their jobs and their lives like I did. There have been similar cases in recent years–most notably in Texas and in Maryland. It boils down to this–without nurses speaking up in dangerous or unethical situations there will be more accidents, more medical mistakes, and more lives lost. Nurses everywhere turn the other direction now because of the threat of retaliation. I’m a strong advocate for patients and families who are at the end of life. The sunset of life is an extremely important developmental milestone in the life of a person and their loved ones. Its a time that should be spent the way the patient and family want it to be spent—and where they want it to be spent. More and more, as I have advanced into nursing, I have seen people lying in hospital beds for weeks on end, suffering debilitating pain, air hunger, bed sores, muscle wasting, and their dignity is not respected–as their family members stood by horrified. No family should have to remember their loved one’s last days and weeks as images of torture. Nine times out of ten my patients were not even aware that they had the option to go home if they wished–they were just told they “had to keep trying something else.” We as healthcare providers do not have the right to omit that information or option from people and their families, we don’t have the right to refuse a patient the right to visit with hospice to ask questions and learn more, and we certainly don’t have the right to deprive a person of the ability to complete very important developmental tasks at the end of life that involve family. The statistics out there about how many people die in hospitals each year are staggering–and they are dying badly. At this time only 18 states have laws in place to protect patients and nurses. I have been working tirelessly with Senator Nancy Barto here in Arizona to get legislation passed to:

1) Ensure that the rights and choices of patients at the end of life or the end stages of disease are respected and fulfilled without question.

2.) Protect nurses from retaliation for reporting unsafe or unethical practice that could jeopardize the life and safety of patients and their families

3) Specifically define the role of the nurse in end of life teaching/counseling so that ALL physicians understand and honor that part of our job (its our duty and its legal–but every physician has a different opinion and were subject to that when we shouldnt be)

     My goal is to get to Capitol Hill. I was making good progress with the Senator until recently when all communication stopped without explanation. I have learned through sources that “politics got involved” and put a stop to my efforts.  I was also advised by a rep from the Arizona Nurses Association that they would not support any nurse reported to the board no matter what the cause because it would “damage their image and reputation”. Our profession is well known for not supporting one another. Nurses who once called me their mentor and friend wont have anything to do with me because it will jeopardize their jobs and reputations. So in essence, this fight has been one that I’ve continued on my own. Now that I have learned that “politics” squashed my efforts at protecting people and nurses I am turning to the public to help me get over that wall. I would appreciate any of you out there writing to Arizona’s legislators: Steve Pierce (President Elect of the Senate); Senator Nancy Barto, Representative Cecil Ash, Governor Jan Brewer, Senator John McCain, or Congressman Trent Franks. I will list their emails at the end of my letter. In the meantime, I need your help and support to get this message out there to the public. Pass my story on to your friends and family on Facebook (Im on there campaigning)–tell them to ask more questions, to speak up when they have concerns, to ask if there are other options. This is real, this is happening, and as the healthcare crisis continues to spin out of control and nurses are pressured “to do more with less”—even less attention will be paid to important safety and ethical issues that can endanger lives and basic human rights. I have written to every media outlet in my state but no one will take my story, I’ve written to 20/20, Dateline, Oprah, Dr. Oz, The Joint Commission, The American Nurses Association, The White House, President Obama,  and the Center for Medicare and Medicaid Services.

I have attached the legal brief for your review so you have a better understanding of what happened–understandably some information has been blacked out to preserve privacy.

The nurse investigator on my case reviewed everything I did and said that she had never seen documentation and care so thorough and “above and beyond the call of duty.” Despite her recommendation to dismiss my allegations, the letters of praise from Mayo Clinic Physicians I worked with at one time,  nurse coworkers, and patients,   the allegations were not dismissed as I had expected them to be. This means I have to wait until January 24th-25th 2012 and go before the board to “explain myself.”

I can accept that my short career as a nurse is over—what I cant accept is that the end of my career will mean nothing. If this is the end of my hard work and education I want it to stand for something, I want it to be for good. I want to know that at least no other nurse, their families, or patients and their families will ever have to experience this kind of horror. I took an oath to “First do no harm.” if I walk away without a good fight, then I’ve become part of the problem and I don’t deserve the RN after my name.

Im growing tired of fighting alone so I have reached out to you……….I have to stay the course because its the right thing to do and because I HAVE TO SET THE EXAMPLE  for my daughter Anaya to stand up for whats right no matter how difficult the journey….Please, tell my story to your friends, loved ones–and tell them to tell others. There is strength and change in numbers……..

Thank you for your time in reading this long email…..as you can imagine, its been a long year.

Respectfully

Amanda Lucia Trujillo MSN, RN, DNSc-NP(s)

Glendale, Arizona

623-249-3138

Please e-mail the Arizona State Board of Nursing and let them know you are following this case arizona@azbn.gov

397104_863320851208_27701254_38985022_333348091_n

Amanda Trujillo on twitter –  @NurseInterupted

(Amanda’s case will go to the State Board on Jan. 24th)

028146

ROBERT CHELLE LAW, PLC

2256 N. 15th Ave.

Phoenix, AZ 85007

(480) 442-3410

(602) 257-0774 fax

robert.chelle@azhealthlaw.com

Attorney for Amanda Trujillo

BEFORE THE Arizona STATE BOARD OF NURSING

In the Matter of Registered Nurse License No. RN137552 issued to:

Amanda Trujillo,

                                 Respondent. )

RN/LPN INVESTIGATIVE QUESTIONNAIRE

DESCRIPTION OF EVENTS

(Nurse Practice Consultant, Ann Schettler)     

Respondent Amanda Trujillo, by and through undersigned counsel, submits this Description of Events in response to a complaint filed against her in June of 2011 with the Arizona State Board of Nursing (“Board”) by Banner Del E. Webb Medical Center (“Webb”).

Description of Relevant Events

The allegations contained in the complaint arise from events that occurred when Ms. Trujillo was caring for a patient with end stage liver disease .  Ms. Trujillo had been a registered nurse with Webb for approximately six months prior to the date of the alleged conduct and she normally worked the night shift from 7 a.m. to 7 p.m. 

After assessing and communicating with the patient, Ms. Trujillo’s evaluation led her to believe that the patient did not fully understand what she had consented to when (pt) agreed to go forward with an intensive transplant evaluation scheduled to begin at Banner Good Samaritan Medical Center the following day. Based on her nursing assessment,  Ms. Trujillo gathered patient education materials and spoke with the patient regarding the transplant evaluation, the waiting period and the commitment needed in following a lifelong self-care regimen.  After their discussion, the patient expressed a desire to learn more about hospice care because (pt) was uncertain she was willing to take the necessary steps to maintain a successful organ transplant.  Thus, the patient inquired into whether (pt) could speak with a hospice representative.  Ms. Trujillo then placed an “order” for a case management consult with a hospice representative.  Ms. Trujillo did not believe that requesting a case management consult was a medical order requiring physician permission; she believed the consultation was for educational purposes in order to give the patient a broad understanding of her options. 

As a result of the additional information given by Ms. Trujillo, the patient determined (pt) did not want to go through with the liver transplant evaluation or resulting transplant procedure.  When the doctor treating the patient found out about the patient’s wishes to forgo the evaluation he was unhappy that the patient had changed (pts) mind and determined that the education given by Ms. Trujillo was the underlying cause of the patient’s change of heart.  He accused her of going beyond her scope of practice by entering a physician order without permission  (“ordering” the case management consultation).  As a result of the accusation, Ms. Trujillo was placed on administrative leave by her nursing director, Venus Gaines, and was eventually terminated by Webb.   

