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The Case of Amanda Trujillo

February 2, 2012

By Shawn Kennedy, AJN editor-in-chief

Post updated on January 10, 2013; see final paragraph. Amanda Trujillo, MSN, RN, is a nurse who until recently worked at Banner Del Webb Hospital in Sun City, Arizona, until she was fired for, as she claims, just doing what she’s obligated to do as a nurse—specifically, providing a patient information about a surgical procedure in an attempt to support fully informed decision making. (You can read her e-mail detailing her story here. She did not, as she has pointed out in comments, ever attempt to directly obtain informed consent herself.)

Amanda Trujillo

Ms. Trujillo says that, when the patient had a change of heart about the surgery, she requested a hospice consult. After a physician complained that Trujillo had overstepped her scope of practice, the hospital filed a complaint with the Arizona Board of Nursing, which has launched an investigation.

Ms. Trujillo has gone public with her story, sending e-mails and tweets to editors, public officials, bloggers, and the news media. The nursing blogosphere is full of posts with her story—Emergiblog, vdutton’s posterous (which has her attorney’s response to the complaint), and thenerdynurse, as well as a number of others. On January 31, she was interviewed on local television. She makes a compelling case that she was advocating for the patient’s right to information, and one wonders why she was fired and is under investigation.

As we have been for 112 years, AJN is all for coming out in support of nurses. Do we believe a nurse’s first duty is to the patient? You bet. We’re also all about accuracy and facts, and in this case, it’s been tough getting information from all sides. While certain assertions have been repeated in most of the supportive blog posts we’ve read, the undertone is that there is more to this case than the obvious.

Here’s what we’ve learned so far from the other parties: According to Joey Ridenour, MN, RN, FAAN, executive director of the Arizona Board of Nursing, “While the investigation is ongoing, information is kept private to protect the nurse should the complaint be unfounded.” She noted that while Ms. Trujillo can go public with details, the Board cannot. She did verify that Banner Del Webb Hospital filed a complaint about Ms. Trujillo’s practice on April 26, 2011, for “non-compliance with Federal, State or contractural arrangements.”

Ridenour also verified that at the January 24 Board meeting, the Board reviewed the case, voted to continue the investigation, and requested a psychological evaluation of Ms. Trujillo. When I asked if this was unusual, she said that in general, if the board feels that there is a lack of understanding in complex cases, the Board will ask for “expert opinion.” The Board will reconvene in March to review the findings and rule on the complaint. In the interim, Ms. Trujillo’s license remains active and without restrictions.

I spoke with Arizona Nurses Association executive director Robin Schaeffer, MSN, RN, CNE. The Board has been criticized for not supporting Trujillo. Schaeffer says the association is “right there to advocate for nurses,” but it must wait for the Board investigation to be completed. Until then, it will monitor the situation. It’s the association’s policy not to comment on the specifics of any ongoing investigation and the association supports the Board’s obligation to regulate the profession. I asked Schaeffer about any conflicts of interest that might prevent the AzNA from supporting Ms. Trujillo’s position, and she said that, contrary to what’s been purported on some Web sites, she is NOT an employee of Banner Health.

I haven’t had any response to phone calls to Banner Health, but on its Twitter page they have noted that “Banner Health, like most companies, does not publicly discuss employee matters.” No surprise there.

It’s regretful that any nurse has to go through what Ms. Trujillo has gone through, and we hope all will work out well for her. We’re following the story and will update you when we have more facts.

Our follow-up post: “Boards of Nursing and the Amanda Trujillo Case”

Also of interest: this post from nurse/blogger Not Nurse Ratched giving a link to the official Arizona Board of Nursing Notice of Charges in the case.

