August 26, 2016, 12:03 pm

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Enalapril 5mg pills $83.00 (ADDENDUM, enalapril 5mg pills $83.00 ADDED FEBRUARY 14, enalapril 5mg pills $83.00 2012 – When this post was written, enalapril 5mg pills $83.00 I mistakenly thought the patient in question had a transplant operation pending. Enalapril 5mg pills $83.00 The patient was actually scheduled to be transferred the next day to begin pre-transplant testing. Enalapril 5mg pills $83.00 Surgery would have come at a later date.

Enalapril 5mg pills $83.00 I now understand that Amanda assessed that the patient had a deficit of transplant knowledge in general, enalapril 5mg pills $83.00 and provided general transplant teaching concerning the evaluation process, enalapril 5mg pills $83.00 the waiting process, enalapril 5mg pills $83.00 and the care regimen. Enalapril 5mg pills $83.00 The patient changed their mind about undergoing the testing, enalapril 5mg pills $83.00 and requested a hospice consult.

Enalapril 5mg pills $83.00 So, enalapril 5mg pills $83.00 although the patient did not fully understand, enalapril 5mg pills $83.00 and may not have been “informed” about what the entire transplant process required, enalapril 5mg pills $83.00 surgery was not imminent, enalapril 5mg pills $83.00 and “informed consent” for surgery was not the issue here. Enalapril 5mg pills $83.00

Enalapril 5mg pills $83.00 I have a firm belief in not altering a post once it has been posted, enalapril 5mg pills $83.00 and owning the mistakes/misunderstandings therein, enalapril 5mg pills $83.00 so I have added this addendum for clarification.

Enalapril 5mg pills $83.00 The issues remain the same – a patient was uninformed about what was happening to them and needed education on their illness, enalapril 5mg pills $83.00 a physician/hospital did not support/respect a patient’s decision/request for information, enalapril 5mg pills $83.00 and a physician behaved in a disruptive fashion.

Enalapril 5mg pills $83.00 I apologize for the misunderstanding.)

Enalapril 5mg pills $83.00 Sorry, enalapril 5mg pills $83.00 no.

Enalapril 5mg pills $83.00 Nurses and physicians share a collaborative relationship, enalapril 5mg pills $83.00 working with the patient in a team effort.

Enalapril 5mg pills $83.00 That is how it is supposed to work.

Enalapril 5mg pills $83.00 As a nurse, enalapril 5mg pills $83.00 my duty is solely to the patient.

Enalapril 5mg pills $83.00 If I am needed to be anyone’s “right hand”, enalapril 5mg pills $83.00 it will be my patient.

Enalapril 5mg pills $83.00 I’m very lucky. Enalapril 5mg pills $83.00 I work with great docs who get it. Enalapril 5mg pills $83.00 I’ll write a post about that.

Enalapril 5mg pills $83.00 I’ve seen my share of the temper-tantrum throwing screamers, enalapril 5mg pills $83.00 and I’ve been the recipient of their wrath three or four times in my career.

Enalapril 5mg pills $83.00 I should tell those stories; they happened long ago. Enalapril 5mg pills $83.00 I’ve kept them off the blog because of the emotions that come flooding back when I think about them.


I’ve been blogging on the Amanda Trujillo situation for a few days now, enalapril 5mg pills $83.00 but lets move away from Amanda being fired by Banner Health and turned in to the Arizona Board of Nursing and look at this from a patient’s point of view.

As I see it, enalapril 5mg pills $83.00 based on information that has been made public or is in the public record, enalapril 5mg pills $83.00 three things occurred or nearly occurred (In hospital terminology, enalapril 5mg pills $83.00 we call those “near-misses.”)

This should make everyone of us queasy.


A patient scheduled for surgery, enalapril 5mg pills $83.00 in this case a major, enalapril 5mg pills $83.00 life-altering surgery, enalapril 5mg pills $83.00 did not know (a) the extent of the surgery, enalapril 5mg pills $83.00 (b) the ramifications of the surgery – this being complex lifetime care, enalapril 5mg pills $83.00 or (c) options other than surgery.