Ms. Trujillo believes she was well within her scope of practice to assess the patient’s understanding of (pts) plan of care.  She was not acting outside her scope of practice by educating the patient (deferring all questions outside of her scope to the medical team), once she determined the patient had a gross misunderstanding of what (pt) had agreed to participate in.  Ms. Trujillo believed that the case management  “order” she placed on the patient’s behalf was not a medical order that needed physician permission.  Each step of the treatment provided by Ms. Trujillo to the patient will be analyzed below.   

Patient Assessment     

It is standard practice for Ms. Trujillo to ensure her patients understand their medications, plan of care and treatments.  While fully reviewing the patient’s medical record Ms. Trujillo read a progress note entered by the patient’s primary care physician from earlier in the day that noted a “transplant evaluation is the only viable option outside of Hospice.”  Utilizing the standard nursing process of patient assessment (assessment, diagnosis, planning, intervention, evaluation), Ms. Trujillo asked the patient a number of open-ended questions regarding (pts) hospital stay, medications, liver disease, procedures, etc.  Ms. Trujillo asked the patient if (pt) had received any information or teaching regarding the proposed transplant evaluation.  The patient, to Ms. Trujillo’s surprise, responded that (pt) did not understand (pts) disease, plan of care or what a transplant evaluation entailed. The patient asked Ms. Trujillo if she could provide some information regarding the disease and any less invasive choices that would allow (pt) to go home and be with (pts) family. Based on this request Ms. Trujillo determined the patient had a knowledge deficit regarding (pts) disease and the choice to receive palliative care.       

Patient Education

Having assessed the knowledge deficit related to the patient’s routine medications,  disease process, associated tests and procedures, the plan of care for transplant evaluation and palliative care options, Ms. Trujillo proceeded to print out patient educational material from Banner’s website that addressed those areas.  Additionally, she printed out education materials from Banner’s transplant website pertaining to what to expect during a transplant evaluation and what to expect after a transplant.  Ms. Trujillo also provided materials related to hospice care per the patient’s request.  Ms. Trujillo, concerned about the patient’s lack of understanding of (pts) treatment regimen and the option for comfort care, discussed her education of the patient with her clinical manager, Frances Fausto, who readily supported Ms. Trujillo’s plan of care and interventions. 

Ms. Trujillo and the patient reviewed the materials over the course of the night.  After a full review of the materials the patient stated, “Had I known everything I would have to go through and the commitment I would have to make, I would not have agreed to the transplant evaluation.”  The patient inquired into whether there was anything else (pt) could do besides enduring more tests, procedures or surgeries.  Ms. Trujillo then explained hospice care services and the differences between symptom relief care and end of life care.  The patient expressed serious concern that (pt) would not be able to commit to an extensive aftercare regimen following the transplant by stating “at this stage in (pts) life (pt) just wanted to be around family.”  The patient requested to visit with a representative from hospice in order to ask some questions and gain additional information that would assist (pt) in making a more informed decision regarding (pts) course of care.

Ms. Trujillo placed a note in the chart pertaining to the assessment of knowledge deficit, the specific education provided and the palliative care discussion, in addition to, the patient’s request to see a case manager from hospice.  She used the SBAR (Situation, Background, Assessment and Recommendation) format of report required in Banner policy when she handed off care of the patient to the dayshift nurse, alerting the nurse that the patient requested more information prior to being transferred to another facility for a transplant evaluation.  She also alerted the dayshift nurse that there was a nursing note in the record for the doctor to read that detailed what occurred over the course of Ms. Trujillo’s shift with the patient.

Case Management Consult

As a relatively new nurse to Banner, Ms. Trujillo self-educated in order to work within Banner’s policies and procedures.  She found no specific policy or procedure regarding end of life care that prohibited her from obtaining case management consultations for her patients. She also could not find any policy or procedure that gave a formal definition of a “physician order” or what nurses could order and what they could not. In fact, Ms. Trujillo had ordered hospice consultations for her patients on numerous occasions prior to this incident without any objections from other physicians or Webb administration.  She entered the “order” with a note stating, “per patient request, patient wants to visit with hospice representative for more information.”  In fact, the computer system in place at Webb allows her to click a box that further specifies “Nurse Ordered,” which she did on this occasion.

The only reason Ms. Trujillo’s actions turned into allegations of unprofessional conduct is because the primary care physician on this case, The Dr. initiated an angry public display when he found out that the patient had changed (pts) mind regarding the transplant.  Ms. Trujillo was surprised when the nursing director, Venus Gaines, went so far as to tell Ms. Trujillo that the physician was angered because she had, “messed up all of the work they had done, and that the doctors were nowhere near going down the hospice route.” 

Conclusion

This was not a medical order.  This was a nurse trying to help a patient become better informed about a life changing procedure and (pts) right to choose what direction (pts) care would go.  Ms. Trujillo’s actions were well within her scope of practice and she conscientiously kept her line of teaching within the boundaries of her scope of practice by taking care to utilize the proper channels to obtain patient teaching materials and advising the patient to ask the doctors about more complex questions she was unable to answer as a registered nurse. 

The patient had the absolute right to self-determination regarding her course of treatment, as illuminated in Senate Bill S. 1052, the Bipartisan Patient Protection Act, after receiving additional information regarding her disease.  Ms. Trujillo, working within her scope of practice and the nurse’s code of ethics, honored and protected that right when she abided by the patient’s requests to the best of her ability. 

Accommodating a patient’s request for a consultation with a hospice case manager does not require a physician’s order.  No medication was requested, no equipment was needed, and no procedures were required.  A patient simply wanted to speak with an expert regarding her options for comfort care and end of life care, so that (pt) could make the best decision about (pts) future. 

It is standard knowledge that the Cerner electronic health records system in place at Webb contains a box that states, “Nurse Ordered.”  Why would this box exist if nurses were never allowed to “order” anything?  The Complainant contends that Ms. Trujillo overstepped her scope of practice by ordering the consult; however, it is standard practice of the hospital to allow nurses the freedom to do the exact thing alleged in the Complaint. 

Ms. Trujillo was allowed to order case management consults on numerous occasions prior to this and was never told by the hospital that this practice was not allowed or outside the scope of her practice.  It is apparent that the hospital is simply trying to appease and placate an angry physician by filing this Complaint against Ms. Trujillo. 

She looks forward to discussing this matter with the Board, if necessary, and hopes to conclude this matter expediently.                

SUBMITTED: July 11, 2011

ROBERT CHELLE LAW

    By: ______________________

Robert Chelle

Attorney for Amanda Trujillo

 

Updates On  Her Case:

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Comments

  1. Dawn Lawson, RN CCRN says

    What a travesty! The hospital and Board of nursing in Arizona should be ashamed of themselves!! If they take away this good, caring nurses license to practice then none of us are safe! We have all been there with a patient who is completely uninformed about their care and upcoming tests and surgeries. Amanda was simply doing her job and should not be penalized because the patient decided not to go thru surgery. Isn’t this still the US?? Do patients constantly have to be forced to live with surgeries and procedures they do not want simply because the doctors say so? When did medicine become all about a power trip and stroking MD’s egos? What ever happened to INFORMED CONSENT? Because it sounds to me like the patient in this case was never fully INFORMED of the risks/benefits, aftercare, and alternative options as required by the law. If she loses licensure over this, then I think nursing as we know it is over for the United states. In my 18 year career in healthcare, I have witnessed the slippery slope that just keeps on sliding and it really makes me think, any of us could be the Next Amanda Trujillo, Fighting to keep our licenses just for doing a good job and caring about our patients.

