January 28, 2012, 12:03 pm

Everybody Look What’s Goin’ Down…

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

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

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

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

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

I apologize for the misunderstanding.)

Sorry, no.

Nurses and physicians share a collaborative relationship, working with the patient in a team effort.

That is how it is supposed to work.

As a nurse, my duty is solely to the patient.

If I am needed to be anyone’s “right hand”, it will be my patient.

I’m very lucky. I work with great docs who get it. I’ll write a post about that.

I’ve seen my share of the temper-tantrum throwing screamers, and I’ve been the recipient of their wrath three or four times in my career.

I should tell those stories; they happened long ago. 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, 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, based on information that has been made public or is in the public record, three things occurred or nearly occurred (In hospital terminology, we call those “near-misses.”)

This should make everyone of us queasy.

1. A PATIENT WOULD HAVE HAD SURGERY WITHOUT INFORMED CONSENT.

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

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

Before the discussion with the nurse, the patient did not know this information.

2. A PATIENT’S DECISION WAS NOT SUPPORTED BY THE MD, OR THE HOSPITAL

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

Why?

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

I’m speculating, but I wonder – how much of that anger did the patient hear, or sense?

3. A PHYSICIAN DISPLAYED DISRUPTIVE BEHAVIOR AT THE NURSES STATION.

Well, this has been going on from time immemorial, but it is no longer tolerated.

Now, concern over a patient is not disruptive behavior. Anger is not a disruptive behavior. (If it was, I’d be in trouble.) Screaming and throwing a temper-tantrum at a nursing station is, 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, the facility? The nurses?

*****

Two of these, the informed consent and the disruptive behavior are issues that are covered by licensing bodies. Joint Commission has looked at the impact of disruptive behavior by physicians and other members of the health care team. 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. Webb Medical Center was not innocuous.

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

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

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.

As a nurse, and as a patient, I am appalled.

Now I want to see exactly what Banner Health, and the Arizona Board of Nurses, are going to do to rectify this situation.

This has huge implications for nurses, and patients.

All of us.

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12 Comments

  • Wander
    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
    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
    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
    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
    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
    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
    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
    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.


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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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