Arizona Nurse's License Threatened by Doctor After Providing pt education - page 8

by lil miss

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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. i’m a registered nurse of six years ,... Read More


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    Merged threads.
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    She still has an MSN after her name which makes her an advanced practice nurse(APN) Her story and the repercussions do not speak well for nurses pursuing APN degrees. The RN after her name makes it ok for her to place a case management referral. In the hospitals in my state- I do not need a doctors order to enter an order for case management. And I'm not an MSN.

    With all the elderly in the state of Arizona- that state better get on the stick and bring their philosophy/guidelines/ regulations on the scope of nursing practice into the 21 st century. With all the healthcare reform going on in this country- that state better get on the stick and re-eval the scope of nursing practice. Unless that " MD doctor" plans on transplanting all the old organs in that state.

    It kinda sounds like that MD doctor has an issue with nurses in general and probably her race and gender.
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    Quote from Not_A_Hat_Person
    I think there's another thread about this.

    Regardless, I'm very skeptical of a story that has so far only appeared on a blog and facebook. Have any news organizations picked up on this?
    Nurse says she was fired for educating patient - CBS 5 - KPHO
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    Quote from hampter320
    i posted this on another forum and haven't been flamed yet, and i hope to encourage some objective discussion here. i have no relationship with this case but i think everyone needs to review the facts and try to be objective as possible instead of this mother duck sticking up for her baby ducks mentality while ignoring the facts. with that said, the events are quite tragic and it's a shame it has come to this.

    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[color=#ffff00]. based on the story, we don't know what this patient's overall prognosis was, comorbidities were, or social status was. it sounds like the nurse painted a much more grim picture for the patient than the physician did and nobody here knows the true details of the case. 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.
    from my understanding the information that ms. trujillo gave the patient was hospital approved information. it was not an internet search.
    in my hospital i seen doctors give a 90 year old hip surgery. i do not have a problem if he or she is healthy enough for the surgery. however, in the case of this patient she had an extensive medical history, including multiple strokes, all limbs contracted, bed bound, and she was unresponsive. the argument was to improve her quality of life; it would be fine if it was measured in miles, but it was only in millimeters. to add to this as we all know without physical therapy the surgery is useless and for a patient who is bed bound and is unresponsive, impossible would be the end result. not to mention the extensive hospital stay to recover from the surgery, if one can call it recovery.
    the point in this case, the doctor did not have the patient best interest in mind. doctors are not in-foulable. we as nurse always need to speak up and advocate for are patients on all levels not just in case of a possible medication error. we need to do it even if it is against the doctor plan of care; it is our duty as nurses to assess our patient to see if he or she has a clear idea to what his or her treatment is going to entail. yes we do not know all the details, but where do we draw the line between blindly following the doctors order because “he said so” or because her or she does not believe in hospice care and that what is best for the patient. sometimes the last mile we ask our patient to walk is just too much to ask.
    in ms. trujillo case, she was advocating for her patient based on what the patient requested and she did follow her hospital's policies. my question to you all is, “why are we so afraid of death? why is it so hard to say enough is enough? where do we draw the line?
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    I so agree with you jblue. I think it is inhumane and in a world of limited resources just plain stupid.
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    Very well said Jblue. I too have seen 90yr olds taken for hip surgery. This was a very common discussion on our unit- Why? are theygoing to run in a marathon.

    I too read the same info from the letter. "Hospital approved patient education material" How many doctors go to that section of the unit- and all units have one, and grab said pamplets and give them to the patients. I worked a cardiac unit for years- the patient ed pamplets on CHF, cardiac cath's, post open heart, could keep one busy reading for months.There was a box on our computer charting where we had to check and name the pamphlet we gave to the patient. We would get dinged in our performance evaluationsif we did not hand these to our patients. So what did this nurse do that was so awful? Maybe it's just the diference between our geographic locations. I am on the east coast- that MD would have nurses fired in droves for educating patients and handing out the hospital's education committee approved patient teaching"tools" ( like that 21st century term) "A teaching tool"I would expect a nurse with her MSN- which she has and is not a "student"to do at least that. Unless the new role for the MSN,RN is to wipe butt only- I wish hospital administrations all around this country - good luck- with that one. And if that's the case- there is alot of nursing leadership that better grab a wash cloth.