  2. says

    I read this with both sadness and outrage. I wrote the same things in my book more than 25 years ago. My license was threatened more than once, I was intimidated etc. That’s why I keep asking as we move into advanced practice, who’s going to be watching our back? The ANA isn’t the AMA and if we are all supposed to grow, so should our organization. I will post this on all my pages and my blogs. And I will write to Amanda and to the Nursing association. We should all hang together or we have no power at all. Let’s not let the business of healthcare and the medical machine make us scapegoats when by our code of ethics we have sworn to be patient advocates. And let’s all tell our stories. How many of us can they fire if we stick together?
    Carol Gino-hopefulhealer.com and revolutionary nurse.com

  3. Sandy Arens MSN RN says

    1. Shame on that doctor! He is the one not practicing within the scope of his license and is denying a patient their right to informed consent! He railroaded this patient by not fully disclosing all the patient’s options. He also took an oath to “First do no harm.” More patients lose faith in doctors everyday for this very reason. How many other patients has he withheld information from and made them feel forced into what he thinks?
    2. Shame on the medical facility for turning their back on a clearly professional nurse who was doing exactly what her job is and within the scope of her practice! This doctor and his temeper tantrum along with his total disregard and disrespect for the patient’s rights and informed consent should concern them…not the nuse who acted responsibly. This leads me to believe that this doctor, or his family, must have some monetary stake in this facility that the facility is in fear of losing! Or, this facility facilitates, and feeds into, the “God Complex” among their doctors and is totally not a patient centered care facility. In either case, I would not utilize this facility, nor would I recommend it to anyone, because this is not a good standard of care, nor is it good practice. They should be investigating this doctor, not the nurse!
    3. Shame on the other nurses for not sticking up fo this nurse! If everyone sticks together, that is power! This facility cannot run without nurses! Plus the negative media would maybe snap them into the proper focus…THE PATIENT! Nurses need to join together and work together. Individuality is great, but not when the profession as a whole is still struggling for our true merit to be recognized. We are not nursemaids and gophers for the doctors’ use! We are invaluable team members. If all the doctors would realize this and treat us as such, the quality of health care would greatly improve.
    4. Shame on the politicians! They should stand for what is right! Yes, I know I am dreaming here, but right should prevail. If we all stick together and let others know who does not stick up for what is clearly right, maybe that will change who get’s voted for. A politician who actualy stuck up for what is right would be a total novel idea! The precedence that would set for public trust would be tremendous. Instead they turn tail and cower because those with the big bucks may frown on them and not vote for them….money over what’s right! WRONG!

    I truly hope that the Arizona State Board of Nursing does the right thing and dismisses these accusations against this nurse and clears her completely. Then I hope that this doctor is investigated for his actions, or lack of, and has to answer to the Medical Board! I would never work for a doctor such as this nor would I work for a facility that supports this type of disgusting patient care and lack of education by its physicians…AND lack of support for its nurses when they are clearly in the right.

    I applaud Ms. Trujillo for upholding what nursing is all about and representing what our profession stands for. What a wonderful example of patient advocacy and education. She truly practices patient centered care, which is what health care is supposed to be all about. I support Ms. Trujillo 100%! I am proud to bein this profession with her!

    • ConcernedRN says

      I have recently received this link about Ms. Trujillo and her actions…and although I suppor her actions, having been a RN for 25 years, there seems to be more to this story than what is coming up in the information being shared. I feel for this person who appears to have advocated for a patient, but the question is what is being left out? Having been a case manager since 1998 – in all relms of case management I know that her referring a patient to case mangement to discuss hospice would have ticked off a doctor — but why was the Ethics committee not brought in? Or were they and we just don’t have that information? Also, in her letter stating her case, what else was left out? I only say this because I have see how HARD itis to actually get a RN fired…even with cause, so if this young lady lost her job was there something more going on here? Also, this is one side to a story…sorry to say but I am jaded longer than I am a nurse. There are two sides, and although a doctor may have ranted what else occurred here?

      Working in case management, trust me, her referral to have this discussion would not have brought a hospice in just because she said so…the case management team would have met with the patient, family, nursing staff, and physicians and if the family wanted a ‘consult’ then they would have had that…a consult is nothing more than someone coming in and iterviewing…maybe this patient didn’t know everything and was taught…but in the land of hositals transplants are not immediate and patients need to be evaluted…and having actively worked in 5 states in all areas of the country the tranplant evaluations are outpatient…not immediate transfers to another hospital…..again, I support this country but not the fear about the discussion of end of life…I work hard to advocate for my patients to ensure they have all options and if there is one that I may not agree — if it is the patient or family wishes then guess what…I will support it even if I don’t always agree….but back to this case…what is missing here? Are we jumping on a “band wagon” without all the facts….if I am wrong I will say so…but again…facts?

      • Mary Margaret McReedy says

        Just so you know, transplant evaluations for decompensated liver failure in fact DO occur in the inpatient setting, sometimes even in the ICU setting. This happens often. All too often, the option of no transplant is rarely broached because most times these patients are encephalopathic.

        Having been the object of a physician’s frustration, this makes you a target. Finding something like “ordering” a case management consult and call it practicing medicine without a physician’s order was just the thing to get her fired. It’s clear that the physician in this case didn’t want to look stupid to a bigger, more powerful group of physicians.

        • says

          Mary,

          I think you are spot on. The Doc pitched a fit and the powers that be found something that they could list a terminable offense. It’s really quite ridiculous. Joint Commission needs to investigate how Banner let’s their Doctors behave.

          Thank you for the comment.

  4. says

    Good luck to her. She needs to stand up for what is right. She is not alone there, never ever to think on it. I truly trust that she will be ok, are smart nurses who know where to look for HER TRUTH.

  5. Mary Ann Aslakson says

    You go girl! This a MD with a “God” complex. This physician’s record should be examined for inproper actions, no the RN. Recommend a review of the physician’s records for clinical documentation and medicare billing practices.

  6. says

    Wow! I am so saddened by this. I have always prided my nursing career on being #1 a patient advocate. If we can not, in good faith, be allowed to educate patients, what is to become of our practice? When I first started working in the operating room, I was stunned every day by patients that had no idea why they were even having surgery, and what it would take for them to recover. After I accepted a postion in an orthopedic surgery center, I always made sure the patient knew why they were having sugery, what the recovery period would be, etc. After I left to go back to surgery, I noticed that teaching and educating the patient took up to much time, and increased turnover time, and was “advised” that I should be quicker. I always make sure the patient is informed, taking to time to answer questions and making sure I am their advocate. The bottom line is, nursing are the ones that educate, inform, listen to concerns of the patient. Surgeons and hospitals are more concerned with the bottom line…the almight dollar. Hosptials support the doctors because they bring in the money, but what the majority of hosptials rarely do, is stand by there nurses, and make sure they are happy. I really hope and pray this excuse for a doctor is called on the carpet, and shame on that hospital for firing a nurse for doing her job!! above and beyond!! Also, shame on those coworkers of hers for there shallow behavior. I hope that Ms Trujillo gets her license reinstated. This is one of many reasons the majorty of nurses do not advocate to the younger generation to become nurses. So very sad.

  7. says

    Here’s a copy of my email to AZ BON, (thanks for spreading the word Brittney!).
    Dear AZ BON,

    Although I cannot pretend to know all details from online news and nurse colleague’s sharing, it seems to me that Nurse Trujillio was doing everything within her power and scope to help this patient make an informed decision. THIS IS nursing at it’s best.

    A collaborative physician-nurse relationship could have been so helpful here. This doc owes this nurse an apology and thank-you for helping THEIR patient make HER decision.

