It might be hard to believe in this day and age of “participatory medicine” and empowered patients — or in any day and age, really — but the fact is that an Arizona-based nurse was fired from her job recently for simply providing a patient too much information on his treatment options.
The nurse’s name is Amanda Trujillo, a single mother living in Phoenix, and licensed nurse in Arizona since 2006. She specializes in cardiology, geriatrics, and end of life/palliative care. The supposed sin she committed was setting up a consultation on hospice care for a patient suffering from end-stage liver disease, who was scheduled for surgery. This “interference” angered the patient’s physician, who then had Amanda fired and reported her to the Arizona State Board of Nursing, where she is now in danger of losing her nursing license. Fellow health care professionals and patient advocates are flooding the blogosphere in support of her cause!
Envisioning this in “our world” for a moment, imagine that a nurse or diabetes educator gets thrown to the wolves this way just for helping you learn about your alternative choices for dialysis treatment or in-home diabetes care.
“This issue isn’t only about Amanda, it’s about the American public,” writes one prominent nurse-blogger. “The health care industry is trying to bully nurses into not talking about abuses in the system and they will stop at nothing to achieve their goal. We will not be silenced. Strong patient advocacy makes for stronger patients who have more control over their own health care decisions. The American public has a right to know.”
Apparently the issue was that the patient in question “had no clue about what they were about to participate in when they agreed to get a major invasive surgery,” Amanda writes. “When I properly educated the patient using the allowed materials by my employer they became upset that the physician never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). 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 and I educated the patient within my nursing license and the nursing code of ethics.”
The primary physician at Banner Del Webb Hospital in Sun City West (where Amanda worked) saw it otherwise, as did the nursing director who eventually fired her. She told Trujillo she had “messed up all the doctors’ hard work and planning for the surgery.” Thus, the patient-requested hospice care consult was cancelled.
Hospital spokesman Bill Byron says their company policy prevents nurses from ordering a case management consult. “The doctor, ultimately, is the focal point that directs care for patients,” he said
As someone concerned with patient advocacy myself (shouldn’t we all be?), all that comes to mind here is WTF? Who cares if the doctor or nurse orders the consult, as long as it’s in the patient’s best interest? This sounds like a case of big swinging doctor egos, if you ask me.
Indeed, the complaint filed with the Arizona State Board of Nursing states that Amanda “exceeded her scope of practice.” If the Board finds that this is true, Trujillo could lose her license, and will be unable to work as a nurse. Can you imagine…?
Over at KevinMD, one of the most respected physician blogs, a nurse guest blogger writes: “The issue boils down to whether the health care industry can 
tolerate highly educated, vocal, critically-thinking, engaged
Exactly!!
But it gets even more upsetting:
Since her firing in April 2011, Amanda has brought attention to her own case with a letter-writing campaign, and reaching out to other nurses and bloggers.
The Arizona State Board of Nursing has issued a statement claiming that Amanda’s campaign to defend herself constitutes “retaliatory behavior” and has therefore ordered a psychiatric evaluation. Can you imagine…? So now they’re claiming she’s just nuts?
And what’s more, the Arizona State Board of Nursing also chose to notify the doctoral program in which Amanda is studying of the investigation — although they waited 10 months to do so. Sources say that is never proper procedure while any investigation is underway.
This whole case has spurred a huge debate about nurses overstepping their bounds, and possible “abuses of power.”
But her peers seem to stand in overwhelming support of her, in apparent agreement that the Arizona Board of Nursing “has gone from ridiculous to abusive in the Amanda Trujillo case.” They’re now charging her with using false credentials because she had added some medical alphabet soup to the end of her personal email signature — albeit with an “S” designating student. In other words, they’re pulling out all the stops to disgrace Amanda into silence.
“Let’s remember what brought this all on,” writes Kim at the popular nursing site Emergiblog. “An informed patient. A change of heart. A fuming physician.”
I don’t know about you all, but if I were on my death bed and had questions about my care options, I’d want someone like Amanda by my side.
