By Shawn Kennedy, MA, RN, AJN editor-in-chief
Amanda Trujillo
Our 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, analyzing, and weighing in on the situation, including statements from the Arizona Nurses Association and the ANA, and a post on a physician blog, “White Coat’s Call Room,” which has vowed to carry all the details once the case is decided.
One complaint raised by several people in response to our post was that the Arizona Board of Nursing wasn’t supporting Amanda. State nursing or medical boards are regulatory boards that exist to ensure the protection of the public and to regulate professional practice according to the law (in nursing’s case, according to nursing practice acts). They do not aim to protect the individual nurse, but to assure that all those who claim to be nurses are eligible to claim that title and practice within their scope of practice as defined by law.
Some historical context: Regulatory boards were set up back in the early 1900s, after nursing associations successfully lobbied for registration laws to keep out unqualified women who posed as nurses. In 1903, North Carolina was the first state to enact a nurse practice act; by the mid-1920s, all 48 states had laws regulating who could practice and who could use the title “registered nurse.”
Thus, boards of nursing are intended to protect the consumer and the standards of the profession.
While I agree with several comments saying that nurses should be able to practice within the full scope of their education and training, as recommended by the Institute of Medicine Report on the Future of Nursing, what’s also important to keep in mind is that we must do so in accordance with the law—which unfortunately may not always measure up to our ideals or accurately reflect actual professional practice.
Nurses and state associations need to work to change the law where it needs to be changed—and there are many people who devote themselves to making such change happen—but until the law does change, this is how nurses’ actions will be judged, whatever other motives may appear to be in play or not.
(Editor’s note: A few readers have misconstrued the last paragraph as implying a judgment in the Amanda Trujillo case. This is by no means the intended meaning. The focus here is a more general look at the roles of boards of nursing and the importance for all nurses of not leaving themselves vulnerable to accusations of going beyond their scope of practice, as it has been defined in a particular state’s practice acts. Further note: The Arizona Board of Nursing did subsequently release the Notice of Charges against Ms. Trujillo to those who requested a copy. It can be found via a link in this post from nurse/blogger Not Nurse Ratched.)
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.
I just found out about this case–I am only a very part time RN now and have moved over into Medical Librarianship. I am appalled. Not at Amanda’s excellent nursing and pt advocacy–from what all I have read, she seems to have been an outstanding RN. I am appalled at the hospital’s decision, and the BON. I cannot say I am surprised by the BON, which has never been an advocate of nurses in any state. They are more like a watchdog organization, which is all to the good, but at times, they become a political tool of the powerful. Poor Amanda must have truly angered some influential people. I also don’t find the glacial pace of the BON surprising–deplorable, wasteful and expensive, but not surprising. I don’t know anything about being an RN in AZ, but I know now that I’ll never be one!
Every story has (at least) two sides. But to call for a psych eval? That ALONE triggers all manner of red flags for me. Calling someone crazy, especially a woman, is the last bastion (would that it were truly last) of a weak opponent. I am so very glad Amanda has lawyered up. I do hope she takes the hospital and the MD, and perhaps even the BON (although they probably have some kind of state level immunity) for enough to make them all think twice about impugning an RN’s reputation and a profession’s integrity. Stay strong, Amanda. You’ll need that strength-and that is a sad commentary on a supposedly caring profession.
RJ – Exactly!!! You ask perfectly legitimate questions. What WAS the policy of Banner? Why were previous orders for the same thing (case management hospice consult), placed by Amanda, not met with disciplinary action?
Why was there a box for “Nurse Order” by that very thing?
Why has something so cut-and-dried taken almost a year to adjudicate? Either she was out of her scope of practice or she was not. Why does this entail a microscopic examination of her entire career and a psychiatric evaluation?
The Arizona Board of Nursing spends an average of 7 months and 17 hours of time on a case. No patient was harmed, no patient died as a result of Amanda’s actions.
So why is this taking so long and why is she being put through so much?
She must have made someone very powerful very angry. Or as she was told when she was fired (and I’m paraphrasing), she messed up all the doctor’s “hard work”.
Seriously.
i turned in the policies i had printed out and submitted them to the board via my previous attorney to show proof there was no specific policy in place and in addition to that highlighted where in the nurse practice act my actions fell under….this wasnt an issue of informed consent, there was no discussion of risks benefits or surgical jargon. it was a conversation, my learning assessment of the patient, that clued me in to the big knowledge deficit. the consult was for a hospice case manager to come and answer questions the patient had. patients do not need permission to access hospice for education to help them make decisions. they do, however, require the physicians lead and involvement in signing up for hospice care. the night nurse manager was consulted by myself regarding the concerns i had as well as my care plan.
Amanda, while we never intended to suggest that you had directly sought to obtain informed consent from the patient yourself, we understand your vigilance on this legal point, and have added this fact as clearly as possible in parentheses in the first paragraph of our original post.
Why isn’t anyone asking what the institutional policy of Amanda’s former employer was regarding who can order hospice consults?
As a surgical nurse, I know that it is the surgeon’s responsibility to discuss with risks, benefits, and alternatives to treatment with patients–this constitutes informed consent. Nurses may teach, advocate, and assess a patient’s understanding of procedures.
As a side note, nurse practice acts (which define scope of practice) vary greatly from state to state. Has anyone looked to see what exactly is permitted in Arizona?
Well said, Sallie.
This is a time for nursing to come together not fight among ourselves. We all need to support the nurses duty to provide patient education and patient advocacy as well as to advocate for the legal right for RNs to practice nursing to its fullest scope, regardless of the setting.
all bets aside we are taught in nursing school to give our patients all the info and options out there and let them decide to bad the doctor and hospital lost money Amanda did her job
Shawn Kennedy, Where Did You Learn About Informed Consent? Kindly Correct!
http://nurseup.com/wordpress/2012/02/shawn-kennedy-where-did-you-learn-about-informed-consent-kindly-correct-amjnurs-shawnkenajn-nurseup-amandatrujillo-nursefriendly/
Editor’s response:
Vernon, the headline of the post you are linking to is manipulative. It should be clear from Shawn’s subsequent comment and the rest of her post what she meant and didn’t mean by “providing informed consent.” What is the intention in taking words out of context, in suggesting that she meant the phrase to mean more than providing information supporting fully informed consent to the patient, as is a nurse’s ethical responsibility?
We may or may not decide to amend the phrase to make it impossible to deliberately misconstrue it or take it out of context. But it’s disingenuous to pretend a reader can’t understand what was intended, and not at all clear what anyone can gain from such an aggressive approach to those who consistently support nurses and clearly know the meanings of various terms.
How is the Arizona BON protecting the public by going after a nurse who educated the public? I think they are protecting a hospital who fired a nurse because she impacted their profit margin. I appreciate your interest in this case and I look forward to your updates.
One of the first things I learned as a nurse was that Boards of Nursing were there to protect the public, and as someone put it to me, “make sure nurses toe the line.” Crude, yes, but accurate.
So, my expectations of BoNs have always been realistic. My belief that they are fair and impartial in their work may not have been realistic.
Despite being a nurse for over 10 years it dawned on me after getting involved in the Amanda Trujillo story that I wasn’t really clear on what my BON does. I learned quite a bit researching my own blog on the topic for RNCentral.com
http://www.rncentral.com/blog/2012/boards-of-nursing-who-do-they-stand-up-for/
I think if we, as nurses, really want to see change in our rights to practice it will only be through bringing our concerns to our BONs and becoming more active in their process.