    Does anyone wonder why TJC efforts like “Speak Up” become ineffective in an environment where a physician can behave this way and an organization so quick to side with him? A respectful dialogue between the doc and nurse would have been a great learning opportunity.

    Beth Boynton, RN, MS
    Author, “Confident Voices: The Nurses’ Guide to Improving Communicaton & Creating Positive Workplaces”.

  8. Meg says

    I am wondering if we need to set up a trust fund for her legal defense like we did for the Texas nurses who got fired for turning in a physician?

    Meg Helgert FNP
    Portland OR

  9. says

    There should be more nurses like this out there! Rulings like this undermind everything we are taught in nursing school and prove that no one is looking out for the pts. This will only result in decreased quality of care. I had a similar situation in which I did not witness a consent for surgery related to the pt.s cognitive status and history of negative outcomes after a similar surgery. The physician, as the one above, also “threw a fit” at the nurse’s station. Luckly for me the Nurse Manger did stand up for me and there were no negative concequences. I am from a different state but we should voice our outrage at this.

  10. Meg says

    here’s what can be done by nurses across the country………….

    TNA Legal Defense Fund Disbursement

    November 17, 2009

    An initial disbursement of $20,000 has been made by the TNA Legal Defense Fund toward the defense expenses incurred by registered nurses Vicki Galle and Anne Mitchell in the criminal case pending against them in Winkler County. The nurses were criminally indicted for reporting a physician to the Texas Medical Board over concerns that his practice was below acceptable standards of care.

    Texas Nurses Association established the TNA Legal Defense Fund as a way to support the legal rights of practicing nurses in advocating for their patients. The $20,000 disbursement is twice as much as TNA’s original goal of dedicating the first $10,000 in donations to assist the nurses in Winkler County with TNA matching every $1 of the first $5,000 collected.

    “Patient advocacy is at the heart of nursing practice,” said Cindy Zolnierek, MSN, RN, director of practice for TNA. “It’s absurd that the nurses in Winkler County would be criminally indicted for advocating for safe patient care. I hope Vicki and Anne continue to be encouraged by the level of support and generous donations of nurses across the country who are helping defend a nurse’s right to speak out for patients,” she said.

    Upon being notified of the distribution, RN Mitchell responded:

    “Thank you so much for all the help with our case. It’s hard to believe that we are in this situation, but hopefully it will change things for the better in nursing and health care. I am amazed and thankful for all the support from all the organizations and individuals. There are silver linings in everything, I suppose.”

    To date, 23 organizations and 438 individuals from 36 states have contributed to the TNA Legal Defense Fund. With the criminal trial date set for February 8, 2010, donations continue to be accepted. Please contribute to the TNA Legal Defense Fund at the link above.

  11. Deb Ward says

    This is why women are choosing other professions! Maybe someone needs to forward this to NBC? FOX would love this one! No, wait, just go from CNN….

  12. Laura Keels RN, C-FNP says

    I heard about this through a colleague of mine on Facebook and I was appalled. I find patients all the time that are misinformed and have not sure about their options and don’t know what their options are. I have had to cancel surgeries when I do pre-operation physicals. I have been talked down to by grumpy doctors mainly when I was a nurse. Fortunately, my colleagues backed me up and urged me to report the doctor. The head doctor of the department was also supportive and the patient involved refused to go back to the doctor. This was prior to becoming a nurse practitioner which is why in many ways that I pursued my NP. I also have worked for a very controlling MD who was very condescending to me so yes, it is a reality for a lot of us but this is old school. This could cost lives as patients often think the doctor has the last word and they do not question the doctor and often the doctor does not assume the responsibility of informed consent.

    It is my opinion that the doctor should be on trial as he did not do his job of gving detailed informed consent. If he had done his job, the patient would have gone into this with more certainty. The nurse was simply doing her job…and sometimes that means challenging the physician. Think about some cases: maybe a medication error, wrong sponge count, drug allergy, Are we just to stay silent and let things happen when we can make a difference or speak up when something is wrong. If we do not speak up…this will keep happening? The system did not support this nurse.

  13. Meg says

    I have actually emailed the Arizona Nurses Association Executive Director: Robin Schaeffer, MSN, RN, CDE, Executive Director: robin@aznurse.org and sent her the statement from the Texas Nurses Association account (2009-2010) of the two nurses from Winkler Texas and their plight. Over 400 people and numerous organizations(from across the country) sent money for the nurses legal fund and the Texas Nurses Association matched funds..so this can be done. I think (regardless) of the outcome this nurse needs the best counsel and resources to get through this.

    Meg Helgert FNP
    Portland Oregon

  14. amanda trujillo says

    The Arizona Nurses Association wants nothing to do with me and I dont want anything to do with them. I dont trust them at this point because its been almost a year without any assistance. The President is the Director of Clinical Nursing Practice at the hospital that fired me.

    Amanda

    • Diane says

      Amanda I feel for you. I have practiced for 35 years and have never heard of such a travesty. Try and contact change.org, they might be interested. You can start a petition on their site that can be sent to the Arizona State Board of Nursing. Also.have you tried your local /state representatives,including the Governor? I wish you luck,do not give up,fight for what you worked so hard for. God Bless.

  15. CSW says

    My sense is that the psychiatric evaluation stems from Ms. Trujillo’s assertion that people should have the right to die with dignity and comfort, without unnecessary and expensive medical procedures. This goes against the medical model which emphasizes extreme measures to preserve a beating heart regardless of quality of life. It also goes against the prevailing thinking in this very conservative state with a “right-to-life” agenda.

    One other thought…Nurses should have the right to sue for medical malpractice if wrongdoing on a doctor’s behalf causes the nurse to lose his/her livelihood. I’d love to see somebody try to establish precedent for this kind of lawsuit. If I’m stripped of my license due to the fault of somebody else and I was acting in good faith and within my scope of practice, I should be able to file suit for damages equal to my future earnings as an RN and my student loans. The board of nursing should not get to have the final say in what should really be a civil matter when it comes to loss of livelihood. Perhaps a case could be made for tortious interference?

    • Jackie says

      CSW, I agree that precedence needs to be set. It is sad to say that this type of discrimination goes on all the time, yet no one does anything about it.
      We live in a world that boasts of equality, yet a single doctor can determine the fate of another person.
      I also agree with you about some states stance on right to life with out regard to quality of life. I have had to fight for family members of mine when doctors have tried to do procedures that were not necessary, but money was actually the main goal by the doctor.
      Most people need to remember that if your physician will not take time to talk with you, rather than at you, it’s time to look for another doctor.
      The doctor is the one who should have been investigated. I would understand if both had been looked at to make sure everything had been followed properly. I also understand the ethical and legal aspects required, but to fire someone because they wanted to make sure a patient was well informed, and made you look bad, is just ethically wrong.

  16. Ofordu faith ugochi says

    You did the write job and as a colleague i’m so proud of u. Your licence will be restored for God is not dead

  17. amanda trujillo says

    I keep remembering stories from the bible about the angels circling around people who needed to be delivered from mortal and spiritual danger….or the story about the disciples in the boat with Jesus. There was a horrible storm that was rocking the boat violently and Jesus was below the deck sleeping peacefully. They all cried out for him and he got up, annoyed, and raised his hands toward the sky and at once the storm ceased and everyone was fine and safe—-he said to the disciples “Do you not have any faith?” This is what is keeping me going. That God delivers those who seek to do what is right and what is good, from danger…..I have to believe that.

  18. says

    This is a downright shame. And seems to be happening across the Globe, nurses are usually considered inferior to doctors and as such have endored much punishment and discrimination by a profession; professional organization that professes “Care, Patient Safety, Advocacy, Professional Obligation.” When will nurses unite World-wide against this “Bully Tactics,” frequently used to derailed our rights for protecting patient rights?