Addendum: January 10, 2013: The eventual outcome of this case can be seen in the “consent agreement” that Amanda Trujillo has signed with the Arizona Board of Nursing, which states that she “admits the Board’s Findings of Fact and Conclusions of Law” and agrees to fairly onerous terms for continuing to practice as an RN on probation. Thanks to blogger Not Nurse Ratched for providing a link to this document in her recent post about the case and its unfortunate history on the Web.
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46 comments

  1. […] read the recent article in the American Journal of Nursing Off the Charts blog (http://ajnoffthecharts.com/2012/02/02/the-case-of-amanda-trujillo/) as well as an article on […]

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  2. Andrew, thanks for the comment. We hope that helps make as clear as possible what we meant and did not mean. Blog posts are written and edited somewhat more quickly than our journal material, points are elided, and sometimes meanings that we assume readers will understand are not as clear as we’d have liked. We hope in the future people will simply ask us what we mean before assuming the worst! Peace.-Jacob

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  3. Thank you Shawn and Jacob for changing the wording of the article. We will reflect the changes that have made in our blog posts.

    http://ajnoffthecharts.com/2012/02/02/the-case-of-amanda-trujillo/

    This issue is too important for nurses to let potentially confusing messages go without clarification.

    With thanks,

    Andrew Lopez, RN
    Nursefriendly, Inc. A New Jersey Corporation.
    38 Tattersall Drive, Mantua New Jersey 08051
    http://www.nursefriendly.com info@nursefriendly.com @nursefriendly
    856-415-9617, (fax) 415-9618

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  4. The public needs to be fully informed of what is happening to nurses today. The Amanda Trujillo case is not an isolated incident. It is happening to so many good nurses that merely do their job. The public also needs to understand the facility Banner Del Webb Medical Center is known to be terribly abusive to it’s nursing staff. Any nurse that speaks up and attempts to advocate for the patient will soon find themselves out of a job and generally having to respond to such outrageous allegations made to the AzState Board of Nursing. You are guilty if you do your job. How do I know? BEEN THERE, WITNESSED IT AND BEEN SCAPEGOATED by the management team at Banner Del Webb. The public deserves better than this treatment. Nurses, if you think this does not affect you, think again. It is all around you. Either you can be part of the problem or the solution. Speak up for Amanda and all the other “Amanda’s” out there. I fear what type of nurse will be left to care for me and my loved ones once all the good nurses are gone. We should all fear this.

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  5. […] prior post on the Amanda Trujillo case elicited many comments, on a variety of themes. There were also referrals and crosslinks to other sites supporting, […]

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  6. Informed consent, as I see it, is largely a legal concept, with the doc ultimately responsible. Education and knowledge assessment regarding all clinical matters lie fully within Nursing scope of practice, as well as a responsibility to address inadequate knowledge and advocate for the patient, even if it may require further work by the doc to verify and ensure informed consent. Consent is not the signature on the form, and is never ‘finished’ unless the patient continues to believe it so: at any point after providing consent, patients retain the right to revoke it at their discretion, whether secondary to Nurse education or otherwise, and in no way subject to any doc’s convenience or profesional opinion. Therefore assessment, education and advocacy in no way constitute informed consent, although they may well influence it. Nurses serve as important editorial role on physicians, who nevertheless retain final responsibility.

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  7. Thank you Shawn, I guess in my mind informed consent involves taking a paper into a room, and discussing specific surgical approaches, risks and benefits–I just wanted to touch bases and make sure you knew my definition of informed consent–because in my practice informed consent has always been the doctors job. I appreciate the candor and your quick response.

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  8. The idea that we need all the facts to have an opinion interests me. By that standard we’d be able to offer no opinions about much any clinical practice, as we certainly have more to learn. We’d have to defer to all corporate and regulatory authorities automatically – we can never know just what facts we have missed. We’d never be able to vote – need more facts.
    And as it turns out, we have plenty of indisputef facts – a BON with multiple conflicts of interest and possibly many more – what I found were only the really obvious ones in open view. We know this case is unresolved after a year. We know a transplant makes a facility hundreds of thousands of dollars more than does Hospice, and we know every corporation answers to share holders on profits. I could go on, but what more do we need? We cannot avoid a decision – we support Amanda, or we do opposite, whether actively or by abstaining.

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  9. The nursing schools in all states preach about being a patient advocate, but it seems any time you explain all options to the patient and family you are open to retaliation from the facility and the physician for lost money, if the patient chooses an alternate therapy. I believe the state boards of nursing should be protecting nurses and helping us provide informed consent.

    Rhonda, RN

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  10. MY opinion :did If the case is straight up and down she only advocated for the patient, then she should be compensated for loss wages, etc.
    I’d like to know what Ajn has done for this RN regarding the case?

