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The Case of Amanda Trujillo

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.

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Comments

Posted by cspellman on Feb 17, 2012 10:08am
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/oco/ocos083.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.

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.

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?

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.

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 www.PeerReview.org info@PeerReview.org 504-621-1670

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.avoidmedicalerrors.com/2012/01/amanda-trujillo-nurse-fired-for-being-a-patient-advocate/

Posted by colleen obrien (not verified) on Feb 21, 2012 11:35pm
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.

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.facebook.com/AZPatientAdvocate Advance Care Planning: https://www.facebook.com/pages/Advance-Care-Planning/148645081898038 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.facebook.com/NurseUpforAmandaTrujillo

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?

Posted by Megan RN (not verified) on Feb 28, 2012 7:46pm
http://www.youtube.com/watch?v=kIcQ2JfUUck&feature=share&fb_source=message

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!!!!

Posted by Michelle Ellis (not verified) on Feb 28, 2012 9:47pm
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.

Posted by Aelens RGN (not verified) on Feb 28, 2012 10:14pm
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.

Posted by Debra Hanna (not verified) on Feb 29, 2012 11:46am
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.

Posted by Beenthere! (not verified) on Mar 1, 2012 4:06pm
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.

Posted by yvonne powell (not verified) on Mar 3, 2012 2:53am
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

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