(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.)
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 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.