Is there any way we can show our support as well? As a patient this is frustrating that a member of your care team would be fired for looking out for your best interest.
It doesn’t surprise me though. I once had my primary Dr call and leave a message berating me about getting a second opinion from my gastroentrologist about a proceedure he wanted to do. My primary physican accused me of not trusting him. I wish I could say I found a new Dr then and there – I was young and naive. It took me awhile to replace him.
I would much rather have a nurse like Amanda on my side also. I wish doctors would learn to check their egos at the door.
Amen! Especially Surgeons!
Thanks for posting about this, Amy. While I relate to Amanda and what she is going through as a nurse, this case is 100% about patient advocacy, and that IS in our scope of practice. When it becomes a career-ending move to set up a referral that gives a patient the opportunity to just TALK to someone, we are ALL in trouble.
too many doctors are seriously full of themselves! the best care for me is what I choose after being given all the options!
This is such a universal topic and it deserves our support. What happened to Amanda has happened to many other nurses, the difference here is she sought support and didn’t stay quiet. And, I venture to guess what happened to her patient has happened to many others…did they ever find out they had options? It’s been said over and over, but one of our main jobs, as nurses, is to teach. It is mandated from the first days of nursing school and clearly falls in our scope of practice. Amanda didn’t order surgery, or medications or any other medical intervention. She “ordered” someone to come and talk to the patient about options. She comes before the Arizona BON in the next two weeks. I for one, will be standing behind her.
You know it has happened to other Nurses. I am Retired RN that would sure like to share my stories of how you are to keep Quiet to keep your JOb. I still have regrets that I did not go to the Media when my patient was Raped! I knew I would not have a job after that. I too had a family to support. I live with that guilt!
My guess is that the surgeon got pissed to lose a patient and the hospital administrators don’t want that to happen. Just speculation on my part but I wouldn’t be surprised. Or else there is more to the story. How utterly ridiculous!!! Did the patient go through with the surgery?
The doctor’s name should be public.
I so agree, David.
Amanda Sue the doctor and get his name in Public Court Records!
All of Amanda’s supporters greatly appreciate your fine work, and your support. A small but growing on-line group has developed, and out efforts to date have been hampered by our need to learn as we go, and the limits of our reach. My own blog is perhaps the youngest in the group: I started blogging and Social Media involvement in January, and the results have been gratifying and exciting. Otherwise I may well have not even heard of this important and compelling case. I was quite skeptical at first, as I am generally with all media reports, but my extensive research has built my confidence in Amanda’s cause, and its relevance to all Nurses and patients, and to all Americans who care about corruption in health care and government.
Part of my research has been into the AZ BON rules, and I have submitted three public letters to AZ Governor Brewer to date, suggesting need changes to protect the public interest. (E.g. see http://wp.me/p278fi-gj ). There has been no response, except for a perhaps not coincidental increase in the seeming abusiveness of AZ BON towards Amanda. My careful review of AZ BON rules, by the way, indicate no restriction on public comment by the accused – none. In fact, Arizona law allows “any person,” whether AZ resident or not, to file requests for AZ BON rules changes as I have suggested to Governor Brewer. To date, Arizona’s admirable efforts towards Government transparency and accountability have, in my view, been thoroughly trumped by conflicts of interest between AZ State government, esp its BON, and corporate interests in health care. A pro-business position, when it becomes anti-ethics, anti-Nurse, and anti-patient, is completely unacceptable and unAmerican, and all Americans owe it to each other as citizens and ethical human beings to fight to address such wrongs.
My blog also includes relevant legal precedents, other cases of Nurses abused for advocacy, AZ government and Banner Health contact information, ways to contribute and participate, and suggestions to put pressure on all involved parties to to the right thing at long last, in for no other reason than to avoid further bad publicity affecting Arizona business and tourism. Personally, until this case resolves appropriately, I must suggest that any Nurse considering work in Arizona strongly consider the risks involved. I suggest the same to anyone considering becoming a hospital patient: when advocacy and education are suppressed for power or profits, it puts all patients at risk of poor care and abuse.