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  11. I used the term ‘informed consent’ , as a description of what you did: when you realized that the patient did not really understand the situation, you provided the necessary information so the patient was truly informed about what was ahead. Is that not so? .I didn’t mean it in the sense of getting a consent from a patient for a procedure and I think that’s clear in a sentence that follows later, “She makes a compelling case that she was advocating for the patient’s right to information, and one wonders why she was fired and is under investigation.” I wish you good luck,

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  12. Amanda, thanks for the response. We will look again at the language we used, in light of what you say here, and make changes as they seem necessary.–Jacob

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  13. Dear Ms. Kennedy
    I have been staying off the blogs–except for maybe 2–and I hadnt seen yours or was aware that there was a quote I apparently made about why I was fired from Banner Health. VDuttons Posterous page was the first to post my story and I reviewed it, I dont see anywhere that I made a statement indicating that I obtained informed consent and was fired for that. When i do learning assessments i ask the patient about their medications, their current illness or why they are there, we go over teaching materials if they have them in the room, and if they are to be transferred out I ask them to verbalize to me their understanding of where they are going and why. this is how i stumbled on the fact the patient thought they were going to be zipped on over to another hospital for an organ and sent right back home to start their life all over again. no consenting was involved in any way shape or form. the concern was that the patient didnt appear to have had the information needed to consent to participation and transfer, which is what i informed my management of. Incidentally—during morning report i had relayed to the next nurse that the doc needed to be paged asap before morning rounds because of the urgent nature of the patients questions, and during my teaching the patient was provided paper, pens, and highlighters and was instructed by me to write down any and all questions for the doctor to answer the next day after we reviewed the materials. If I had indeed performed informed consent I would have been swiftly disciplined by now. The nurse investigator said my charting was thorough, my nursing diagnoses and interventions were very well documented and the only thing she disagreed with was placing the case management consult for the patient because her understanding is that a patient has to have less than six months to live in order to even see hospice—I respectfully disagreed and pointed her to information that specifies a patient can self refer, as a family member to refer, or the nurse or doctor– to see hospice for teaching and getting questions or concerns answered. Where physician involvement is needed is when the the patient and team have established that the patient is to enter into hospice care. that is when the certification of a life expectancy of six months or less has to be made by the doctor. no hospice company was called in by me nor did i talk to any hospice staff. i clicked a case management consult for hospice teaching and placed a note next to it that the patient was requesting that be done on her behalf and passed on all crucial info via SBAR to the morning nurse emphasizing a page needed to be put out as soon as possible. I thought I should clear that up, because, I dont see my function as a nurse as one that involves obtaining informed consent. It isnt my job to talk the jargon about how the operation is done or its risks or benefits. I view my job as making sure the patient can tell me what is going to happen to them, why its going to happen to them, and how whats going to happen them will affect their health/self care regimen after it happens….I hope this clears up any misconceptions…..Ive asked the team of RN supporters to go back through their blog posts to make sure they have not stated anywhere that I was fired for obtaining informed consent to prevent this misunderstanding by others in the future…….I found my copy of what was mailed to me at the beginning of all this telling me exactly what the complaint was on my license–my support team is meeting about that to decide how to release that so nurses can view it themselves. There are no limitations on that document prohibiting me from sharing it with my nurse colleagues.

    Editor’s note: As Amanda’s comment suggests, the broad wording of a phrase in the first paragraph of this post, while never meaning to suggest that Amanda had taken it on herself to obtain informed consent from the patient, nevertheless led to several misreadings and to blog posts that quoted the phrase without giving sufficient context. To avoid any further misreading or misuse of the post, we have edited the sentence to clarify our understanding of Amanda’s story, which is that Amanda gave information intended to support the patient in making a fully informed decision about the procedure in question.–Jacob Molyneux, AJN senior editor

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  14. […] by the case of Amanda Trujillo, and as stated in the American Journal of Nursing‘s blog (Off the Charts), at the heart of the controversy sits informed consent: “…she was fired for, as she […]

