Arizona Nurse's License Threatened by Doctor After Providing pt education - page 4

by lil miss 50,722 Views | 212 Comments

the email and arizona state board of nursing casethis is a (must read) e-mail that was passed to me from echo heron. @echoheronauthor hello ms. heron, my name is amanda trujillo. iím a registered nurse of six years ,... Read More


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    well fwiw she is a rn and a np student according to her own signature (amanda lucia trujillo msn, rn, dnsc-np(s)), not a licensed np. she was working in the capacity of a staff rn when the incident in question occurred. it is not a hypercritical detail, but i thought i'd help clarify the point.

    my only quibble with the story is with the banner. her license isn't being threatened by a physician, it is being threatened by her state bon. the initial conflict was with a physician, and subsequently her employer, but it has escalated way beyond that. accuracy matters and there is more than enough unnecessary rancor between physicians and nurses as it is, without spinning this story to hold the physician responsible for what appears to be gross abuse of power by the bon.

    the tennessee bon behaved in similarly bad fashion recently. we should be holding our own professional organizations accountable rather than making bogeymen out of colleagues in other professions. our inability to police ourselves effectively is part of what is holding us back, and it is the real disgrace here.

    best wishes to amanda for a positive outcome.
    justmeinlv, Woodenpug, CCL RN, and 4 others like this.
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    Quote from bluedevil,dnp
    well fwiw she is a rn and a np student according to her own signature (amanda lucia trujillo msn, rn, dnsc-np(s)), not a licensed np. she was working in the capacity of a staff rn when the incident in question occurred. it is not a hypercritical detail, but i thought i'd help clarify the point.

    my only quibble with the story is with the banner. her license isn't being threatened by a physician, it is being threatened by her state bon. the initial conflict was with a physician, and subsequently her employer, but it has escalated way beyond that. accuracy matters and there is more than enough unnecessary rancor between physicians and nurses as it is, without spinning this story to hold the physician responsible for what appears to be gross abuse of power by the bon.

    the tennessee bon behaved in similarly bad fashion recently. we should be holding our own professional organizations accountable rather than making bogeymen out of colleagues in other professions. our inability to police ourselves effectively is part of what is holding us back, and it is the real disgrace here.

    best wishes to amanda for a positive outcome.
    beginning to piece the the story together...from listening to the interview she did and reading, she was working in the capacty as a staff nurse, not an aprn. i still think its ridiculous to hang her on the tree of woe for a case management consult. hell, i have done that while working as a measly adn staff nurse, in an attempt to assist the patient. in addition, i have been hung out in a very similar manner by a previous manager, who is also now fired (as the manager who fired her is) and can totally relate to this story. you are absolutely right. this is not a territorial dispute between an aprn and physician, this an issue with an antiquated state board and equally antiquated nursing "association"
    nursehomesupplies, tewdles, CCL RN, and 4 others like this.
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    Quote from bobbyzr7
    It sounds like some seriously dirty politics involved, and the BON, as usual, appear to be helping build the gallows to hang her. But...didn't she go way overboard in her "patient education"? I feel that she should have spoken with the physician about this case and gotten his input also prior to going crazy on the education. I believe she did what she thought was the right thing to do, and I respect that. Of course, hospital admin is going to side with a money-making physician, but that's not a shock or unexpected either. Also, don't NPs have a legal right to prescribe or order a case management consult? Guess not. Sounds like she wasn't working in the role as an NP or perhaps Arizona's rules are wacky.
    I disagree that she went overboard with the "patient education". Patient education is part of the nurse's scope of practice. She assessed that the patient had a knowledge deficit and she addressed it. I don't discuss all the education I provide to patients with MDs. I can't even count the number of times I've been in a room, had a surgical resident come in and say "Ok, the MRI showed this, we need to do xyz" and walk out leaving a stunned parent and terrified child there and me to pick up the pieces.

    All the documents state that Amanda was a night shift nurse... what kind of physician do you know that wants to be called in the middle of the night to hear "your patient doesn't understand the risks of surgery and would like a case management consult to explore hospice." I have never once asked an MD to place a case management consult. In fact, our computer system does it automatically if in our nursing admission assessment, we chart that the patient has existing services at home or is likely to need them upon discharge. Most of the MDs I work with have no idea what the case manager even does to facilitate the patient's eventual discharge home with services or to another facility for rehab (or hospice). Fortunately we have inpatient NPs who do get it and if a situation like this ever happened on my floor (which I can't imagine) the NPs from the surgical team would stand up to the surgeon. Actually a couple weeks ago one of our Attending surgeons came up to the floor and asked why one of his patients was still inpatient. The NP and the Case Manager informed him that the patient was waiting for an inpatient rehab bed as recommended by Physical Therapy. The surgeon's response? "Well if they can't take him today, just send him home". The NP looked at him and said, "the child cannot walk. He can't go home." If I had a patient ask about hospice in the middle of the night, I would talk to them about it and I would not call the doctor to ask permission first. I would probably do exactly what Amanda did, write a note and inform the physician in the morning as well as the day shift nurse. In fact, I have done this before.

