Could What Happened to Amanda Trujillo Happen To You??

In case you don’t frequent twitter, the nursing blogosphere, Facebook or other online nursing communities, Amanda Trujillo is a nurse in Arizona who is under investigation by the State Board of Nursing there. In short (you can read her account here) Amanda relates that when she became aware that a patient awaiting a liver transplant had considerable misunderstanding about the procedure and the lifelong aftercare that would be required, she spent time with the patient discussing related issues and ordered a hospice/case management consult at the patients request so the patient could explore his/her options, something that was within her scope of practice and not against her employer’s policies.

The patient’s surgeon, when he found out about this, became irate and demanded that she be fired and her license taken from her. Amanda was then fired by her employer Banner Del E Webb and reported to the state board. Much of the nursing community is enraged about the situation while some nurses are reserving judgment, wanting more information or waiting to see how things unfold. There are also some who doubt the validity of her story and believe she is simply seeking publicity after getting fired. But regardless of what actually happened between Amanda, her patient, the physician and her employer, there are many troubling facts in the case – things that all nurses should be concerned about.

Regardless of your thoughts about/knowledge of the actual events leading up to Amanda’s dismissal, the case has evolved into something much bigger. Yes, Amanda’s license, livelihood and reputation are on the line and she deserves our support. If given the choice, I’d much prefer to err on the side of supporting her than on the side of doubting her. But what’s even more disturbing is how Amanda is being treated in the course of the investigation.

Reports are that the board notified Amanda’s university (she is an NP student) that she was under investigation even though other insider sources say that should/would never be done while any investigation is underway. What could have been the board’s motivation to do that other than to possibly negatively influence her university against her before the investigation is completed?

Even worse, Amanda has been required by the board to have a psych consult, allegedly because she brought the case to the media and is “speaking out.” Some might say that there is a witch-hunt going on – that the powers-that-be are searching deep and wide for anything they can use to make their case. Just for argument sake, even if there were communication, chain of command, or policy issues in question (I’m not suggesting that there are), how does that warrant the type of humiliation and violation of privacy issues that she is being subjected to? And then – what if they still find nothing? What lengths might the board go to, to prove a point or ruin her career?

The case is pivotal not only because of what is happening to Amanda but also because if it happens to her, what’s to prevent something similar from happening to any other nurse in any state? Didn’t we take an oath, public or private, to advocate for our patients, educate them, and operate in their best interests? I’m sure a case can be made for either side on this issue depending on your title, whom you work for, or what your credentials are. But the bottom line is that a fellow nurse is under attack in the course of doing her job to the best of her ability.

Let’s join forces and give Amanda our support and the benefit of the doubt. But beyond that, let’s speak up for fair and equitable treatment for all nurses and the allowance of due process. Remember, anyone can report a nurse for any reason to their state board. It’s then up to the board to determine if there was wrongdoing of any sort or not. It can easily turn into a David and Goliath situation when a board holds enormous power over an individual nurse and her license and exerts undue influence in the state.

Comments

  1. Thank you SO MUCH Donna for this article. Well written, and my support has always been for Amanda, and the Amanda within each and every one of us!

  2. Donna,

    I took the time to read this to Amanda over the phone a few minutes ago, and before I could finish she was in tears. She wanted me to thank you for not assuming her guilt and for taking the time voice support for her. She says this is one more reason for her to keep fighting for what is right for nurses and patients.She sends her deepest gratitude. (shes been trying to stay off the blogs)

  3. Steven Yockey, RN says:

    This scapegoating of nurses, like that which was done to Ms. Trujillo, is endemic in our healthcare system. Nurses are regarded as chattel, but demanded to act as professionals. This schizophrenic workplace existence is an example of the many things which need to be fixed in the American healthcare system. I support Ms. Trujillo. She was merely doing her job.

  4. I am so thankful that you have weighed in on this issue! You are right to say that this could affect every nurse. If the board is successful, in what appears to be a witch hunt, it will set a presidence that will make nurses fear being advocates for their patients.