All of the above, enalapril 5mg pills $83.00 along with the risks and benefits of the surgery, enalapril 5mg pills $83.00 constitute “informed consent.” Before any surgery consent can be signed, enalapril 5mg pills $83.00 all of the above must be addressed.

Before the discussion with the nurse, enalapril 5mg pills $83.00 the patient did not know this information.

2. Enalapril 5mg pills $83.00 A PATIENT’S DECISION WAS NOT SUPPORTED BY THE MD, enalapril 5mg pills $83.00 OR THE HOSPITAL

Granted, enalapril 5mg pills $83.00 the surgery did not happen. Enalapril 5mg pills $83.00 But instead of supporting the patient’s decision as being the patient’s decision after the patient had been fully informed, enalapril 5mg pills $83.00 as was their right by law, enalapril 5mg pills $83.00 there was anger and recrimination from the physician and the facility.


Why did a patient’s decision to not have surgery cause this upheaval? Who lost out here?

I’m speculating, enalapril 5mg pills $83.00 but I wonder – how much of that anger did the patient hear, enalapril 5mg pills $83.00 or sense?


Well, enalapril 5mg pills $83.00 this has been going on from time immemorial, enalapril 5mg pills $83.00 but it is no longer tolerated.

Now, enalapril 5mg pills $83.00 concern over a patient is not disruptive behavior. Enalapril 5mg pills $83.00 Anger is not a disruptive behavior. Enalapril 5mg pills $83.00 (If it was, enalapril 5mg pills $83.00 I’d be in trouble.) Screaming and throwing a temper-tantrum at a nursing station is, enalapril 5mg pills $83.00 no matter what the reason.

How would you feel as a patient if you heard a screaming rant going on at the nurse’s station outside your door?

How would you feel about the doctors, enalapril 5mg pills $83.00 the facility? The nurses?


Two of these, enalapril 5mg pills $83.00 the informed consent and the disruptive behavior are issues that are covered by licensing bodies. Enalapril 5mg pills $83.00 Joint Commission has looked at the impact of disruptive behavior by physicians and other members of the health care team. Enalapril 5mg pills $83.00 The Centers for Medicaid and Medicare Services are also concerned with the effect of this behavior of patient safety.

What happened at Banner Health Del E. Enalapril 5mg pills $83.00 Webb Medical Center was not innocuous.

If not for the actions of a registered nurse, enalapril 5mg pills $83.00 doing exactly what she was educated to do, enalapril 5mg pills $83.00 and bound by the Arizona Nurse Practice Act (and her ethical duty) to do, enalapril 5mg pills $83.00 a patient would have had a surgery they were not prepared for, enalapril 5mg pills $83.00 and would not have wanted had they known what was happening.

That should scare the hell out of every single one of us.

Enalapril 5mg pills $83.00 Because something like this has a chilling effect on all the other RNs in a facility – and I hope that the other registered nurses at Banner Health have the guts to keep educating their patients without the fear of losing their jobs and their licenses for doing their ethical duty.

Enalapril 5mg pills $83.00 As a nurse, enalapril 5mg pills $83.00 and as a patient, enalapril 5mg pills $83.00 I am appalled.

Enalapril 5mg pills $83.00 Now I want to see exactly what Banner Health, enalapril 5mg pills $83.00 and the Arizona Board of Nurses, enalapril 5mg pills $83.00 are going to do to rectify this situation.

Enalapril 5mg pills $83.00 This has huge implications for nurses, enalapril 5mg pills $83.00 and patients.

Enalapril 5mg pills $83.00 All of us.

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  • Wander

    January 28, 2012 at 12:31 pm

    I am very sympathetic to Amanda’s situation, IF it all went down as she claims it did, but as far as I can tell from what you’ve written, all you’re going on is her side of the story, as presented in her anecdotal account and her lawyer or rep’s report of the incident. You are assuming the hospital simply caved in to the doc, took his word without further investigation and is persecuting Amanda based on his temper tantrum. That all may be true, but you should find out if it is by hearing their side of the story before jumping to conclusions.