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  15. What’s Missing in the Amanda Trujillo Story? by @jm_healy

    http://nursingnotes.posterous.com/whats-missing-in-the-amanda-trujillo-story

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  16. With limited data, it’s not surprising that folks have come to a diverse set of opinions, reflecting individual priorities, assumptions, values, and experiences. Different parties to these debates are also likely to have little information as to what preparation others bring to the table. Personally, I spent nearly as much work studying the situation before I ever mentioned it on line, a deliberate approach that prevented any comnent on the Komen episode until the latest chapter had already come to a conclusion. Others have likely been more decisive, and also better skilled with thes tools to gather relevant data quicker than newbie Greg. I’d suggest not attacking others by assuming poor preparation or judgement or character on no more basis than a different interpretation of a complex situation than your own. Instead, we should look at available facts, relevant context, and the validity of others’ reasoning. Its a common but serious mistake to judge critical reasoning skills on nothing more than the final output. For me, passion for this case derives not from certainty re all the facts or any sense that Amands is perfect (no one is, right?). Instead, I see the response to her actions that night, regardles of interpretation, as grossly out of proportion to the facts all seem to agree on. We all err in judgement, especially if we push ourselves to do the most good possible – often work environments contribute to such errors w overwork, inefficiency, and distraction that are generally ignored in favor of individual blame. And in many difficult clinical situations, reasonable conscientious professionals can often disagree how to proceed. And a well-intentioned attempt to educate a pt and respect their wishes on a very serious crossroads with very high stakes and no turning back later with a choice like surgery, should not lead to termination in my opinion. That is a private business decision, of course, and if that were the only consequence I might never have become involved, but seeking loss of licensure is far more serious, and a public matter and open to public review, as are most all aspects of democratic governance. Involving AZBON when termination effectively ended Amanda’s involvement with Banner’s clinical operations strikes me more as a vendetta than any measured response. Letting an unemployed RNs license hang in limbo for a year, while taking inflammatory actions like the Psych evaluation we’ve discussed, also seems unreasonable and perhaps punitive. Conflicts of interest between AZBON and Banner are troublesome regardless of other facts, and inherently lessen the credibility of the process. You simply don’t have to assume you know all the facts on the ground to find this case worthy of attention.

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  17. With all due respect to RN to MD, Amanda’s patient requested the consult. Repeat – the patient requested the consult. Also, this all occurred on the night shift. Amanda left full and complete documentation on the chart AND passed along to her day shift colleagues the full report on what had transpired during the night. She also conferred with her nurse manager prior to initiating any action on her shift.

    You going to call a physician – ANY physician on the NIGHT SHIFT saying “Hey Doc, come on in, your patient has questions!”

    Answer truthfully, we’re talking real life, here.

    Clicking a button for a case management order for a consult that a patient requested does not constitute tearing apart a care plan. The patient was provided paper, pen and encouraged to write down any and all questions for her physician the next morning.

    The only problem that occurred here was that the patient actually HAD questions and wanted something different than the physician did.

    Even the nurse investigator was impressed at the amount of documentation done by Amanda on the case.

    So I’m sticking with the RN on this one.

    MD makes big ruckus and the nurses run for cover and don’t stick up for the one nurse who isn’t there to defend herself. He calls for her license, and Banner Health capitulates. Arizona BoN takes this WAY beyond where it needs to go.

    Just my humble opinion.

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  18. I feel bad for her. At all times, we juggle between being a patient advocate and following doctor’s orders. In this case, it seems like we couldn’t win doing both.