    I think this fight is much bigger. I don't think it's so superficial as nurse gave education to patient.- I think it involves an archaic doctor's whose idea is- that the little nurse should be seen and not heard. Look at that goof ball in Texas. I think this is a blow for the argument of the RN - APN. I think that doctor better get a grip. Look at the health care reform proposals from the Dept of Health and Human Services. Primary care. Whose going to be doing most of the "Primary care" in this country? Doctors?? There is such a critial shortage of Primary and Family Doctors now. The care has to come from some one. A Nurse Practioner is the only logical solution to this problem. This is a sleeping crisis. Nurses are going to have to fill the gap. Those transplant surgeries bring in much bucks- to the hospital and the surgeon. Of course that surgeon is peed off. I think he needs to be investigated as to why he did not present the patient with ALL the options, and what his attitude is toward nurses especially APN's and the of her being addressed as "Doctor" also. If she were a Doctorate of Psychology- would he have the same problem with her??They are called Doctor also, or a Doctorate of Education is also called"doctor" Up until the recent past few years there was very few and very little push toward nurses obtaining a doctorate. Now, all NP's have to have their docotrate by 2015. In my state- MSN,RN ARE NOT at the bedside nor do I ever think they will be. Maybe that surgeon needs a transplant- Brain. or at least some informational readings.
    I think this also has alot to do with her personally- a hispanic and a woman. Given that it is Arizona with it's boarder issues. I wonder if the situation would be different if the nurse was a male nurse( guys - I mean no harm).
    Form where I live and work- this so bizzare, it's like something out of Marcus Welbe, MD or Ben Casey. This is so retro.
    , vintage, colonial.
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    In my state this is the definition of a Registered Professional Nurse, This is what an RN( not only BSN, not only MSN, not only NP, not only DSN) but all RN's are held accountable for doing. NOTE: "health teaching, case finding, health counseling". What did this RN do that was so awful that necessitated this physician to report her to the board of nursing and now a psych eval??


    Statutes Annotated

    Title 45. Chapter 11. *****************Board of Nursing Statutes 45:11-23. Definitions

    The practice of nursing as a registered professional nurse is defined as diagnosing and treating human responses to actual or potential physical and emotional health problems, through such services as casefinding, health teaching, health counseling, and provision of care supportive to or restorative of life and wellbeing, and executing medical regimens as prescribed by a licensed or otherwise legally authorized physician or dentist. Diagnosing in the context of nursing practice means that identification of and discrimination between physical and psychosocial signs and symptoms essential to effective execution and management of the nursing regimen. Such diagnostic privilege is distinct from a medical diagnosis. Treating means selection and performance of those therapeutic measures essential to the effective management and execution of the nursing regimen. Human responses means those signs, symptoms, and processes which denote the individual's health need or reaction to an actual or potential health problem. The practice of nursing as a licensed practical nurse is defined as performing tasks and responsibilities within the framework of casefinding; reinforcing the patient and family teaching program through health teaching, health counseling and provision of supportive and restorative care, under the direction of a registered nurse or licensed or otherwise legally authorized physician or dentist.

    Does this mean that EVERY time we do something so simple as pass a newly prescribed (or even a med these patients have been on and are not takeing correctly at home) medication to a patient, we have to stop at our Kardex, pyxis, or med cart , call the physician and get their permission to teach a patient about the what, where and why's and side effects of this drug? How rediculious!! Especially when we have a law/nursing practice Act that say this is what we as licensed RN's MUST(* are legally accountable in a court of law infrom of a jury of our PEERS) do.??

    This doctor is so personally wrapped up in an issue and IMHO, it's not the Nursing Practice Act. I will take this one step farther- that doctor taught that patient what HE wanted to teach that patient and not one sentance more. It was clouded by his PERSONAL interests not the patients. He failed that patient.

    In my day in nursing school- 1979-1980: we had to memorize this definition of Professional Nursing Practice from our State's Nursing Practice Act for our VERY First Foundations of Professional Nursing Class. It was an essay question and we had to write it out in it's entirety. An d I will say, over all these 32yrs this very first test has served me well.
    Last edit by kcmylorn on Feb 4, '12
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    Everyone is looking at this from a biased point of view, simply because it is a nursing profession board. First off, it doesn't matter if she was an RN, DNP, NP, janitor, or God of all surgical medicine - the bottom line is she was NOT the physician or care provider dictating the patients care. That name at the top of the chart - that is the physician who makes the medical decisions during the patient's hospital stay. He/she may call consults, but a consultant's purpose is to make recommendations to the care provider managing the patient during his/her stay. That's just the way it is, that is the system. You cannot have 20 hands in the cookie jar. You need one person managing a patient and making final decisions, with input from other sources including the patient.