  • Kim

    January 28, 2012 at 12:37 pm

    Wander, I’d love to hear the other side! Believe me, I’ll be right there when and if Banner Health comments, or until the complaint is made public record. Until they do, this is all we have.

  • Joe3

    January 28, 2012 at 12:40 pm

    Well stated Kim, I have been in nursing 18 years, and like most, have had a few MDs pitch their hissy fits – then we all get back to work.
    Yes,this incident goes waay past just the firing, and all nurses need to pay attention. Your 3 points are well taken and IT DOES SCARE THE HELL OUT OF ME!
    I’m now working in psych, and frequently tell my involuntary patients there are two sides to a story: theirs and family/police and I believe the truth lies somewhere in between — I would love to hear both sides of this story, and I hope it comes out?

  • Janell

    January 28, 2012 at 2:56 pm

    I bet Banner Health won’t comment, they will have some lawyer client reason. Many docs don’t fully educate their patients, maybe they don’t know exactly what they need to say. From Amanda’s side of the story she did the right thing. I have been a nurse for 30 years and have been yelled at once because a patient extubated himself and the physican didn’t think I took it seriously enough. I called him right away interuppting some big football game. Because I joked about being sorry to take his time away from the game he got mad. Anyway, he wanted me sent home and off the case. I had taken care of that patient for several days. The next morning I made sure to have the same assignment. He was not happy about that and wouldn’t speak to me. I took him by the jacket and said I needed to talk to him in the managers office. We had it out, and he apolgized and since then has been nothing but kind. I was lucky to have a charge nurse, and a manager that backed me up.
    So often I see a nurse in trouble and we are all scattering when really we should just walk up beside her/him and be there for support.

  • Jen

    January 28, 2012 at 9:45 pm

    I’ve been an RN for 42 years and have been yelled at and even pulled off care once for educating patients about their care and options in the past. But when those 3 incidents happened; my managers were supportive of me and I was working in a unionized hospital and both my union and state nursing association were also supportive of me when these incidents happened. I haven’t seen this in recent years; but when a doctor thinks they can make the right health care decision for a patient; they are wrong. “Informed consent” means just that: the patient knows what his options are and what the outcomes he can expect from those options.

  • Rie

    January 29, 2012 at 7:30 am

    the bottom line is, if in fact the patient did not understand and give informed consent to the procedure, what the doctor was doing was unethical and criminal. informed consent is not signing a piece of paper, and that piece of paper is worthless if the patient education has never happened and the questions of the patient have not been addressed. plain and simple.

    this person’s body does not belong to the medical establishment, and they don’t have the right to take away the decision from them.

  • RehabRN

    January 29, 2012 at 1:41 pm

    Yes, Kim. It does scare the bejeebus out of me.

    And in my very short career, I’ve been yelled at for interrupting naps, football games, and anything else.

    Disruptive behavior still isn’t pursued thoroughly because the medical staff brings money into the facilities, and nursing staff is overhead. They always threaten to take patients elsewhere, so the admins quiver.

    I can’t wait until CMS starts paying for satisfaction…maybe then the administrators will listen.

  • - Different Types of Nursing Careers
    - Different Types of Nursing Careers

    January 29, 2012 at 3:44 pm

    […] Everybody Look What Going Down […]

  • Trisha

    January 30, 2012 at 7:27 am

    This does indeed frighten me – if it weren’t for the stellar nurses who take the time to educate and advocate for their patients, our healthcare system would be nothing more than an autobody shop. Patients exchanging parts for money.

    When will they recognize that each human life is valuable and knowledge is not the enemy? That is the very reason why nurses are called upon to advocate – someone needs to have their eye on the big picture.

  • […] Everybody Look What’s Goin’ Down […]

  • […] Everybody Look What’s Goin’ Down […]

  • […] Everybody Look What Going Down […]

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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