  5. I appreciate your good work. There is no regulatory function or group whose work will not benefit over time from the sunlight of public scrutiny. Public accountability can be messy at times, certainly inconvenient and irritating, but that is how a health democracy functions: involvement, and the willingness to form and express an opinion:
    “Many forms of Government have been tried, and will be tried in this world of sin and woe.
    No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government, except for all those other forms that have been tried..” – Churchill
    This Nurse agrees with Churchill, and advocates for democracy often. AZ BON may need a dose – on the next renewal of its mandate, limits on complaints should be considered: some sort of abuse prevention system. At the very least, provide a clear record of cases, findings and identities of the complainant – their anonymity is well-intentioned but provides strong encouragement for abuse of the complaint process without culpability or public awareness. Also, AZBON (every BON) must have adequate resources to process cases in a timely and effective manner: 1000 Nurses a year, or 1 in 35 of the total, suffering over 7 months of professional limbo is unacceptable. It causes the innocent grievous harm and has the potential to turn protection of the public into harassment of the individual. It also delays accountability for those Nurses. and their patients, in need of it. Both aspects harm Nursing and patients.
    In California, the situation has been worse – see http://www.latimes.com/news/la-me-nursing-board14-2009jul14,0,1002564.story. In 2009, in response to a publication showing an average of over 3 years per case, the Governor fired half of sitting board members: “Fred Aguiar, secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. ‘This plan needs to include how many more investigators are needed, how much that will cost. . . . I want to know now.’ ” Outside pressure does have its place in public affairs. In America’s most deadly war ever, President Lincoln gave us the enduring precedent that we are one nation. We Nurses, too, need to think more of the whole, and how the suffering of one like Amanda, as precedent, and the functioning of our BONs, affects that whole. The time for complacent apathy has long passed: out duty for advocacy calls. Who will answer?

  6. “The case is pivotal not only because of what is happening to Amanda but also because if it happens to her, what’s to prevent something similar from happening to any other nurse in any state?” Thanks Donna!

  7. Please see my new letter to Governor Brewer of Arizona regarding the need for AZ BON reforms, and a comment regarding AZ BON rules and standards, which I have down loaded and reviewed at some length: wp.me/p278fi-gc

    Also, comments on ANA and how well it lives up to its own professional standards for Nurses: wp.me/p278fi-g8

  8. Nancy Wilson says:

    Thanks Donna for an excellent article citing the ramifications of this case for nursing. Time to stand up for nurses and the nursing profession. We no longer accept chattel status!!

  9. Marla Meletis, RN says:

    It seems as though this nurse is just advocating for her patient, which is something I believe we were taught we were SUPPOSED to do as nurses. I hope she fights this tooth and nail and that the surgeon actually has to go through the same type of investigation for being negligent!

  10. Thank you, Donna. This is the case, in a nutshell. It could be any one of us, at any time, if we don’t take a stand NOW.

  11. Thank you for sharing this important story with your readers. You’re right, this can happen to anyone, and it’s not fair to the patient or the nurse. Excellent article.

  12. Amanda Trujillo’s story is frightening for every nurse and every patient. Nurses have to be advocates for patients – who don’t know their options, who don’t know how to get more care or care from a different person, or who need someone to get them help NOW. We are all advocates for patients. An attack on the advocacy role is an attack on one of the fundamental roles of nurses. The issue goes beyond explaining treatment options to an uninformed patient. It enters the heart of nursing and our responsibility to assist patients.

  13. Thank you so much for that wonderful statement Donna, as nurses we have stood in the shadows for so long and taken a beating while others walked over us. As a nurse who works at the bedside in the ER still after 25+ years I am so tired of not having MY voice heard, I am a person and not just a warm body. I will stand behind Amanda all the way, she empowers me to keep going and make sure my patients have an advocate- me!

  14. Caryl J. Carver, RN, BSN says:

    AMEN, yes, the outcome of this case has consequences for all nurses in the US. We MUST organize. Does anybody following this case have any contacts in the media? This needs to be brought to the attention of the public because it effects the future of healthcare for us all!!

  15. Tracy Sutton says:

    It made me sick to read about Amanda’s situation. I am an RN-BSN in Missouri and currently working on my MSN-FNP. I went through a similar situation & was terminated 2 months ago. I had worked at the hospital for 7 years with a “perfect record” so to speak. The doctors respected me, the care I provided to the patients and trusted my judgement. I rarely called in, was never a minute late and had never been in any trouble whatsoever. I am a psych nurse & if I felt patient care was compromised, I felt it was my duty to speak out. There were a total of 4 serious issues in 7 years, please don’t get the impression that I was constantly complaining to management. This did not make me a popular person with my nurse manager & she made my job miserable for years. I continued to work there because I love working psych & there are not many available psych jobs within an hour of my home. I worked nights so that helped my situation as the manager worked days. Long story short, they wanted me to do an assignment the following week that I felt would constitute pt abandonment. I told them I would check into by calling the MOBON to clarify pt abandonment. I did so & was prepared to carry out the assignment per direction of the board. My director & manager actually told me I had no right to contact the state board. I had never been in trouble, but I was wrote up as a final warning/suspension, was demoted from senior to staff nurse, placed on a 90 day probation and my pay was cut by 6%. I was forced to attend 9 meetings with my manager & director & was yelled at, threatened, demeaned & accused of not having proper values. Yes, I did speak back to them & reminded them of all the unethical situations I had reported to them over the years that they failed to correct. There are cameras all over the psych unit & there is a nurse that falls asleep every night she works. I was seen on camera walking by her & not waking her as was every staff member that worked that night. Also, a security guard was sitting 3 feet away from her the entire shift. My termination reads, “Failure to act as a Mercy nurse is expected when observing another nurse sleeping on the job.” The nurse that was sleeping was not terminated, neither was the security guard or any other staff member. Thankfully, I haven’t been reported to the state board at this time. I think the public would be shocked if they knew half the things that actually go on in hospitals today. My administration had little regard for or care & the nurses were afraid to speak up. Most of the nurses I worked with would not even assess their patients! Management rewards the lazy & attempts to ruin the reputations of nurses that actually do care for pts. I will never work in a hospital again for fear of losing my license. I feel terrible for Amanda & support her fully. I am not sure nursing can survive if we are not allowed to perform our job as set out by our state’s BON.