    This nurse was practicing well within her scope; and MUST be re-enstated for her good job. Maybe the “Arizona Nurses Association,” should revisit their policies to facilitate the work of GARBAGE to which it seems to stand for. ……….

    • says

      Amanda, how can we help?

      There is such an irony in the fact that year after year nurses are the people who patients trust the most. And imagine, being in a hospital room in the middle of the night facing a crisis you don’t understand. The nurse is with you and has information that will help you. I would have done the same thing.

      At the very least the hospital could have facilitated a respectful dialogue between the nurse and doctor rather than give in to his tirade. This sends a message to all nurses there, “shut up”, not “Speak Up” like we are supposed to. UGH….

      Employers and nurse organizations need to support nurses in the day to day work we do.

      Beth

  19. says

    I must have had my head in the sand, because this is the first I’ve heard of this. I’m writing a post now, and linking to this post. Please keep me in the loop as far as what I can do to help get support mobilized.

    • says

      I just heard about it myself from Amanda. Thank you for helping to spread her message.

      It is so very important for us to advocate for each other so that nurses like Amanda can continue to advocate for patients.

      I will add your link here!

  20. says

    Faith. Yes. I have it. Yet the nurses here are here for you Amanda with faith plus ACTION. This play that you have been cast in is an opportunity for you and your supporters to take action. We are with you in thought, words + action. We shall overcome. Together.

  21. Eileen Fahy, MSN, RN says

    What a nightmare for you, Amanda, and for all of us who are in danger of losing our licenses for doing what we have been trained and educated to do: Advocate for our patients!! I agree with what others have posted that it seems the doctor is the one who should be investigated for not following current standards that require “informed” consent prior to setting up any procedure. From the information available for us to review, this patient was clearly not informed and her rights as a patient were violated by that physician. He must admit a lot of patients to that hospital and generate a lot of revenue for them… The hospital administration, management, and staff, AZ state board of nursing, media outlets, etc. should be ashamed for not recognizing the rights of patients everywhere as well as for demeaning the ethical duty of nurses everywhere to to educate their patients. This is a story that definitely needs to be shared nationwide!

  22. amanda trujillo says

    I just dont want this to ever ever ever happen to another nurse, the pain, isolation, devastation to lives is unspeakable, there are no words to describe the impact it has had one me and anayas lives—and the lives of my parents. I cant believe i spent my entire life dreaming of being a nurse, that i fought to get off of welfare, fought to get advanced degrees, only to be back on welfare once again. im still having a hard time processing that a complete stranger–the doctor–had the ability to in essence–wipe out the lives of both me and my baby with the wave of a hand and a tantrum. in america i did not think such a thing was possible. how does one person have that power, that devastating power to destroy the lives of me and my daughter? to take away everything? to jeopardize our future? How? I think I will spend my life asking that question. It is the coldest thing I have ever seen a human impose upon another and Im not sure it is something my daughter and I will ever forget.

    • Debra V. RN says

      In time, you will see that you were delivered to a better place. All things work for the good. I was terrified when I got Lyme disease. But I fought like a cornered animal, to get well.

      What way to fight? I arrowed straight toward getting healthy, ignoring all distractions. And I chose EVERY healing modality. And I am completely Lyme free for over 7 years now, with NO treatments of any kind.

      But, I learned to FIGHT, by myself, for myself, and believe in myself, and in what I saw and felt. (This was BEFORE it was acknowledged by Doctors and insurance companies).

      AMANDA TRUJILLO, you WILL overcome this, and be STRONGER, and be BETTER off! And I say IN EVERY WAY, you will be better off. IN EVERY WAY.

      Peace to your heart and mind and soul, in time to come, all these will be yours……..

      …………and I am proud of you.

  23. amanda trujillo says

    What I hope for someday is to sit down face to face with the nursing director Venus Gaines, and the doctor to ask them why. To ask them “how could you do this to another person?” I feel I need that closure, I feel i need the ability to tell them what this has done to me and my daughter, my family, my career and to ask them if this was really worth destroying lives for. The nursing director that fired me was fired shortly after I was.

  24. Mila says

    While I do sympathize with Ms. Trujillo’s situation and truly believe she thought she was doing the right thing, does anybody think this nurse should’ve WORKED WITH the doctor instead of taking matters into her own hands? Perhaps she should’ve dropped a quick phone call to the MD and requested he explain the procedure and the patient’s options more thoroughly to her. I will 100% guarantee you the MD knows more about the intricacies of a liver transplant and post transplant care than this nurse did, despite her googling. You are all so quick to defend the “i-must-advocate-for-my-patient- nurses” and jump down the “big bad MD’s” throat, but this is supposed to be team work – not nurses against doctors. If you see a wrong medication dose or questionable treatments, the first thing you do is go to the MD and ask him/her what their line of thinking is. If you are dissatisfied with his/her answer, THEN you escalate to a supervisor. Not every liver transplant is the same, not every patient’s condition is the same. Googling and printing out material is not a substitute for medical school and residency. The fact that Ms. Trujillo worked so hard to get where she is, is a single mother, etc.. is irrelivant to this case. Facts should be examined here, and the fact that she took matters into her own hands instead of discussing the case with the physician first is the issue I have.

    • says

      Mila,

      I think you raise an important point and wonder how involved parties would answer.

      I am a huge proponent of respectful dialogues and in an ideal world believe that everyone can learn from conflict. In this situation, I wonder if and when there were opportunities to discuss varying perspectives.

      I too have questions:

      Was there a history of conflict between this doctor and nurse?
      Does the doctor have a history of disruptive behavior?
      Does the organization have problems with horizontal and/or workplace violence?
      Why was the director of nurses fired too?

      Sadly, I think nurses often become sitting ducks when underlying issues are so complicated. I don’t know if that is the case here.

      I do worry about taking sides and although my sentiment lies with Amanda and the patient, I suspect there is more to the story and want to remain open.

      Beth

      • amanda trujillo says

        1.)the doctor never met me.
        2.) heresay history of disruptive behavior
        3.)the organization does have problems with horizontal violence
        4.) I reported the director who fired me to the ethics committee/compliance department and she was fired shortly thereafter. the CNO who gave the order to fire me still works there.

        It was a clean transaction. I followed the policies, I ran the situation past two colleagues–one being my charge nurse, and I documented my butt off. There were no inappropriate exchanges verbally between me and any people involved in this case. There were no opportunities for anyone to talk because I was promptly placed on administrative leave and then fired.

          • amanda trujillo says

            I am a former heart transplant nurse with a history of transplant pre and post nursing care for 6 years.

