January 29, 2012, 3:03 pm

Mandated by Law, Obligated by Ethics…

I’ve been blogging for 6 1/2 years.

I have a twitter account and although I went to Facebook kicking and screaming, I’m firmly ensconced in the world of status updates, messages, and the occasional “poke.”

I never miss BlogWorld New Media Expo, and if I can make it to BlogHer, I will be at the party (can you say “swag”?)

You might say I’m into social media.

The best thing about social media? It enhances the ability of people to band together, to support causes, and each other.

This week, we’ve seen nurses band together online to support one of our own, fired and in danger of losing her license for acting as a patient advocate and providing patient education.


Patients use social media to band together with others who share the same challenges, to find support and encouragement.

They use the internet and social media to gather information; to be able to decide, in discussions with their healthcare provider, the best treatment to pursue.

The “patient” is you. And me. We are all patients.

Knowledge is power. Knowledge empowers a us to advocate for ourselves.

But what happens when you are sick, lying in a hospital bed with new information flying fast and furious, with no time (or access) to “look it up”. No time to find an “online support group”.

What if the quality of the rest of your life depends on the decision you make with the information you get, now.

Who advocates for you/us then?


The entire healthcare team advocates for you.

Nurses and physicians advocate for you.

They advocate for you by making sure you have all the information you need to make an informed decision on any plan of care.

They advocate for you by telling you all of the options open to you, including no treatment.

They advocate for you by making sure you understand all of the information and education provided.

They advocate for you by respecting the fact that you are able to advocate for yourself and respecting the decisions you make.

Doing all these things is the right thing to do.

It’s also the law.


When a nurse assesses that a patient does not have the information needed to make an informed decision about their care, either because they have not been informed, or because they did not understand the information provided, the nurse has a duty to:

a. provide the missing information, or the needed education and/or

b. refer the patient to the appropriate source of information

There is no choice.

It’s not a case of making a note and hoping the next shift deals with it.

It’s not a case of thinking, “oh well, they need this surgery/procedure anyway.”

The nurse is mandated by law, and obligated ethically to act if they discover a patient does not have the information they need to make an informed decision about their care.


Here’s the ethical principle in operation here, as defined by the American Nurses Association, who have a great website on nursing ethics:

Autonomy: agreement to respect another’s right to self-determine a course of action; support of independent decision making.

This is why the firing of Amanda Trujillo, RN, MSN, an experienced transplant RN, by Banner Del E. Webb Medical Center is so mind-boggling.

She was doing exactly what she was supposed to do as a registered nurse, for a patient with a knowledge deficit regarding an upcoming transplant.


For the record, to those who have written to say I don’t have both sides, Banner Health isn’t talking. They made a statement on their Facebook page to that effect.

I have written to the Arizona Board of Nursing for a copy of the original complaint, which should be public record.

I’ll post any response I get from them.

In the meantime, Amanda’s legal response to the original complaint, which answers the complaint point-by-point, can be found at vdutton’s posterous.

I encourage you to read the comments, as there is some interesting dialog there, as well


I am not militant.

I rant now and again, but I am very happy in my corner of the couch with my trusty old MacBookPro.

But I would take to the street for this.

I am that angry.

If I thought for one minute that there was more to this case, I’d be watching from the sidelines,too.

My gut tells me, there is not.

My nursing instinct tells me there is not.

My nursing instinct tells me that a hospital corporation got upset because a “rainmaker” (in the legal world, that means “moneymaker”) got angry at an RN, ergo, she must be punished.

Most hospitals just fire people, Banner Health reports them to the Arizona Board of Nurses.

God help the nurses at Banner Health, because I’d be watching my derriere 24/7 if I worked there.

Corporate healthcare at it’s finest.


  • Michele Roberts
    Michele Roberts

    January 29, 2012 at 4:32 pm

    As usual Kim, you are dead on right – and you are an inspiration to all of us out there in cyberspace –
    I can’t imagine how Ms. Trujillo must feel, but I know from my experience that she must wake up every day raging mad at the absurdity of her situation. Having worked in an institution that rewarded those who “obeyed” the desires of the hospital, in essennce those who came in, punched the clock and made no waves (even if the care they gave was sub standard) and who came down with a heavy hand on anyone who tried to give their patients, units or co-workers a voice, how frustrating remaining true to oneself must be.
    I have written to the Arizona board of nursing, and I anxiously await their decision –

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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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