This appears to be an issue of “trying to right a wrong” versus “overstepping one’s bounds”. In this case, and in many cases, I believe the former should excuse the latter.
As I see it, there was no malice here (by Amanda), she was only trying to fill in some huge gaps left by a patient’s doctor, hence trying to right the wrong.
Thanks for posting about this, Amy. Such an incredible travesty of the nursing profession. I, too, would very much like to see the doctor’s name public.
I would like to have the doctor sanctioned, if the report is true, that s/he did not adequately consider the patient’s desires and/or understanding of what the doctor was proposing. Last I heard, informed consent was still required to do medical procedures, no? Sounds like the doc sidestepped that…..
Amy,
Thank you so much for giving this issue a voice–because it needs to reach as many healthcare providers and patients as possible in order for change to occur and for patients to get better care that is indeed focused on them and their unique needs and wishes for their lives and futures. If anyone has more question or would like any more details I can be reached via Greg, Kim’s, or Jennifer’s blogs(Emergiblog, RNCentral, GRC) for further comment. Thanks again!
Here is a petition
http://www.change.org/petitions/arizona-state-board-of-nursing-remove-amanda-trujillos-nursing-license-from-under-investigation-status
@Amanda – thanks for the petition link. We are promoting it via FB & Twitter now.
Ironically, I am reviewing a paper at this very moment for the Journal of Participatory Medicine that states, in part:
“Patient-centered care is an approach to care delivery in which the work of providing care is reorganized around what patients want and need, rather than around the convenience of the organization and its clinicians and staff.”
Hello, Arizona HC Professionals!!
if the hospital administration and the doctor say that “amanda went overboard” (just by informing the patient about his health condition, surgery and post surgery care)
Den just ask the hospital administration that the doctor did not discharge his duty of informing the patient fully about the health condition, surgery, surgery complications and alternative course of treatment !!
If the patient would have come to know about these things they might have sued the hospital and doctors license would hav been taken away or a huge compensation would have been given ..
bottomline amanda is hero in real sense !!
The doctor was only worried about his next Boat Payment or such!
10 yrs ago my father in law was dying from colon cancer. NO, he had not been to the doctor. We all knew he was dying, but until after he passed, we were not sure from what (stomach cancer/colon or liver). He knew he was dying. He didn’t believe in doctors or hospitals and won’t go. Finally his heart stopped (at home). They brought him back and sent him to hospital. Shorten story: The doctors wanted to run all these various test to determine type of cancer, etc. The man had hardly eaten anything for weeks. Suddenly they wanted to have him drink over a gallon of crap so they could ‘track it’ through his system. All of this was torture for him & my mother in law. (the man was 89 – good health other than cancer). A nurse pulled me aside & told me what all these test would mean to the man’s body and the fact that there was a 50% or higher chance he would not survive the one test because it would be way too much for his system. Then she informed me that if my Mother in Law told them that she did not want the test done and she was taking him home, that they couldn’t force him to stay. I shared the -’whispered’ news with my mother in law. She made the decision to take him home. He lived another 2 months – in very little pain – and he just slowly slipped away one evening. I was so thankful for that nurse. My Mother in law was so thankful. She knew it was what my father in law would have wanted. All four of his sons were thankful. At a time of emergency, you don’t normally think about some of the questions you should be asking: ie: how will this test/surgery affect him? What will be the long term results from these test/surgery? How will it help him? And yes, in todays world, How much will this cost? And because we are not thinking clearly it puts us (the family and patient at the mercy of doctors), nurses are our only – ONLY – protectors. Praise God for all those who are willing to take a stand and think about the patient instead of their own pocket book or ego. Praise God for them one and all.