        • amanda trujillo says

          Mila. I did not write for the patient to go home on hospice. i did not write orders for hospice care. I did not write to discontinue all life sustaining treatments, nor did I write a certification that the patient had less than six months to live. I faciitated a request for education that I myself probably could not have provided as well as a hospice case manager. Per Hospice organizations standards all that is necessary is for a patient to call themselves, ask a nurse, or ask a doctor. Putting a patient in touch with education that facilitates their ability to make a better decision is not taking any situation into my own hands–especially when I was aware enough of the ethical implications to run the situation passed a manager and another peer for review and opinion. Furthermore, my teaching did not involve teaching the intricacies of a surgery which is indeed out of my scope. It involved standard transplant nursing patient education of which I am quite experienced with. I also had the hospitals literature to back up my teaching. Shift change report using SBAR is a time when things of this nature are carried from provider to provider as a means of facilitating a smooth transition of information regarding any change in patient status—it is meant as an interdisciplinary communication tool (Ill be happy to email you articles that are recent that support that) The Institute of Medicine also considers SBAR to be an effective tool for interdisciplinary communication. I wrote a very thorough note in the computer addressed to the physician with everything that occurred and my concerns–that was relayed to the next nurse that took over. I do not feel that I have to call a doctor in the middle of the night to ask permission for a patient to be educated per her request. In fact, its not necessary at all. When my patients ask for education, they get it, within my scope and if I cant accomplish it, they get paper and pens to write their questions down for the doctor when he rounds the next day. As an advanced practice nurse I dont feel it my duty to take anything into my own hands because that is not patient centered or team oriented care. But like obtaining an order to ambulate a patient, I find it insulting that I must ask permission to provide my patient education within the scope I was educated to practice within. While I appreciate your candor, I ask that in the future you might consider the sharpness of your words in what is and has been a very difficult and painful process—I have enough people here in Arizona assuming Im some misfit danger to society.

          • Denise says

            I am a hospice nurse and you are very correct about the process for referring a patient. ANYBODY can refer somebody to hospice including the patients themselves. A hospice referral can simply be a name and a phone number. This lets the hospice contact the prospective patient to schedule an education visit to explain what hospice is and what type of services can be provided. From that point the hospice contacts the attending physician of the patients choosing to obtain an order to admit if that physician agrees that the patient is terminal. That is the first certifying physician. The second will be the hospice medical director i he/she agrees that the patient is eligible

            The
            pool boy, the mwil man, the house keeper

    • says

      I agree with Mila’s post. The prudent and reasonable action on Ms. Trujillo’s part would have been to communicate with the patient’s physician before presenting any information to the patient. Note I use the words “prudent” and “reasonable” rather than allowable or legal. Also I am curious as to the reasoning behind the patient inquiring of the nurse rather than her physician about her condition and care. Did Ms. Trujillo broach the subject with the patient or did the patient initiate the conversation? Ms. Trujillo’s assessment of Mila’s comments as “sharpness” conveys an unreasonable sensitivity on Ms. Trujillo’s part. Mila was stating her opinion, not criticizing Ms. Trujillo. Also, at this juncture, I do not think the Board Of Nursing should be criticized. If I understand correctly, the Board has taken no action threatening Ms. Trujillo’s license or career. Cases coming before the Board invariably take close to a year to come to fruitiion.

      • says

        Julie,

        The patient asked her nurse because that is who the patient has the most time with.
        Most MD’s spend 5 minutes at the bedside and the patients have so little time to ask them questions and are often very intimidated to.

        It is within the nursing scope of practice to educate and inform a patient on their option. The doctor cannot dictate what type of education you provide to a patient. A patient has a right to know ALL their choices, not just the one’s that will be profitable for the doctor.

        IF the patient didn’t initiate the conversation, it is still Ms.Trujillo’s responsibility to ensure that the patient is informed of the care they are receiving and will receive. If the patient was at all apprehensive and the nurse did not investigate, educate, and other additional options, she would not be fulfilling her responsibilities. Nursing isn’t about doing what is easy, it’s about doing what is right and what is best for the patient. And what is best for the patient is what the patient decides when they know ALL their options.

        The board has put Ms.Trujillo’s license “under investigation” which pretty much eliminates any possibility of her securing employment as a nurse by any reputable healthcare organization.

      • Jackie says

        I hate to be a realist here, but coming from someone who has had three family members end up in hospice, after being at the hospital; each time it was the nurse who recommended we speak with hospice, not the doctor. Not just that, but come on ladies lets be real here! This is a specialist we are talking about. They don’t like to be bothered unless it affects their pocket book. I have been by the nurses station plenty of times when the doctor chews out a nurse just because they want to ask the doctor a question about a chart or point out something they have put in a patients chart.
        Doctors, and especially specialists, act like they are God a lot of the time; they make it clear their word is the last one. You are not to question a doctor, only accept what they tell you. For the record, two different times I questioned the specialist and both times I was correct, NOT THE DOCTOR! Yet, because they are the ones who bring in the money, most do not want the repercussions that come with disobeying the doctor. This usually means someone loses their job, and it’s not the doctor. I’ve heard doctors yell at nurses “I could have your job for this!” And it was because the nurse was annoying the doctor. Once because the male nurse put the doctor on hold and other time because the female nurse was trying to show the doctor something on a chart and he couldn’t be bothered, which made him angry. All the nurse wanted was for the doctor to look at the chart. Yes, that was it. Even the other nurses admitted it to me and said the doctor had a temper. That if he was in a bad mood you needed to keep away, because he fired people for no reason other than he was looking to take his anger out on someone and if you were in the line of fire it could mean your job.
        I’m not a doctor, nor am I a nurse, but I will tell you that doctors, from what I have seen, feel they are better than most people. The problem is that instead of questioning the doctor we sit here and question the nurse because they are the one who cares for the patient most of the time, while the doctor only gives the patient two to three minutes of their time and then is hard to reach after the fact.
        I always tell my kids “just because its always been done that way, doesn’t mean its ever been right to do it that way.” Sometimes changes is truly for the best! Amanda, good luck with your case. I hope the truth comes out about this and you get your license back.

  25. Shaquana Barham says

    I just graduated and I often hear stories of how doctors can be and I wonder as a new nurse is this what I have to look forward to.

  26. Lisa A says

    I wish you the best Amanda. It is a tough fight but you are doing the right thing by exposing the Arizona Board of Nursing & the facility to the nursing community. This is the only way the public will become aware of what the real dangers are in medicine. There seems to be a wall of silence when known “malpractices” are occurring. Instead of protecting the client, the staff seems to make excuses, hide behind co-workers, blame it on “policy” or just ignore the issues & collect that paycheck. “Evil prevails where good men do nothing.” I will spread the word on your story as it is very important & will affect the nursing community.

  27. Julie says

    I agree with Mila’s comment. Ms. Trujillo should have communicated with the patient’s physician pertaining
    her concerns about the patient’s lack of understanding. This would not entail “phoning the doctor in the middle of the night”; time was not of the essence unless the transplant was taking place in the morning.
    Communicating with the patient’s physician first, waiting for his response, being satisfied that the physician provided his patient with information pertaining to her condition and care; or, if not satisfied that the
    physician followed through with the information, then providing the patient with her requested information
    would have been the prudent order of actions. I am curious as to the reasoning behind the patient asking the nurse about her care rather than asking her physician. Did Ms. Trujillo take it upon herself to inquire into the patient’s understanding of her condition and care or did the patient choose to ask Ms. Trujillo instead of her physician? In any event, the reasonable chain of events should have started with Ms. Trujillo communicating with the physician before she took any action. Note I chose the word “reasonable”,
    not “legal” or “allowable”. Ms. Trujillo’s assessment of Mila’s words as “sharp” connotes an unreasonable
    sensitivity on Ms. Trujillo’s part. Mila was merely conveying her opinion in an uncritical manner. Also, if I am understanding correctly, the Board Of Nursing has not conveyed their opinion or undertaken any action threatening Ms. Trujillo’s license or career. All settlement of cases the Board sees takes several months to a year to come to fruition. The Board should not be criticized at this juncture in the process.

    • says

      Honestly, Amanda have EVERY reason to be sensitive about this subject.

      Her loves and livelihood have been stripped from her.

      How would you feel if someone who didn’t even know you came in and said “You’re fired, and you can never do this sort of work ever again”

      She’s invested years and sweat, blood, and tears into being a nurse.

      I’d be offended if she weren’t sensitive about it.

