RE:Connect

A blog written by oncology nurses for oncology nurses

RE:Connect

The Case of Amanda Trujillo

[By Carol Cannon, RN, BSN, OCN]

I know I’m a lit­tle late to the meet­ing, but I recently was cap­ti­vated by the story of Amanda Trujillo—a nurse from Ari­zona whose license is under inves­ti­ga­tion for what she claims was her role in edu­cat­ing a patient. One can eas­ily spend hours read­ing her story and pub­lic opin­ions online, but essen­tially, it started on the eve of her patient’s surgery.

Amanda and her patient were dis­cussing the surgery and its com­pli­ca­tions, and she noted gross inad­e­qua­cies in the patient’s under­stand­ing. So, Amanda edu­cated him. As a result of their con­ver­sa­tion, the patient decided to delay the surgery and con­sider alter­na­tives. She ordered a case man­age­ment con­sul­ta­tion for the patient to be edu­cated about hos­pice care.

The patient’s physi­cian said this was out of her scope of prac­tice and demanded nurse Tru­jillo to be fired and stripped of her license. He also denied the patient access to the hos­pice team. Amanda was fired from her posi­tion, and although her license remains active, it is under review mak­ing it nearly impos­si­ble for her to find another job.

What first came to my mind when I read Amanda’s story was fear for my own license. I put myself in Amanda’s shoes. If I felt that my patient had not been fully edu­cated regard­ing an upcom­ing pro­ce­dure or treat­ment, I cer­tainly would be com­pelled to con­tinue the edu­ca­tion to the best of my knowl­edge, and refer the patient to appro­pri­ate resources in areas that I was not well versed.Providing con­tin­u­ous edu­ca­tion and rein­force­ment is sec­ond nature to nurses. We are patient advo­cates. It would be far worse to have a nurse who was indif­fer­ent to the patient’s knowl­edge of his plan of care. Isn’t patient auton­omy valued?

Per­haps the most dis­ap­point­ing piece of this story is that Amanda does not feel sup­ported by her pro­fes­sion. Instead, she feels alien­ated by for­mer cowork­ers and the Ari­zona Board of Nurs­ing. Amanda has made her story very pub­lic. There seem to be very few com­ments from the hos­pi­tal who fired her or the Ari­zona Board of Nurs­ing, but I eagerly await more news of this case in March. I encour­age you all to fol­low it as well and to sup­port a fel­low nurse. I recently read that nurs­ing is the sec­ond largest pro­fes­sion after teach­ing. That means that we are a pow­er­ful group. We can be vocal. We can be loud. Let’s be heard.

No related posts.

Carol Cannon Carol Cannon, RN, BSN, OCN currently works as a Clinical Research Nurse on an oncology/hematology/stem cell transplant unit. This is her first experience in oncology nursing, with previous experience in cardiology and critical care. She is constantly amazed at the level of education, empathy, and stamina that oncology nursing demands every day. She lives with her husband and their German Shepherd in Bethesda, MD, where she enjoys cooking and reading. Read more articles by Carol Cannon --

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Comments

  1. February 17, 2012 at 10:08 am
    Crystal F. Spellman says:

    I think this really dove­tails nicely with some of the other posts that have shown up on RE:Connect the last few weeks, par­tic­u­larly Alene’s entry last week com­ment­ing on the power of social media to insti­gate mean­ing­ful change.

    The US Bureau of Labor Sta­tis­tics reported about 2,618,700 reg­is­tered nurses in 2008 (http://​www​.bls​.gov/​o​c​o​/​o​cos083.htm). In con­trast the total num­ber of physi­cians and sur­geons reported by US Bureau of Labor Sta­tis­tics in 2008 was 661,400.

    There are so many of us, yet we con­tinue to strug­gle to get our voices heard. I think Dr Trujillo’s case is a great place for us to start. Thank you for for this post.

  2. February 19, 2012 at 10:06 am
    yoganurse says:

    Carol, I have been fol­low­ing this story too and help­ing to advo­cate aware­ness in the nurs­ing community.

    Your post is one of the best I have read. Con­cise. You Wrapped up the story in a few para­graphs that really touched me.

    Nurses are the sin­gle LARGEST group of health care providers...we have the LARGEST voice...I have been call­ing out to nurses for years to be heard.

    Since when is offer­ing patient edu­ca­tion when there is a knowl­edge deficit a crime?

    The real crime is the mess of our cur­rent health care and the liti­gious & profit dri­ven sys­tem we all work under includ­ing the doctors.