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  19. Question is “Why are nurses furious with the Trujillo case?” One reason being is she stepped out of her scope of practice. Another reason is she didn’t advocate for the patient as best as she could as a nurse. And also, she tore apart the treatment plan that the healthcare team seems to have been working very hard on. She should have FIRST consulted with the attending, the surgeon, and other doctors on the case regarding the patient’s lack of confidence with the surgery or treatment plan. Due to the lack of details of the patient’s case, this “major invasive surgery,” as Trujillo quoted, could also have been life-changing for the patient! Liver transplants have a high success rate! Trujillo should have been a better patient advocate, become a good liaison to her team members and involve the physicians in the plan to question hospice. Trujillo should’ve called the surgeon right away BEFORE calling a hospice consult (which she had without an order) and inform the surgeon and simply say, “Hey Doc! This patient needs more information from you, can you come over and explain it to them?” Maybe the patient just needed reassurance from the surgeon or maybe not. Who knows the actual details, but don’t just rip apart the team’s plan of care without consulting anybody about it. You can’t just call case management and tell them the patient needs hospice without consulting the physician or without an order. This wasn’t her decision and it wasn’t her right to alter the plan of care behind the surgeons’ back…and this is what got her fired. Her nurse manager and hospital didn’t even support her. Why? Because she made a mistake. She enacted solely without discussing the issue with her team members. Her being fired could’ve been prevented if she had just stopped being so gung-ho with, “I’m an independent nurse who can make my own orders without the doctors’ knowledge” kind of attitude. Granted, she claims this is all about being there for her patient. It was nice that she acknowledged the patient’s concerns. However, her method of correcting the issue was wrong. So why are nurses so furious like I am about this case? Its making us look like we can’t critically think before we do something that can alter a patient’s life. I understand why the surgeon was so angry at Trujillo.

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  20. Conflicts of interest in health care have become so common as to be customary and expected in many contexts, unfortunately. Regardless of intentions, good or bad, COIs cause corruption that erodes care quality and increases the bloat and waste so rife in our system.
    I appreciate this information – had been unable to find it and had to move on to other priorities. Truly, it pays to network!

    If interested, I offer some analysis and information including a plan to offer Amanda support and influence and increase the power of Nursing overall, at wp.me/s278fi-178 and other Posts on my blog, grchealthcareblog.com Amanda has recently learned of and approved this plan, although we have not involved her in it for her protection.

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  21. Thanks for covering this story.
    An observation concerning potential conflict with the Arizona Nurses Association- it appears it is the president who is an administrator at the same hospital. The person who was interviewed was the Executive Director works full time for AzNA, according to their website.

    Teri Wicker
    President, Arizona Nurses Association
    Director of Professional Practice Banner Del E. Webb

    https://m360.aznurse.org/GroupDetail.aspx?id=50755

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  22. Amanda Trujillo – Emergency Physicians Monthly

    http://www.epmonthly.com/whitecoat/2012/02/amanda-trujillo/

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  23. Why Nurses are Furious about the Amanda Trujillo Case

    http://torontoemerg.wordpress.com/2012/02/07/why-nurses-are-furious-about-the-amanda-trujillo-case/

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  24. For me the central issue is clear – to achieve our full potential and make the greatest, most positive contribution to patient care possible, we need to adjust the relationship between Nurses and other providers, especially Physicians. More collaboration and teamwork, however, will not happen, until we unite sufficiently around effective strategies to make it so. History proves: no group in a position of power and prestige ever cedes either to anyone else, until it decides such is in its best interest or has no choice. Nurses will never improve our situation by merely discussing amongst ourselves how things should be. We will have to raise our voice in unison and demand what is right. Will we make things better, or merely regret that it hasn’t happened?

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  25. Hey Greg, I agree with you about the secrecy in this whole situation, it does make you wonder. One thing I want to mention here is that this is not an unusual case in nursing. Bedside nurses are subjected to mistreatment and bullying on a regular basis. Which is why, although the story here is sad and Amanda needs our support, the issue is much bigger. It is an issue of how bedside nurses are often at the bottom of the rung and the importance of truly having a collaborative model of health care across the board. A model in which all healthcare providers are partners and work for one and one cause only, the well-being of the patient according to what the patient believes is important to them. This includes through education of the patients by physicians and the nursing staff about the treatment being proposed, its consequences, good or bad, and all the alternatives available. The key is of course a true collaborative process that puts patient at the center of the care. We have talked about such models of care for decades, they look really good on paper. Now is the time to use these models to transform healthcare from money centered to patient centered.

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  26. Mare,RN
    I appreciate your insightful look back at Rosa Parks in regard to her individual rights as well as what her bold stand did for Equal Rights. One Black Woman- who just had a strong conviction- and stood against a “system” that no one else- as one person- such as Amanda Trujillo- was willing to do.
    I am a #patient, a cancer survivor- twice. I would not have done as well, nor maybe even still be here were it not for so many dedicated and skilled nurses. I have been hospitalized many times and never realized that nurses had to deal with such pressure.
    I am an outspoken #nurse advocate, and also advocate of doctors of conscience. I’ve had very doctors who at their core are simply put, just good people. Period.

