Arizona Nurse's License Threatened by Doctor After Providing pt education - page 5

by lil miss | 55,037 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


  1. 5
    Quote from KatieMI
    from one who'd been in transplant trenches:

    .
    Thank you KatieMI for your adding your perspective. It helps.

    There are multiple scenarios as to how and why this went down as it did. The truth is in there somewhere... an outright railroading job for whatever reasons, and/or there is much more to her story than we are privy to.

    I'm still inclined to think railroading at this point, but I'm not sold on it.
    friggasdistaff, MassagetoRN, Hoozdo, and 2 others like this.
  2. 4
    Katie's input helps clarify things a great deal for those of us (myself included!) not familiar with protocols surrounding transplantation evaluations. The patient was not, in fact, getting transplanted in the morning without informed consent! As I understand it, he was merely beginning physiologic workups to determine suitability for transplant. The nurse in question determined overnight (apparently correctly) that he was not likely a strong candidate from a psychological view point, and went "Rambo," initiating all kinds of consults -that I gather while not seemingly outside her scope of practice as alleged, were probably well outside the normal protocol of the transplant evaluation.

    Frankly, I think it would be most interesting to know why she felt compelled to do so, when it is clear from Katie's information that is it wholly unnecessary as his in-suitability for transplant would have come to light directly when the people who's job it is to vet him did their due diligence. In short, she stirred up a hornet's nest for no apparent reason, but she must have had some motivation. I think her underlying motivation is probably what has landed her in so much trouble (power, control, whistle blower, trouble maker issues??). Is this a case of "too big for her britches?" Since we only have her version of events we cannot know. I suspect there is a great deal more than meets the eye. She may be a troublesome employee and one Webb is well to be rid of and right to terminate, but terminating her license seems over the top. Without a great deal more to go on, I just don't see the logic or justice in that at all.

    Based only on the information at hand, I think her actions were wrong headed and probably worthy of disciplinary action from her employer. I do not think she deserves to lose her license based on this alone, and I still hope she is able to salvage it from this situation.
    friggasdistaff, EricJRN, lindarn, and 1 other like this.
  3. 4
    Quote from BlueDevil,DNP
    Katie's input helps clarify things a great deal for those of us (myself included!) not familiar with protocols surrounding transplantation evaluations. The patient was not, in fact, getting transplanted in the morning without informed consent! As I understand it, he was merely beginning physiologic workups to determine suitability for transplant. The nurse in question determined overnight (apparently correctly) that he was not likely a strong candidate from a psychological view point, and went "Rambo," initiating all kinds of consults -that I gather while not seemingly outside her scope of practice as alleged, were probably well outside the normal protocol of the transplant evaluation.

    Frankly, I think it would be most interesting to know why she felt compelled to do so, when it is clear from Katie's information that is it wholly unnecessary as his in-suitability for transplant would have come to light directly when the people who's job it is to vet him did their due diligence. In short, she stirred up a hornet's nest for no apparent reason, but she must have had some motivation. I think her underlying motivation is probably what has landed her in so much trouble (power, control, whistle blower, trouble maker issues??). Is this a case of "too big for her britches?" Since we only have her version of events we cannot know. I suspect there is a great deal more than meets the eye. She may be a troublesome employee and one Webb is well to be rid of and right to terminate, but terminating her license seems over the top. Without a great deal more to go on, I just don't see the logic or justice in that at all.

    Based only on the information at hand, I think her actions were wrong headed and probably worthy of disciplinary action from her employer. I do not think she deserves to lose her license based on this alone, and I still hope she is able to salvage it from this situation.
    Ehhh, honestly, why subject someone to an expensive and time consuming battery of tests when they decide that they won't even want the procedure in the first place? Giving pt education is part of a nurse's job. There weren't any guidelines prohibiting Ns. Trujillo from giving her pt hospital-endorsed brochures that outlined the procedure for which the pt was being tested. Also, if I'm remembering correctly, Ns. Trujillo didn't cancel the pt's workup--the pt did. It was his right to be able to do so. The doctor was, in fact, just acting like an oversized, overly-educated baby because someone took his "play thing away." ...

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    SE_BSN_RN, cindjo717, tewdles, and 1 other like this.
  4. 5
    Quote from Xsited2baNurse
    Ehhh, honestly, why subject someone to an expensive and time consuming battery of tests when they decide that they won't even want the procedure in the first place? .
    That's the second from the bottom step in the practice of "defensive medicine". I count as the ultimate bottom line things like quadruple bypass+valve replacement done on a 90+ y/o patient already legally blind, on dialysis and severely demented for the reason of satisfying repeated requirements of loving family "to fix grandma up somehow".