    Time for a rev­o­lu­tion and unity con­scious­ness based on a model of car­ing and ser­vice ver­sus a model based in fear and greed.

    thanks for let­ting me share my voice.

  3. February 19, 2012 at 10:45 am
    Patty Hedrick RN BSN BA CRRN CCM CLCP says:

    Carol,

    Very well said and excel­lent points. As I read about her case, it made me fear for my own RN license and other nurses too, because many of us would have done the same thing. Patient edu­ca­tion is one of our fun­da­men­tal roles as nurses.

    I would never want a patient to have a surgery of that mag­ni­tude, with­out mak­ing the effort to make sure they felt they had been fully informed.

    I don’t under­stand why the Physi­cian isn’t being rep­ri­manded. Isn’t it part of their Stan­dards of Care that the patient is fully informed?

  4. February 21, 2012 at 12:48 pm
    Lynn Goodman RN,BSN says:

    Patient edu­ca­tion is a fun­da­men­tal basic of nurs­ing care. Upon assess­ing any new patient the first step is to asess knowl­edge base and cor­rect mis­con­cep­tions. To not do so would be a trav­isty. The deci­sions made by the patient should be founded on informed con­sent. If the physi­cian does not com­pletely inform the patient of all of his/​her options, the respon­si­bil­ity falls to the nurse. Amanda should be applauded for doing her job. She deserves the sup­port of every nurse in the coun­try. This sit­u­a­tion is out­ra­geous and and insult to all nurses. It is an attack on the very core of our profession.

  5. February 21, 2012 at 4:14 pm
    Richard Willner says:

    Yes, via Face­book I came across this very inter­est­ing case. The Cen­ter for Peer Review Jus­tice is inter­ested
    in this. I would love for Amanda to get this post or for oth­ers to con­tact us by email.

    Thank you

    Richard Will­ner
    The Cen­ter for Peer Review Jus­tice
    http://​www​.Peer​Re​view​.org
    info@​PeerReview.​org
    504−621−1670

  7. February 21, 2012 at 6:31 pm
    Andrew Lopez, RN says:

    Carol, thank you for chim­ing in on the Amanda Tru­jillo case. It is highly dis­turb­ing that a nurses career could be destroyed at the “Whim” of an angry physician.

    Please visit http://​www​.nurseup​.com for more information.

    This is an arti­cle from the Past Pres­i­dent of the Amer­i­can Asso­ci­a­tion of Legal Nurse Consultants.

    Amanda Tru­jillo – Nurse fired for being a patient advo­cate, @PatIyer, #nurseup #aman­da­tru­jillo #nurse­friendly
    http://​www​.avoidmed​icaler​rors​.com/​2​0​1​2​/​0​1​/​a​m​a​n​d​a​-​t​r​u​j​i​l​l​o​-​n​u​r​s​e​-​f​i​r​e​d​-​f​o​r​-​b​e​i​n​g​-​a​-​p​a​t​i​e​n​t​-advocate/

  8. February 21, 2012 at 11:35 pm
    colleen obrien says:

    Today I met and sup­ported US Con­gress­man Steve Israel’s bill HR3790 to have Medicare cov­er­age for an edu­ca­tion ses­sion with a oncol­ogy nurse for can­cer patients.Generally most insur­ance com­pa­nies fol­low Medicare’s lead. This will val­i­date the role of the nurse as an patient edu­ca­tor and advo­cate.
    Oncol­ogy nurse have Rep Israel as our advo­cate. Thank you!!
    What hap­pened to Amanda is appalling, but she was there for her patient.

  9. February 22, 2012 at 9:52 am
    Lisa Lovell says:

    I also came across Amanda’s case via FB, and have become a huge advo­cate for her and her efforts to pro­tect patient & nurses rights. Please read more about Amanda and her strug­gles in her bat­tle, and ways to help sup­port Aman­das efforts!

    Josies Law: https://​www​.face​book​.com/​A​Z​P​a​t​i​e​ntAdvocate

    Advance Care Plan­ning: https://​www​.face​book​.com/​p​a​g​e​s​/​A​d​v​a​n​c​e​-​C​a​r​e​-​P​l​a​n​n​i​n​g​/​1​4​8​6​4​5081898038

    Nurse Up For Amanda Tru­jillo:
    “To sup­port Amanda Tru­jillo finan­cially and advo­cate for the duty of all nurses to edu­cate patients and to stop the intim­i­da­tion of nurses by admin­is­tra­tive author­ity due to con­flict of interest.”

    https://​www​.face​book​.com/​N​u​r​s​e​U​p​f​o​r​A​m​a​n​daTrujillo

  10. February 23, 2012 at 1:10 pm
    Joyce Harrell says:

    As a fel­low oncol­ogy cer­ti­fied nurse,I am in sup­port of Amanda, and find the non sup­port by those asso­ci­a­tions which should come to her defense but are’t, is very dis­heart­en­ing. Who has our back as nurses?