    Second, as far as everyone saying she was just advocating, educating, blah blah blah... We all know this wasn't a simple case of the nurse giving the patient some pamphlets and saying "what do you think?" No, this is all going down because she took matters into her own hands and used her medical judgement (which she wasn't qualified nor allowed to do in the system) and determined the patient wasn't a candidate for the surgery. Then proceeded to give advice (possibly wrong? who knows) to sway the patient's decision towards not having the surgery. She did not simply hand the patient hospital-pamphlets and say "I will have the attending come explain the risks and benefits of the procedure in the morning." It is not her job to tell the patient what medications and how long he'll have to take them post-transplant. It is not her job to tell the patient what his prognosis is post-op. I'm sorry, but if somebody is going to tell me about my upcoming transplant or whipple's procedure or bypass surgery, I want it to be the surgeon or MD who is responsible for actually performing 1000s of said procedures. Not the family practice doctor who sees me as an outpatient for my yearly physical, not the dermatologist who did a skin check for me last year, and not the nurse who manages my care on the floor pre and post op. This is the problem with society today... nobody understands how much they don't know. Everyone deems themselves an expert in everything in the day of the internet regardless of their profession.

    Again, this all could have been avoided if she simply told the day nurse to give the MD a call and say they don't feel the patient is well informed, can you please have a discussion when you come back to see him. The surgery wasn't the following day. The situation wasn't emergent. And this is NOT a matter of a doctor just wanting to make money from a surgery. As someone already pointed out, the risks and costs to the hospital for a transplant FAR outweigh the actual monetary gain from performing the procedure. This is why transplants are not done at small community hospitals or even every larger hospital. This is not about the big bad MDs and their struggle for power, this is not about the hospital wanting to make money. We've only heard one side of the story, and are providing biased commentary based on the nature of this message board.
    Last edit by Hampter320 on Feb 4, '12 : Reason: spelling
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    Quote from hampter320
    that name at the top of the chart - that is the physician who makes the medical decisions during the patient's hospital stay
    really?

    is this the type of healthcare model you want to be a part of?

    i want a collaborative and teamwork approach to patient care that values all members of the medical team and does not put a doctor in a god-like position to be the supreme leader who needs no input from anyone.

    no one person can take care of a patient by themselves, not even the surgeon with the biggest god-complex.
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    Quote from TheNerdyNurse
    Really?

    Is this the type of healthcare model you want to be a part of?

    I want a collaborative and teamwork approach to patient care that values all members of the medical team and does not put a doctor in a god-like position to be the supreme leader who needs no input from anyone.

    No one person can take care of a patient by themselves, not even the surgeon with the biggest god-complex.
    Nobody mentioned taking care of a patient by themselves. A good physician should be open to input and recommendations. Sometimes they will follow those recommendations, sometimes they won't. But there needs to be a team leader. I'm sorry if you disagree with that but it's fact. You cannot have 5 different consultants with differing opinions arguing about what treatment to give and then the nursing staff on the floor throwing in their two cents on top of everything else. Pulmonary recommends Meropenem for the HAP, infectious disease recommends Zosyn, and cardiology believes this is all CHF and there is no pneumonia. There needs to be a team leader who makes the final decision and that is the physician whether we like it or not. If you think a physician has a god complex just because he/she has the most training and is typically the team leader then that's simply an inferiority complex on your part. If you want to make the final decision in medical management then go to medical school. I know nurses who have god like complexes and think they know more than all the doctors in the hospital. I know internists who think they're God and look down on surgeons. I know surgeons who look down on the ER docs. Again, that's the problem in society today. Nobody understands how much they don't know, and everyone thinks they can do the job of the next person.

    In my hospital the nurses and doctors get along beautifully. There is none of this friction. Everyone accepts their role and does their job. If there's a problem, the physician who the patient is admitted to (ie: the team leader) is called and he/she straightens things out. It really is that simple. It's a beautiful thing when egos don't get in the way of functioning with other heathcare workers. There is good communication, and none of this going behind the physicians back or taking matters into our own hands.
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