    For doctors, after they're trained for years that way, leaving a disease to its natural course is often an action completely unthinkable, whether patient desires that or not, and anyone who in some way obstucts their heroic action is thought to be a traitor of a sort. That goes on top of their permanent fear of being pulled into endless court war about "if (...) would have been done...".
  5. 13
    I have a button on Cerner to "nurse order" social services consult and do this for patients from time to time when there is an issue that comes up about the patient disposition. I would not nurse order a hospice consult.

    In our facility that the MDs are VERY touchy about hospice consults and will usually not want to consider a consult. I have seen MANY patients die within 1 day to 1 week after the hospice consult was given a "no." During the interim, the patient, who doesn't go to hospice, gets a feeding tube. The feeding proceeds to his lungs and out his nose. We drown him in tube feeding, which we suction aggressively from his airway. The family keeps trying to feed him, the lab pokes him, we turn him and undermedicate him because he is still being "TREATED" .... Nobody states the obvious, patient is dying, nature running it's course... Oh, not to mention the thousands and thousands of dollars spent on the multiple antibiotics and treatment procedures and surgeries, ICU charges, intubation, 1:1 staffing, consults, you name it, that take place during the active dying phase because no one wants to acknowledge what's happening.
    MMaeLPN, teampurple, skyandsydneysmom, and 10 others like this.
  6. 2
    Quote from BlueDevil,DNP
    Frankly, I think it would be most interesting to know why she felt compelled to do so, when it is clear from Katie's information that is it wholly unnecessary as his in-suitability for transplant would have come to light directly when the people who's job it is to vet him did their due diligence.
    Remember how we were taught that the healthcare is a system of many checks to ensure excellent and accurate care? And how we nurses are in the sequence of those checks, sometimes as the final stop before something happens? And how even though it seems that there is a multiplicity of the same task, it just as much our responsibility as the next guy and if something goes wrong we can still be blamed for not doing OUR role?

    Well, in that vein.. if a transplant coordinator (and a whole team actually) is to evaluate a patient's candidacy, why can't the floor nurse help make an additional assessment? For the record, I've seen patients STILL slip through the cracks and end up getting transplants in situations like: where they have been noncompliant on their psych meds and have no social support, or lived 100 miles away and had no reliable means of transportation to make frequent visits to the hospital for follow up visits. (i worked in transplant too)
    tewdles and lindarn like this.
  7. 4
    Why can't a RN whom is not part of the transplant team evaluate a patient's candidacy? Since I don't work in that system, I don't know the answer to your question. Apparently the system she worked for did not empower her to do so. The fact that the hospital system regarded the breech of conduct serious enough to fire her suggests to me that there is far more to this story than meets the eye. We have only been provided with limited and obviously biased information. Something else must be factoring in, or at the very least this action was so far outside the norm of their usual protocols they felt it worthy of termination. I find it hard to believe that she thought she had the autonomy to act thusly, when it is patently clear she did not.

    In short, all she needed to do was pass along the information in report. I suspect that is the extent of what she was empowered to do by the system, hence the brouhaha. While she may have broken institutional protocol (and frankly, she must have or they wouldn't have fired her) I cannot see how she exceed her scope of practice as defined by the BON. Therefore, while she may have no cause to sue for wrongful termination, she probably has cause to sue for harassment because filing complaints against her license seems unfounded, calumniating and inimical.
    friggasdistaff, MtBpsy9609, lindarn, and 1 other like this.
  8. 3
    The hospital she worked for must have the same attitude that the last hospital I worked for: 'The physician is the most important customer'. Over my dead body.....!
    SE_BSN_RN, tewdles, and lindarn like this.
  9. 3
    It doesn't make sense for a masters prepared RN to be working as a staff RN. I searched Arizona State BON and her name does not exist for a license and I typed in her license number and it doesn't exist either. Where is all this information coming from? I almost wonder if it's a scam for them to make money.
  10. 2
    Quote from LynnLRN
    It doesn't make sense for a masters prepared RN to be working as a staff RN. I searched Arizona State BON and her name does not exist for a license and I typed in her license number and it doesn't exist either. Where is all this information coming from? I almost wonder if it's a scam for them to make money.
    As far as i understand, she was not a ceritified mid-level, but only a student in DNP program and so she worked as staff RN while doing her Masters. I don't know if a student in Masters or Doctorate NP program can say about herself as that she is "specializing in cardiology, gerontology and palliative care". I do not know if there are exams like CCRN for any of these specialties for which a BSN could be eligible. That's another point in the story which makes it "a little strange".
    ProArizona and lindarn like this.


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