      I take GREAT pride in the RN behind my name, and hope every other nurse does the same.

    • Gypsy says

      This is ridiculous, she is not a staff nurse, she is an ADVANCED PRACTICE NURSE and a PRIMARY CARE PROVIDER. She absolutely does not need to ask the physicians permission to put in a case management consult.

  28. says

    I agree with Mila’s comments. The prudent and reasonable action on Ms. Trujillo’s part would have been to
    communicate with the patient’s physician before presenting any information to that patient. Note I use the
    words “prudent” and “reasonable” rather that legal and allowable. Also, I am curious as to the reasoning
    behind the patient inquiring of the nurse rather than her doctor about her condition and care. Did Ms.
    Trujillo broach the subject to the patient or did the patient initiate the conversation? Ms. Trujillo’s choice of
    word to Mila’s comment as “sharp” conveys an unreasonable sensitivity on Ms. Trujillo’s part. Milo was
    merely stating her opinion, not criticizing Ms. Trujillo. Also, at this juncture I do not think the Board Of
    Nursing should be criticized. If I understand correctly, the Board has not taken any action threatening
    Ms. Trujillo’s license or career. Cases coming before the Board invariably take close to a year to come to
    fruition.

  29. Gypsy says

    I just realized after doing some more research on this topic (particularly the interview she did) that Ms Trujillo may have been working in the capacity of STAFF nurse when this incident occurred. Her mentions of the “charge nurse” and so forth. While this doesn’t in any way excuse the incident I wanted to get some clarification on that matter. I see that she follows this discussion so I am positing here. I think that this is an important point, as if she were acting in her capacity as an APRN this is far more than typical abuse of a staff nurse (which I have personally experienced) and moves more into the realm of a territorial dispute between a primary care provider and a surgeon.

  30. says

    This is an outrage! A sad example of the oppression in medicine. Nursing culture has the tell tale signs of the the culture of the oppressed. We do not support our own, at least not enough. This is a great opportunity for nurses to join hands and rise. We are partners in healthcare, our rights are denied the same way the rights of the African Americans were denied before the civil rights movement. It is time for a civil rights movement of our own. Amanda, hats off to you. I plan on writing to AZ BON too and your story is on my SM network. I might also write about this on my blog.

  31. Judy McBride says

    This may be a repeat, but I noticed my email address was wrong in the comment bar the first time

    I sent the link of this strory to FOX New’s Megyn Kelly, she does “Kelly’s Court” it would be interesting for a major news network to get a hold of this. All my support to Amanda!!

  32. says

    Amanda Trujillo was guilty of doing what we are all trained to do- to be a patient advocate. We are required according to our ethical codes to speak up on behalf of patients. The physician was obligated to explain the risks and benefits and alternatives of the surgery. Somewhere along the way this process got derailed, and the patient was left not understanding the impact of what she was facing. Shame on the doctor for not seeing his patient as a person instead of a case, and shame on Banner Health for bowing to the pressure to terminate Amanda for doing her job. Shame on everyone for labeling Amanda as being in need of a psychiatric evaluation.

    I have been reviewing medical and nursing malpractice cases as a legal nurse consultant for 23 years. I am a past president of the American Association of Legal Nurse Consultants, a national organization of people who practice in this field. When nurses do NOT speak up to question doctor’s orders, to advocate for their patients, to report changes in condition because they are intimidated, BAD outcomes can result. All of us are patients, all of us need advocates to help us make decisions. Amanda fulfilled that role. The nightmare that has descended on her head is horrifying.

    I will be posting information about Amanda’s case on http://www.avoidmedicalerrors.com. I am so sorry she is going through this.

    • Madeleine says

      Thank you, Patricia, for your voice!! Sadly, this is, but, one example of a horrendously broken “system” … where WE are threatened and tyrannized for ADVOCATING and RESPECTING the rights and well-being of THE INDIVIDUAL, whom we care for with the utmost integrity — honoring with sincere mindfulness the TRUST bestowed upon us by many individuals.

      Dear Amanda … Please, know that you and your family are in my prayers. I commend you for your wisdom and strength. Your character speaks volumes in your dedication to this Profession. Your fortitude is honorable. With Respect, Madeleine

  33. Sandy says

    As a nurse, I believe that Amanda Trujillo did the right thing. What does the patient have to say? This doctor overreacted 100% and so I am wondering what stake he really had in it. How much was he to gain from this surgery?
    If there is such a huge shortage of nurses, then why arent the ones that are already nurses being supported and not “forced out” of nursing practice? Just a few thoughts. Has Amanda’s attorney thought about investigating this physician and his relationship to the hospital?

    • says

      I would be very interested in hearing what the patient had to say as well.

      I am not sure about what her attorney is doing in terms of the MD and the hospital. I certainly hope he is digging.

  34. Joe Woolsey says

    from the Arizona Bioethics Network webpage on the Arizona informed consent law:
    Physician/provider criteria:
    Physicians must disclose to their patients:
    the patient’s diagnosis, if known;
    the nature and purpose of the treatment or procedure;
    risks and benefits of the proposed treatment or procedure;
    reasonable alternatives;
    relevant risks, benefits, uncertainties of each alternative;
    the risks and benefits of not undergoing a treatment or procedure.

    Seems to me she was doing HIS job for him after he failed to do so. He is the one who should be fighting for his professional life–NOT HER! What part of ‘Physician MUST disclose’ is so difficult for anyone to understand?

  35. says

    from the Arizona Bioethics Network webpage on the Arizona informed consent law: Physician/provider criteria
    Physicians must disclose to their patients:
    the patient’s diagnosis, if known;
    the nature and purpose of the treatment or procedure;
    risks and benefits of the proposed treatment or procedure;
    reasonable alternatives;
    relevant risks, benefits, uncertainties of each alternative;
    the risks and benefits of not undergoing a treatment or procedure.
    Seems to me she was doing HIS job for him after he failed to do so. He is the one who should be fighting for his professional life–NOT HER! What part of ‘Physician MUST disclose’ is so difficult for anyone to understand?

    • says

      Nurses constantly are working to help “cover the doctor”, because honestly this is how team healthcare should work. We are working towards a common goal and we should help each other achieve it.

      • Maggy says

        Herein lies the problem, ‘Nurses constantly are working to help COVER THE DOCTOR”. Nurses should not be helping to cover for anyone. If they witness wrong doing they MUST speak up otherwise they are a part of the problem, not the solution

  36. Melissa says

    This is terrible! My husband had a cardiologist that performed a procedure on him without first answering his questions. He was ignored, lied to, and then coerced (once he’d already been drugged) into continuing with the catheterization. Afterward, he had it out with the physician who was rude, insulting, and spoke to him as if he was G-d and my husband wasn’t even a human being. Fortunately for us, the nursing staff backed us up when we filed a formal complaint with the hospital. The arrogant physician lost his privileges and eventually his license. It is a shame that the nursing staff did not band together and protest this situation. My heart goes out to this nurse. I hope that she will get justice in the end.

  37. Rita Lawrence says

    Many of us are aware of nurses plight once a complaint is logdge against a nurse and how alone they have stood under accusation. Many turn in their licenses because they are afraid to stand and face the SBRN and charges. Please join “nurses undergoing state board discipline” on facebook. Link with Rep. Tony Shipley (R-TN) who has had a direct experience with the SBRN and consequently got two new bills through to oversee the board. 1) they must report and suspension or revocation within 74 hrs to a committee and 2) and fines over $1,000. Connect your State Represenative with Rep. Tony Sthipley and let’s get some uniformity with oversight. The Gov. of TN commented that he viewed the actions of the SBRN toward Rep. Shipley for having the FBI investigate him as “vindictive,” See the Knoxville News for information and YouTube for a speech by Rep. Shipley.
    lawrencerita511@gmail.com

  38. says

    Thank you Britney for following Amanda’s case, this is the latest.