  16. Caryl J. Carver, RN, BSN says:

    Tracy– I am so sorry to hear you were terminated for doing the RIGHT thing. I, too, was terminated from my employment in 2007 after I reported the hospital were I had been working to OSHA after management there told me I could no longer wear exam gloves when I transported patients. After giving numerous examples of how an OR nurse is exposed to body fluids when transporting patients, even the Infection Prevention and Control Department at this facility sided with management. I get furious whenever I hear of nurses who are punished for doing the RIGHT thing. Somehow we have got to make the public aware of just how serious the future of healthcare is in this country.

  17. Amanda Trujillo’s story should be a wake up call to every nurse, that we need to not only be advocates for our patients, but advocates for our fellow nurses.
    This is a time for us to all stand together and help right a wrong. Nurse’s have rights too and one of our rights is to provide support and patient education. One of our fundamental roles as a Nurse is to educate and advocate for our patients.Nurses are one of the most trusted professions, because we are there for our patient’s best interest. Now we need to be there to support Amanda Trujillo for honoring one of the principal roles of nurses.

  18. The hospital that Amanda was working at has a long history of abusing and then turning on their employees. Del Webb Hospital seriously needs to be scrutinized

  19. In reading Ms Trujillo’s statement of what occurred, in her own words, I feel as a nurse, she did the right thing. I also have to ask-when the pt agreed to this procedure, and the pt had to sign off on the procedure form, stating the pt is aware of the procedure, risks etc… WHO signed ooff on that as a witness to the pt “understanding” the procedure etc?
    When pt’s sign procedural consent forms, I always add on-(witenss to signature only) because it is the doctor that has to go into detail with the patient of the procedure and prognosis etc. Sure Nurses can help educate the pt but ultimately it is the dr that has to explain it to the pt.

    and I agree, this should have been taken up by the ethics committee of the hospital. Doctors get a slap on the wrist and nurses get fired. It is unfortunate what happened to Ms Trujillo, and as nurses, we are comitted to our patients, career and to stand up for what is right.

  20. Gretchen (Nursing Student) says:

    Thank you so much Donna! I am a nursing student in Colorado, and although, this happened in AZ, I think it is important that this spread like wildfire. I am going to share this story with my Nursing Instructors. We have Banner Health Facilities in Northern Colorado, and this story does not paint Banner in a good light either. I think that AZ BON and Banner need to go back and understand that what Amanda Trujillo did, was in her scope of practice and is expected of us, as Nurses, to advocate for the patient. Thank you.

  21. OlderNurse says:

    My heart goes out to Amanda, it seems the basic rules we have worked with for years in nursing are being twisted and turned by employers these days and they no longer have any respect for most nurses. It’s all about big business, $$$. It’s sad to see greed be the foundation of everything in this world, including health care. 40% of people in the US DO NOT have healtcare coverage…that’s astounding. People are choosing to die because they will be bancrupt otherwise. It’s really tragic.

    I too was fired from a dialysis unit. I was newly hired, still on the 90 days probation…but I was very experienced and had MORE experience than the current staff combined.

    The dialysis unit was hospital based, an acute care unit. One of the patients dialyzing lost approx. 400ml of blood of when the machine malfunctioned. I pulled the machine and tagged it for biomed to repair, taking it out of service. The next morning, the nurse in charge removed the tag and put that broken machine back in use. Another patient was put on that machine…and they too lost their blood. I AGAIN tagged and removed that machine. The Nephrologist came in and saw the tubing on the machine with blood in it…400ml of HIS patients blood and asked what happened. I explained. He was furious…as he should be.
    I told him I removed the machine twice…management was upset with me for doing so and I expected to be fired for it. He said, “no way will that happen”.

    Next day, I was fired.

  22. Post by Matthew Browning in support of Amanda Trujillo deleted by American Journal of Nursing

    http://vdutton.posterous.com/post-by-matthew-browning-in-support-of-amanda

  23. Sherry Jones RN QMHP says:

    I totally agree that what they have done to her is wrong. I strongly believe that nurses be strong advocates for their pts and also pt and family education is a must always. She was just doing her job. Good luck to her!