    If you as nurses stood with the nurses in the ate as case, why not now? And those of you “waiting on the “facts”, how do you know you will ever know them? Without you coming together as one body, you are all in danger of it happening to you. Quote; ”
    A house divided against itself will fall.” Matthew 12:25
    Bottom-line: If you band together now and fight to make sure the already established rule of law for nurses are kept, you will certainly not fail as individuals or as groups.
    I wish a good and just defense for Amanda TrujilloRN. The original legal statement @innovativenurse, as well as many blogs state that she was advocating for a sick person, a #patient. What of it had been you? I can tell you she has many more for her than against her.
    I wish all #nurses a good and decent place to work. You have my deepest respect.

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  27. As a graduate in Philosophy (BA) , I think Have some minor ability to assess limited data for patterns. The pattern here does not add up particularly well at face value – hence suspicions of various forms of foul play become much more reasonable than they might otherwise. To say we must hold all opinions until given all the facts by parties apt never to be fully able or willing to do so, seems self-serving and circular to the point of absurdity. We are to simply trust our corporate and regulatory authorities, as they act in secrecy? Given American and other history, the track record of blind trust for secret decision-making is rather dismal . I argue that the reasonable course in such unusual circumstances is to think like a detective with limited data: look for means and motives, and make working assumptions on which to proceed. Such pervasive conflicts of interest as seen in any corporate hospital ( primary responsibility to stock holders , not employees or customers) and in health care regulation (part of the political process currently so heavily influenced by money), coupled with such unusual known facts, render dire suspicions sadly reasonable.

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  28. Thank you for highlighting Amanda’s cause.

    This is much bigger than just this once case with Amanda.

    This is about nurses being able to advocate for their patients without fear of retaliation and losing their livelihood. Cultures in healthcare need to change. This is especially true in hospitals who will act on a tantruming physician’s request to fire a nurse for providing education.

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  29. Make a difference with this case: we can influence the outcome. Its easy to join and participate, you don’t even need to leave home. Details:
    wp.me/s278fi-178
    LET BANNER HEAR US ROAR!
    Join now!

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  30. This is pretty scary–I do believe that the more the public realizes the important role the professional nurse holds as a patient rights advocate the more the public will insist that nurses be protected in that advocacy role. For that reason I like that this case has been made public.

    Like it or not a conflict of interest exists in our country in the md/pt relationship and patients don’t seem to make that connection–I mean the person advising you to have that procedure is the person benefiting the most financially from you having said procedure. Mds & hospitals don’t like it when nurses interfere with the revenue stream. So unsettling that the Az Nursing Association isn’t supporting her.

    I’m curious–Ms Trujillo appears to be a nurse practitioner with MSN and Doctorate of Nursing Science. Was she working in an RN or NP role at the time of this incident? Not that it really should matter, as an RN I call case management in for help all the time, Mds should never be allowed to keep information from a patient…where is the medical board in all of this? Where is the MD psych eval?

    Editor’s note: In response to your concern at the end of this comment: Our initial draft erroneously had Ms. Trujillo as “DNSc-NP(s).” This was how she’d described herself in an online letter. But AJN doesn’t usually acknowledge student status as a credential, and we should have removed those credentials before posting. We’ve amended her current credentials to MSN, RN, in the current version of the post. Pardon the error.

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  31. This does not say much for the Arizona Board of Nursing and puts them in a very bad light. If any inappropriate coercion was involved surely this should immediately become a criminal proceeding and not a matter for a state board. I am therefore assuming that the patient in this case was a decision making adult and once they had made a decision, that should be the end of it. If the medic involved was unable to convince the patient thereafter about the efficacy of the procedure, that is a matter for his/her own knowledge base and communication skills. Ultimately I fear it comes down to a matter of ego. The Board does it’s reputation no good when it calls for a psychological evaluation of the nurse, whilst at the same time saying she is still fit to continue practice. If they cannot see the glaring flaw in this logic and what that says about their own decision making ability, I can only pity the poor populace of that particular state regarding the quality of their healthcare.