    The War Against Amanda Trujillo, April 25, 2012, Mother Jones, RN, Nurse Ratched’s Place:”I still support Amanda Trujillo and some people who have read the allegations against Amanda have questioned my judgment. Frankly, I don’t believe these allegations because I personally know two other nurses who have been reported to their nursing boards by their former employers. One of my friends was reported to the BON after she spoke up about unsafe nursing practices at a shady nursing home, and the other was reported after he chastised hospital administration for placing psychiatric patients and staff in an unsafe environment. Their former employers cooked up all kinds of false allegations against my friends who are both stellar nurses. Their former employers crucified their character, but in the end they were both cleared of any wrongdoing by their respective state nursing boards. There is an escalating pattern of abuse as more unscrupulous employers are using nursing boards as the ultimate scare tactic to keep nurses “in their place. ” Amanda is just another victim of this ploy.”
    http://www.nurseratchedsplace.com/2012/04/the-war-against-amanda-trujillo/

  39. says

    Thank you Brittney for discussing Amanda’s case, this is from her blog.

    1,000 Shades of Nursing: Why are we “really” celebrating Nurses Week? May 9, 2012 By Amanda Trujillo, MSN, RN, @nurseinterupted:”There was an interesting tweet chat taking place this evening with regards to Nurses Week and how everyone celebrated their week or reflected on their profession. Several great view points were offered up. My own perception of Nurses Week is that it is a metaphor for every way our profession has stagnated, failed to progress, remaining fractured and at odds with itself about where it should be and how it should get there. Hell, we’re still trying to bridge the gap between academic nursing and clinical nursing. It’s not difficult to empathize with some of the views raised this evening: The disdain with the recycled food offerings, the traditional ice cream social that makes some of us seethe inside, the hospital logo stamped on nursing “swag,” the lack of any gifts of appreciation, the “lumping in” of Nurse Week with “Hospital Week,” or whether we even need the proverbial “pat on the head” as one nurse blogger put it. Im conflicted: As a profession—HOW are we leading, and HOW are we advocating?
    http://nurseinterupted.wordpress.com/2012/05/09/1000-shades-of-nursing-why-are-we-really-celebrating-nurses-week/

  40. says

    Thank you Brittney for following Amanda’s case, this is from TruthAboutNursing.org

    Fired for educating a patient? TruthAboutNursing.org, May 2012:”On February 1, the Phoenix CBS affiliate KPHO-TV ran a short but good item by Peter Busch about veteran local nurse Amanda Trujillo, who said she had been fired by Banner Del Webb Hospital and had a complaint filed against her with the state board of nursing because she had educated a patient about the risks of an upcoming surgery and scheduled a consult about hospice. A hospital spokesman reportedly said that “the doctor, ultimately, is the focal point that directs care for patients” and that “company policy” forbids nurses to order a case management consult. The report does not mention other accounts suggesting that these events were set in motion because the patient’s surgeon was displeased that the patient had decided against the surgery.”
    http://www.truthaboutnursing.org/news/2012/may/trujillo.html

  41. Jean says

    No wonder healthcare is so expensive! People aren’t even informed of their less costly, less invasive options. Maybe if patients understood what was involved in their treatment, they would choose a different path- IF they even knew they had choices!

Trackbacks

  1. […] Amanda Trujillo – Nurse fired for being a patient advocate Posted on January 30, 2012 by Pat Iyer The story of Amanda Trujillo is a horrifying one. Briefly, she is a single mom who fought to get off welfare and fulfilled her dream of becoming a nurse. Not only did she become a nurse, she earned a masters and doctorate degree in nursing. One night while working a Banner Health in Arizona, she took care of a patient who was being asked to undergo a liver transplant. In talking to the patient, Amanda learned that the patient did not fully understand what was going to occur. Amanda educated the patient. She explained the option of hospice instead. The patient decided against the transplant. Then the physician came in, had a well- witnessed tantrum at the hospital when he found out his patient had decided against surgery, and Amanda was fired by the hospital. Her case came up for review by the Arizona Board of Nursing. The summary of her case written by the attorney representing her is below. Amanda has been devastated in terms of her career and her finances. She is back on welfare, her dream of being a nurse shattered. Read more about the details of what happened here, including Amanda’s description of the even… […]

  2. […] I blogged about the need for nurses to not be afraid to advocate for their patients; Nurses like Amanda Trujillo strike a personal and deep chord on my heartstrings. I felt the need to share her story with the […]

  3. […] The story of Amanda Trujillo is a horrifying one. Briefly, she is a single mom who fought to get off welfare and fulfilled her dream of becoming a nurse. Not only did she become a nurse, she earned a masters and doctorate degree in nursing. One night while working at Banner Health in Arizona, she took care of a patient who was being asked to undergo a liver transplant. In talking to the patient, Amanda learned that the patient did not fully understand what was going to occur. Amanda educated the patient. She explained the option of hospice instead. The patient decided against the transplant. Then the physician came in, had a well- witnessed tantrum at the hospital when he found out his patient had decided against surgery, and Amanda was fired by the hospital. Her case came up for review by the Arizona Board of Nursing. The summary of her case written by the attorney representing her is below. Amanda has been devastated in terms of her career and her finances. She is back on welfare, her dream of being a nurse shattered. Read more about the details of what happened here, including Amanda’s description of the even… […]

  4. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education January 22, 2012 By…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” http://thenerdynurse.com/2012/01/arizona-nurse-has-license-threatened-by-doctor-after-providing-patient-education.html […]

  5. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education January 22, 2012 By…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” http://thenerdynurse.com/2012/01/arizona-nurse-has-license-threatened-by-doctor-after-providing-patient-education.html […]

  6. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education January 22, 2012 By…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” http://thenerdynurse.com/2012/01/arizona-nurse-has-license-threatened-by-doctor-after-providing-patient-education.html […]

  7. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education, January 22, 2012 B…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” […]

  8. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education, January 22, 2012 B…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” […]

  9. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education, January 22, 2012 B…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” http://thenerdynurse.com/2012/01/arizona-nurse-has-license-threatened-by-doctor-after-providing-patient-education.html […]

  10. […] Arizona Nurse Has License Threatened By Doctor After Providing Patient Education, January 22, 2012 B…:”There are times in my nursing career when I am so very proud of how far we have come in advancing our profession. Unfortunately, there are also times where I am reminded that this is still very much an uphill climb we must make in order to legitimately participate in truly collaborative healthcare. Today is one of those days in which I am reminded we still have battles to win. The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012. Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.” […]

  11. […] The story of Amanda Trujillo is a horrifying one. Briefly, she is a single mom who fought to get off welfare and fulfilled her dream of becoming a nurse. Not only did she become a nurse, she earned a masters degree in nursing. One night while working at Banner Health in Arizona, she took care of a patient who was being asked to undergo a liver transplant. In talking to the patient, Amanda learned that the patient did not fully understand what was going to occur. Amanda educated the patient. She explained the option of hospice instead. The patient decided against the transplant. Then the physician came in, had a well- witnessed tantrum at the hospital when he found out his patient had decided against surgery, and Amanda was fired by the hospital. Her case came up for review by the Arizona Board of Nursing. The summary of her case written by the attorney representing her is below. Amanda has been devastated in terms of her career and her finances. She is back on welfare, her dream of being a nurse shattered. Read more about the details of what happened here, including Amanda’s description of the even… […]

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