    To me, the key in this case is that the patient requested to meet with case management and the social worker. The patient absolutely has the right to request these things. And the most bothering thing of all "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." Informed consent, anyone? Not to mention, as far as I can tell from the story, the patient hadn't even undergone the transplant evaluation yet and if the patient truly lacked the ability to comply with the post-transplant regimen or expressed his/her unwillingness to do so, the transplant team would have ended up declining to list him/her with UNOS anyway.

    I can't believe the Arizona BON is even taking this case. As someone else said, this is a huge abuse of power from their end. I can't imagine this ever happening in Massachusetts.
    tewdles, nyforlove, maelstrom143, and 7 others like this.
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    This is ridiculous. She was doing exactly what nurses are supposed to do.
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    I am still struggling with why this was deemed so horrific of an offense that she got fired AND lost her license. I haven't seen what the charge was according to the BON. My guess is failure to follow an MD order? I can understand if they wanted her to jump through more hoops to make the surgeon and hospital administration happy. I know about hospital politics. Still, why this need for blood? Why not educate her and staff on how to make So-and-So, MD not cry, slap her on the wrist and move on. Why is there such a need to fire a nurse for a mistake? Why take her license?

    I empathize with her for reasons I wont get into for fear of hijacking this thread.
    SE_BSN_RN, Hoozdo, lindarn, and 1 other like this.
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    New interview of Amanda herself.........This is crazy. This facility is nuts!!!!

    Audio Interview with Amanda Trujillo - Banner Health incident / Arizona State Board of Nursing threat
    leslie :-D, Vespertinas, Fixit, and 1 other like this.
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    I have not had time yet to listen to the audio interview. Will do so when I can.

    I'm interested in this "Psych Eval" as knowing a bit about hospital politics and railroading techniques, my guess is, she was already "on the radar" for reasons not known to us, and that, for whatever reason(s) she was already labeled by Admin as a pia long before this isolated incident.

    I can easily visualize a scenario where they were actively looking to get rid of her.
    SE_BSN_RN, Fixit, and lindarn like this.
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    @Guttercat:
    I was thinking exactly the same thing, but why not just fire her then? Why destroy her career? Like I said, I have been a victim of similar machinations by a manager that did not like me (and was later escorted off the premises by security when she was fired) but I have never understood it.
    SE_BSN_RN, Not_A_Hat_Person, lindarn, and 1 other like this.
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    from one who'd been in transplant trenches:

    transplant services are not money-makers. They're actually perpetual money-suckers b/o they serve population which is 90%+ Medicare/Medicaid while providing ridiculously expensive services. Transpalnt programs can bring prestige, faculty, training opportunities or research grants, but they hardly can bring any surplus of money.

    the patient in question had life-threatening condition (otherwise, there wouldn't be a question about transplant in the first place) but he clearly was not actively dying at that moment if he was really admitted for transplant evaluation. If he was in hospital specifically for that, then his doctor(s) must thought that he has enough time ahead to be put at least in "short" waiting list.

    there is no such thing as "consent for evaluation". The patient should sign a general consent for hospitalisation, which covers HIPPAA stuff and such, but it doesn't imply that risks or benefits of anything POTENTIALLY PLANNED must be explained in full then and there. He should be asked to sign separate consents for every procedure, such as biopsy; he would have to sign more consents about his obligations (to live within "X" distance from hospital, to be always available by phone, to agree on supervised drug screens and so forth), with risks, obligations and benefits explained at that time.

    so-called "transplant boards" have to sort a lot of patients (all of them dying) out of the system b/o shortage of organs. Their requirements are harsh, restrictive, sometimes humilitating and can interfere with basic human freedoms. They don't make secret about it, and don't put any patient in the coveted "list" till there's a good del of assurance that he completely understands and accepts the details of the process ahead. Transplant coordinators (who're, as far as I know, mostly RNs) are very good at patients' education as well as picking any non-compliance issues.

    My opinion is that if only Nurse Trujillo didn't try to ask all the patient's questions by herself and directed him to the people whose job was to do just that, she would be safe now. I would understand her actions if the patient had unusually high risk, unable to make his own decisions and was already in OR list for surgery for the next day. But if the situation was like she described it, he only had to say "no, I don't like to be not able to drink alcohol to the end of my life, and I don't care when and how the end comes" to transplant coordinator, and that would be the end of the story.


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