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  32. This case concerns me on so many levels that I am unsure which one is the priority. I am confident though one of the main messages this situation sends is that nurses should not do the right thing by the patient (patient advocacy and education)and jeopardize their own moral integrity and character out of fear of retaliation and punishment. In addition, nurses are continuously put into positions where inadequate ‘informed’ consent or factual information was provided hence nurses are left to clarify and educate the patient on alternatives, risks, etc. in effort to provide patient centered care and allow the patient to share in the decision making. It is a perilous situation for a bedside nurse as they are not the revenue generators and are not seen as customers. I am also concerned as others have stated that there is no professional support system for her or another nurses. I too can’t help but feel my state board of nursing would do the same thing leaving me to rally my own support; it does not seem just.

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  33. @JParadisiRN Thanks, I really appreciate it, and the clarification.

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  34. Getting all the facts is very important, but so is promoting nursing and supporting nurses. AJN, ANA, and the AZ State Nurses Association should be using this opportunity to educate the public about the important role nurses have in patient education and patient advocacy. In addition, they could use this crisis to help understand how not allowing nurses to practice to the fullest scope of their education and licensure impacts health care. The future of nursing is too important to stay neutral and sit it out on the sidelines. I call on AJN, ANA and all state nurses associations to use this situation to educate the public and inform opinion leaders..

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  35. @torontoemerg, our admiration is mutual. I applaud your passion. In clarification, silence is not my ONLY response to a nurse in trouble. In this case, however, I feel it is my best response.
    My hope, like yours, is for a favorable outcome for Amanda.

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  36. @Shawn: I’m not sure the difference here is as great as you make is out to be, and I would urge you to read carefully the original documentation at http://vdutton.posterous.com/94287821 or the voluminous amount of commentary and other materials here: http://www.nursefriendly.com/amanda/ . You are correct that the Winkler County nurses were cleared in their state BON proceedings. But still, they faced legal proceedings with consequences potentially far worse, i.e. a criminal record, prison term *and* subsequent loss of licence because of a criminal record record. This blog did not wait till all the prosecution’s evidence came out before making a judgement about the veracity about the prosecution’s case. True, they were innocent until proven guilty, but why does that make me think the attitude of ANA and AzNA is Trujillo is guilty until proven innocent. I’m a bit puzzled by this, frankly.

    @JParadisiRN I admire you a lot, but I think you are wrong. I’m disturbed and disappointed, in fact, that your first response, when hearing of a fellow nurse in trouble, that your only response is “silence.”

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  37. Shawn,

    Thanks so much for writing about Amanda’s case! It’s pretty clear where I stand on the matter. I am in contact with Amanda daily.

    In 34 years, I’ve never seen anything like this. Maybe I’ve just been lucky, but what they want you to do in a case like this is shut up and stay isolated.

    When you speak out or garner support, it is seen as retaliatory behavior and psych evals are requested (that is the reason Amanda was given for the eval).

    It’s like something from the Twilight Zone.

    All because a patient received information. If the patient had received the information and said, “Hey, thanks, you know, I’m am so glad I am getting this procedure, thanks!”, none of this would be happening.

    Scary.

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  38. I agree with Mare, RN……All I know is that whatever I do to another human being on this earth will be be remembered by those who DO MATTER in the end and because of this belief I will NEVER be afraid to speak up for what is right and what my patient wants!!!

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  39. True we don’t know all the facts in this case; but to me this situation sounds plausible at the least. I agree that a lot of healthcare professionals are afraid to speak out and speak up about the grey areas they are asked to step lightly over in their daily duties because they don’t want to lose their jobs, upset their co-workers with more power, or irritate administration. Let’s be honest, hospitals are a business and doctors are pressured to perform one procedure after another. Unless a physician, nurse, administrator has a strong conscience it’s easy to become bogged down by the bottom line of business and money-making in a hospital. And not every employee even realizes when this is happening, which is not an excuse to let it persist.