As we all know doctors do not explain any procedure,that is left to the nurses.It has been that way from as far back as I can remember under patient teaching..Is ther something missing in this story..Every facility has it’s policy and procedure..Is their policy nurses are not to do patient teaching?WOW, it would be nice for doctors to start teaching their patients on their procedures ,that they will be preforming..I was all ways toldthat nurses are advocates for their pts..
Any hospital I ever worked at in later years! The Nurse was no longer to take the Operative Permit for the patient to sign.
The Hospital Policy was for the DOCTOR to present the patient with the Consent Form and answer the questions. Sorry the nurse is still doing it like we always knew it would be done.
Actually the nurse is to really only witnessing the signature. You are to ask the pt. did the doctor explain the procedure to you? Do you fully understand it? If they have no further questions then nurse is ok to get the signature witnessed. If they have further questions you are to actually stop because then you no longer have an INFORMED CONSENT. Because pt does not fully understand the procedure with all risks etc explained to them. It then is beyong your scope to explain a surgical procedure to a pt. Now, what I am seeing today is SLOPPY, SLOPPY SLOPPY on the surgeons part. Do they explain anything to the pt let alone the family? Heck no! Things are so rushed, it makes me sick. But if my pt or family still has questions or I can tell they do not understand what is going to be done, I STOP. I wait for the surgeon to come and talk to them. Do I piss off some surgeons? Heck yes! Do I see OR nurses step outside of their scope of practice to appease them and explain the surgical procedure? You bet! It is ugly out there. Surgeons on the whole are miserable creatures.
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I really wanted to sign that petition but I got the above error. Sigh.
Amanda, I am not surprised a DOCTOR trumpted you when push came to shove. As a retired nurse that graduated in 1966, I well remember the rule that if a Doctor came to the nurse’s station we were to get up and give HIM our seat. I am sure that I would be fired for some of the thoughts and actions I would have in this day and time. Nurses have long suffered by the hands of doctors and many times by Nurse Supervisors. I do have to admire the California nurses. All I hear and read about them says they go after their Rights.
The thoughts of your firing bring back a lot of hurtful thoughts during my years as an RN. Keep fighting! I am new to your situation but would like to learn more and help in anyway I can at this time. Patricia A Sheley
Get up and give him your seat? What the heck is up with that? No wonder so many nurses are ok with being abused. I’ve always said it is a certain personality that goes into the field of nursing. Boy did I make a wrong turn. Surgeons especially love those types of nurses to give up their seats for their royal behinds. Well not this nurse. I’m looking for my exit door asap!
We just created a petition calling for a boycott of Arizona tourism and other business, as well as on Nurses seeking education or employment there, until the abuse of Nurses and pressing defects in Nursing regulation are addressed, because we care deeply about these very important issues.
To start, we are trying to collect 100 signatures and spread the word absolutely everywhere and ASAP, and I could really use your help. We anticipate much greater numbers soon, as we are only just today beginning to reach out for this campaign.
Regardless of outcome, our message will be heard by every news outlet and business and civic group in Arizona very soon, as well as every venue for conventions, tourism, and entertainment. Some national politicians and journalists have expressed interest, as have multiple groups in Arizona: those in favor of your recall, immigration activists, and so one. To think, we only started yesterday, and only started spreading the word in earnest today. We’re well on our way to the next Komen: exciting times indeed!
To read more about what I’m trying to do and to sign my petition, click here:
http://www.change.org/petitions/governor-state-of-arizona-address-corrupting-factors-in-the-arizona-board-of-nursing?share_id=qRDrhNqFSw&pe=d2e
It’ll just take a minute!
Once you’re done, please ask your friends to sign the petition as well. Grassroots movements succeed because people like you are willing to spread the word!
Thanks for your consideration,
Greg
Former nurse here who whistleblew, was fired, blacklisted and am now destitute and unemployable. What is happening to her is the NORM. Not the exception. Nurses and physicians cannibalize those who lack the professional autonomy and influence to protect themselves as they advocate for patients.