  12. February 28, 2012 at 8:12 pm
    Sally RN says:

    I have not read any­one com­mit on the physi­cian. Do you think the physi­cian may be con­cerned about the money or polit­i­cal posi­tion he may lose with his peers. I too am con­cerned with the lack of sup­port from the pro­fes­sional asso­ci­a­tions. Maybe we should all remem­ber this event when our mem­ber­ship dues need renewed!!!!

  13. February 28, 2012 at 9:47 pm
    Michelle Ellis says:

    I have seen things like this hap­pen before with other health­care pro­fes­sion­als. It is usu­ally a physi­cian or other indi­vid­ual who wields power because of the money that he or she brings to the orga­ni­za­tion. Ethics go by the way­side, the patients are not being served, and the aggres­sor con­tin­ues to oper­ate with impunity. This can­not be tol­er­ated. I am in sup­port of Amanda as well, and after fur­ther read­ing about her case, it seems that she got in trou­ble doing an excel­lent job. How very sad.

  14. February 28, 2012 at 10:14 pm
    Aelens RGN says:

    Although the mat­ter as described here is prob­a­bly not the whole story, it cer­tainly appears Amanda made the best judge­ment pos­si­ble in the sit­u­a­tion at hand, and acted as any ded­i­cated, pro­fes­sional, and self respect­ing Nurse would and should have done, but one thing does puz­zle me;
    When Amanda noticed gross inad­e­qua­cies in the patient’s under­stand­ing of pend­ing surgery, she could have con­tacted the sur­geon and requested him/​her to see the patient and resolve the remain­ing Issues. The sur­geon did obtain con­sent from the patient, but this con­sent, cer­tainly does not seem to meet any of the require­ments for an “informed” con­sent, and can thus not be con­sid­ered as such. The fact that Amanda chose to “fill in the gaps” her­self, rather then involv­ing the sur­geon at that point, is at worse an error but cer­tainly not a rea­son for dis­missal, and recon­sid­er­a­tion of reg­is­tra­tion. I can’t help won­der­ing what the “com­pany cul­ture” is like where she worked. Could the sur­geon be a bit of a bully, and was Amanda per­haps too intim­i­dated to request the help of the sur­geon when it was appro­pri­ate to do so ? In deal­ing with this the way they did, a good Nurse was lost, and the hos­pi­tal lost a pre­cious oppor­tu­nity to reflect on cur­rent prac­tice and per­sonal atti­tudes, that could have improved work­ing rela­tion­ships along the whole line of disciplines.

    Sev­eral com­ments men­tion Nurses Rights. We do indeed rep­re­sent the biggest pro­fes­sional group after teach­ers. We should be far more pow­er­ful, but his­tory has shown on may occa­sions that we seem to be the worst orga­nized group. It is this lack of orga­ni­za­tion that lets us down, and as long as we allow that to con­tinue we only have our­selves to blame for that.

  15. February 29, 2012 at 11:46 am
    Debra Hanna says:

    I also was threat­ened to be fired by a physi­cian for advo­cat­ing for my patient. Every nurse should stand up and sup­port Amanda.

    I read more about the case and have sug­gested that it be a future dis­cus­sion for our Nurs­ing and Med­ical Ethics rounds.

  16. February 29, 2012 at 7:24 pm
    Lisa berggren says:

    This is ter­ri­ble every nurse is at risk for this we should all come together as one and sup­port our fel­low peer

  17. March 1, 2012 at 4:06 pm
    Beenthere! says:

    The facil­ity Amanda worked at has a seri­ous his­tory of abus­ing staff. They work under fear and intim­i­da­tion daily. Peo­ple would not believe what really goes on there. There are many “Amanda’s” that have suf­fered and are liv­ing in fear from Ban­ner Del Webb.

  18. March 3, 2012 at 2:53 am
    yvonne powell says:

    Patient teach­ing is sec­ond nature to me. many times I find myself clear­ing up mis­con­sep­tion that my patients have about their dease, treat­ments ect. should I start wor­ring about my lis­cence too? No doc­tor should be given that much power. Was he required to explain why his patient did not have all the infor­ma­tion? Hang on Amanda this affects us too and I will keep you in my prayers

What do you think?

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