  24. Trujillo situation however troubling is true. I am a transplant nurse and have gotten into that same trouble. My patient was not properly informed of the long-term management of receiving a transplant so when questions came up I answered them. The patient tried to turn down the liver so that he could think about his options but was told he would never be put back on the list again. I assumed before the patient is ever listed they are properly educated, pro/cons, complications,medications, expenses, expectations etc.Yet that obviously is not happening. The process of being listed, matched,called in and scheduling a team is already difficult and time consuming but if a patient turns down an organ, that organ could have gone to someone else. I understand the hopsital/doctor frustations but the nurse was right to properly inform the patient.

  25. We have a Change.org petition up to boycott Arizona until we see some BON changes – please check it out & help us spread the word, next Hearing is 3/19 and AZBON reauthorization is still in the Legislature – we’re running out of time on this sweet spot for change.

    See http://www.change.org/petitions/governor-state-of-arizona-address-corrupting-factors-in-the-arizona-board-of-nursing

    and/or

    http://wp.me/p278fi-iV

  26. Beenthere! says:

    Arizona is such a sad state to be working in for Nurses. I must add for all healthcare professionals. Including good intentioned doctors. Because even they are thrown under the bus if they dare speak up for patients, the nurses or just doing the right thing. It is a very Right Wing state. Hate to get all political here. But I got to call it what it is. Greed, money, power hungry is Corporate’s Almighty God! It rules their world. Management teams today are unbelievably incompetent. I have been an RN for many many years now. Working primarily in Arizona. I have been fortunate to also have taken travel assignments OUTSIDE of Arizona. Therefore I know it is different. Always has been different. However, what I am witnessing today in Arizona is an unwarranted abuse towards the very people that are capable of helping make the healthcare system better. In other words I feel CEO’s are biting off the hand that feeds them. They are extremely greedy and lie. They talk out of both sides of their mouths. But then again, they are looking at short term goals. They are making sure they will make their money now. Because facilities will NOT survive the way they are functioning today. I signed the petition for Amanda because you see, I was almost an “amanda” at the very same facility. I know how they operate. I know the wickedness of their administrators. I know the incompetence and bullying tactics used by the management team. I know the Stepford Nurses that they intimidate that say “yes” to whatever they are told to do. The majority of the present staff will NEVER report an unsafe or unjust condition for patients or staff. Why? Because then they will become the next “amanda.” Arizona has always been backwards. Never to the degree I am seeing it now. Arizona treats teachers with the same intimidation and bullying tactics. I see it as a political game. We are lower level labor to them. We are nothings in their eyes. I am sorry to say, the nature of the Arizona nurse WILL NOT speak up or join groups to better their working environment. I’ve tried to encourage it so many times. They don’t want to even hear about it. They don’t even want to know about the “amanda” story. (promote a discussion about this topic) They live in denial. I just had to get this off my chest. I hate to say it, since I do live here but please; BOYCOTT ARIZONA! Hit them in the pocketbook. But let them know WHY you are doing so.

  27. RUkiddingMe says:

    Seriously? I’ve been in this game 15yrs now in WV! And let me tell you something~~~on 3 different occasions I ‘spoke up’ on shady business practices~~guess what it got me? UNEMPLOYED and reported to the WVBON! As RN’s we all know that we make mistakes daily, from documentation to clinical practices…. all it takes in one co-worker with and ax to grind and your in for it! There is no standing up to the BON because they have complete power. When I seen Amanda’s story I burned with anger! But what can we do? The only thing I can think of is ALL RN’S COME TOGETHER AS A WHOLE AND PUT AN END TO THE UNCONDITIONAL POWER OF THE NURSING BOARDS!!! MD’s are never sanctioned much less held to the standard of the RN,,, and they make all the money!

  28. Fed Up Nurse says:

    How far will the abuse of nurses go? I am an older nurse and witnessed far too much abuse of nurses at the hands of incompetent managers and totally out of touch administrators. How much more are nurses going to take? We are now just a watered down pretend profession. I don’t care to hear all the hype and bs about how we have advanced. I say BULL CRAP! We are going backwards. But why are so many nurses not banding together for the better of what is left of our profession? I don’t get it.

  29. Candy Kinser, RN says:

    Such corruption isn’t isolated to Arizona. When I lived in Oklahoma it became quite apparent that the Oklahoma Board of Nurses included nurses who were there because a large, financially powerful health care organization had “nominated” them. Certain of these nurses were therefore expected to support whatever legislation was financially beneficial to the powerful hospitals, etc. For example, I spoke in front of the board when they were under pressure to allow nurse’s aides to pass medications in hospitals. I met with significant hostility from the head of the nursing board as I advocated the cause and purpose of nursing. The corruption was shockingly apparent!