What can you do? Get appointed to the state board of nursing. Be physically present with the nurse as she goes through this ordeal. Stand with her and offer employment/means to support herself as she is professionally ostracized. Demand the right for nurse and physician employees to enjoy adequate collective representation.
What most likely will happen?
She will be abandoned, will have her career/earning potential/home/family/finances ruined.
With ostracism comes health problems, and half of affected people consider suicide.
Our respective professions in healthcare are intrinsically co-dependent, and unpleasant personal and professional engagement in Karpman’s Drama triangle is a regular and subtle entanglement. Egos and fears are rampant until we detach; few manage to do so.
So to all parties: judge not lest ye be judged, and apply the golden rule. Forgive and be forgiven; even if there is a worldly lesson to be learned.
As far as being a hero, that title belongs after the conversion of understanding takes place, the old person left behind.
My anger almost killed me. Remission and recovery — “cure” — are not the same thing.
MAL
Thank you for following Amanda’s case, here is the latest:
Red Flags & Questions I See in the Amanda Trujillo, ARNP Case, April 25, 2012 By Beth Boynton:”Amanda Trujillo is an ARNP yet was practicing as an RN. Now maybe there is a perfectly good explanation for this. Third shift is typically tough to staff and given our economy and the financial needs and family commitments, perhaps this was a perfect job opportunity for Amanda. But, honestly, I wonder why she wasn’t practicing as an ARNP rather than an RN? Scope of practice is an important issue in the case and quite different for RNs and ARNPs. Banner health could face serious liability issues if their RNs on duty are practicing out of scope.”
http://www.confidentvoices.com/2012/04/25/red-flags-questions-i-see-in-the-amanda-trujillo-arnp-case/
Thank you Kathleen for following Amanda’s case. Here is the latest.
The War Against Amanda Trujillo, April 25, 2012, Mother Jones, RN, Nurse Ratched’s Place:”I still support Amanda Trujillo and some people who have read the allegations against Amanda have questioned my judgment. Frankly, I don’t believe these allegations because I personally know two other nurses who have been reported to their nursing boards by their former employers. One of my friends was reported to the BON after she spoke up about unsafe nursing practices at a shady nursing home, and the other was reported after he chastised hospital administration for placing psychiatric patients and staff in an unsafe environment. Their former employers cooked up all kinds of false allegations against my friends who are both stellar nurses. Their former employers crucified their character, but in the end they were both cleared of any wrongdoing by their respective state nursing boards. There is an escalating pattern of abuse as more unscrupulous employers are using nursing boards as the ultimate scare tactic to keep nurses “in their place. ” Amanda is just another victim of this ploy.”
http://www.nurseratchedsplace.com/2012/04/the-war-against-amanda-trujillo/
Thank you for following Amanda’s case, this is from her blog.
The Moment of Impact: April 21, 2010: by #AmandaTrujillo, MSN, RN, #nurseup #nursefriendly #healthcare:”The day my life collided with something greater than I could ever wrap my head around in this lifetime…..I heard a quote recently that conveys the enormity of the year’s events…its message, perfection, but not in the way I would like to envision life perfected, the way I want it, the way I wanted it, the way I thought I had it…..in any case, I like this quote because it encompasses the past, the present, and the future all at once.”
http://nurseinterupted.wordpress.com/2012/05/09/the-moment-of-impact-april-21-2010/
The day that changed Amanda’s life forever. To follow her case and others, kindly visit http://www.nurseup.com
The latest on the case:
Facing a Crossroads, #AmandaTrujillo, MSN, RN & the Arizona State Board of Nursing:”At the heart of Amanda’s case is Patient Advocacy. Her patient was having second thoughts about a Liver Transplant evaluation, and Amanda helped fill in the gaps. The doctor, Dr. Keng-Yu Chuang (Source AZBON public records), who had only offered the liver transplant, went ballistic when the patient asked for Hospice info instead. He demanded the hospital serve Amanda’s head up on a platter and that the Arizona State Board of Nursing be contacted.”
http://nurseup.com/wordpress/?p=2850