    This story can serve as some encouragement for healthcare professionals to look around in their place of work and see if they agree with the ethics of what takes place from day to day. Yes, you can lose your job when you speak up. That is an absolute reality. But I hope when the time comes I will understand that it is more important to live by my values and ethics as an advocate for patients and communities then to please the business people that run the hospital. Would the civil rights movement have happened if Rosa Parks just did what the people in charge asked her to do? This is truly where we are right now. As we all know, these are people’s precious last moments on earth we are dealing with – not just a number on a fee slip.

    I hope the facts about Ms. Trujillo’s case can come out. I hope she has a good lawyer who cares about justice and can therefore participate in a fair match against the powerful lawyers employed by the hospital or what-have-you. But I can definitely say that most people I see in a hospital are more afraid of losing their jobs then dealing with the ethical slips that occur daily, so they don’t say anything.

    There are so many ways in which healthcare needs to change in this country. Let’s all be agents of change and work to make it a better place to work, a place in which we would be proud for our families and loved ones to be cared for. For example, would you want your mother cared for at a hospital where one nurse is in charge of 10 sick patients on a tele floor? How about working at a hospital where the radiology receptionist is being asked by his manager to help transfer an obese patient onto an MRI table? Does that sound right? Wake up! This is happening people! Little exceptions often slowly or quickly lead to big breaches of ethics.

    From the rural community hospitals, to all county hospitals, to all private hospitals and more, we have a responsibility to our communities to improve delivery of care in spite of the powers that be. We can do it and it needs to be done.

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  40. Well stated, Shawn.

    Remember: in the case of the Winkler County nurses, the TNA became involved because the two nurses were criminally indicted for misuse of patient information, not because they were fired. Neither were the licenses of either nurses called into question before the Texas BON. The internet uproar surrounding this case supported Texas’ Whistle Blower Laws, and defense of colleagues wrongfully charged with felony within the court system. Their licenses, albeit their livelihoods, were not in question.

    State Boards of Nursing may not be perfect, but they are the established method of self-regulation in nursing.

    I am following the case of our colleague, Amanda Trujillo. Unanswered questions lead me to keep my opinion to myself for the time being. Until more information is available, my support of Amanda Trujillo is silence.

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  41. We did get the facts in the Winkler case – and that was vastly different, as it was CRIMINAL charges brought against nurses after they were exonerated by the Texas Board of Nursing. (The Texas Medical Board also supported them.)

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  42. Incidentally, this blog had no compunction about “getting all the facts” and “both sides of the story” before the Winkler County nurses trial concluded. I think the blog pretty encouraged readers to contribute to their legal defence fund.

    I could engage in some snark about the difference being these nurses were managers, but you see the point.

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  43. I am so glad to see that AJN is following this story. We do need the facts but we need the support so much more. Support for nurses through our trials from a reputable organization like AJN will set the tone that we do care about each other and our profession. Physicians do it all the time. It’s long overdue that nurses do the same.

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  44. […] http://ajnoffthecharts.com/2012/02/02/the-case-of-amanda-trujillo/ Share this:MoreLike this:LikeBe the first to like this post. […]

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  45. I think this answer, i.e. “we must wait for facts through a formal adjudication process” is pretty much a dodge and an evasion. Either Trujillo is cleared of any misconduct, in which case, hey no problem, or is found guilty of misconduct, which, from your point of view, would settle the matter. Either outcome means both the ANA and the AzNA have to do, well, nothing.

    In the meantime, who advocates for nurses? Not only Trujillo, but the many other nurses who are victimized by their employers?

    What has been an eye-opener in all of this has been the utter failure of nursing’s formal leadership to advocate for front line nurses. By taking a position of “neutrality” the ANA and AzNA effectively support managerial/corporate abuse of front line nurses — and front line nurses are left to wonder who really supports *them*.

    To say this is disillusioning would be an understatement.

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  46. Im trying to remember the goal of the Arkansas sbn. “Protect the public and act as their advocate by effectively regulating the practice of nursing.” That doesnt mean protect nurses to me and it has always given me pause. I have never felt the asbn would be there if I were in a situation such as this. I have been close and had to make the best decision I could, then just ‘white knuckle’ through the fallout afterwards. So far I have survived. I do put money in savings, In case my luck runs out.

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