February 17, 2012, 11:13 am

When Nurses Attack At the Highest Levels: A Blatant Abuse of Power

I am not a conspiracy theorist.

I am not militant.

I am not a bleeding heart, I don’t embrace every cause du jour, nor do I hop on what someone termed a “clown car of supporters” for whatever happens to run across the blogosphere on a given day.

I am as straight-arrow, by-the-book, trust-the-Establishment as you will find in this world.

So when I say that I am reeling; when I say that I would take to the streets about something that has happened…when I say that I am questioning everything I thought I knew about authority, power…and nursing…

I’m not bluffing, over-reacting or being hysterical.

Pardon my unprofessional language, but there is some bad s*** going down in Arizona.

**********

The Arizona Board of Nursing has gone from ridiculous to abusive in the Amanda Trujillo case.

It wasn’t bad enough that they felt clicking a box on a computer that would order a case management hospice consult should mean enduring:

(a) a detailed interrogation about every facet of your entire career,

(b) or that talking about your situation should lead to a psychiatric evaluation, including obtaining signed releases from all your physicians for the last six years and seeing a board appointed PhD. Yep, clicking that box meant giving up all your protected HIPAA information! I can’t repeat that enough, it’s that appalling.

But that’s old news, isn’t it?

Here’s the new stuff.

********

Amanda received a letter from her university stating they were informed by the AZBoN that her license was under investigation.

Still, old news, you say? But wait!

A Board staff member wrote a letter denying it!

At Amanda’s request to keep the name of her university out of the spotlight, I’ve not listed it here. I have seen:

(a) the letter from her university stating they were “notified by the AZ Board of Nursing that your license is under investigation” (that’s a direct quote, italics mine.) Not that they looked it up, not that they deduced, but that they were notified.

(b) I’ve seen the BoN letter requesting confirmation of her attendance and,

(c) I’ve seen the BoN letter from a staff member who denies reporting it and is “…not aware of any other Board staff member doing so.” (Italics mine.)

So who the hell did?

Amanda’s university was notified by somebody at the Board. A request for confirmation of attendance is not a notification that a license is “under investigation.” Nowhere on the letter for confirmation does it say or intimate that the license is “under investigation.”

But it gets better…

********

Amanda is now being charged with using false “academic credentials”!

Yeah, this is what you do when (a) the original charges aren’t legitimate, (b) you’re angry that someone had the ovaries to not be afraid and stick up for herself, (c) they weren’t intimidated by the psychiatric evaluation, and (d) you need to ramp up the intimidation factor.

And I’ve seen the letters for this, too.

Amanda was accepted into a different university’s Acute Care Nurse Practitioner doctoral nursing program in the Fall of 2010. She began using the designation “S” following the professional designation, to denote “Student” on the auto sig on her email.

Due to some major health issues that included surgery, Amanda was unable to start the program. In November of 2010, she resigned from her job at the Mountain Vista Medical Center, using her personal email.

She had forgotten to take the “DACNP-S” off the “MSN, RN, DACNP-S” of her personal email auto sig.

********

So they are investigating this, per the Nurse Practice Act, for deceiving, harming or defrauding the public and/or stating or inferring she was a nurse practitioner through the use of the initials.

Boy, I hope all the public harmed by those six initials on her personal email sought help.

The Board found this terrible, egregious action of professional malfeasance during their extremely thorough investigation of Amanda’s career. For the record, the Arizona Board spends an average of 7 months investigating the average complaint, on which they average 17 hours (see this open letter to Arizona’s governor, by RN Greg Mercer.)

They must really be gunning for something here. If they had anything on the original complaint, this would have been over long before now.

What the hell is going on?

********

And let’s remember what brought this all on.

Patient education and a referral for a case management hospice consult.

No injury. No death. No tort.

An informed patient. A change of heart. A fuming physician.

And the nursing management at Banner Del E. Webb Medical Center, who feels that patient advocacy is something to be punished and reported to the Arizona Board of Nursing.

And apparently the Arizona Board of Nursing doesn’t take kindly to being questioned and operating out in the open.

In the meantime, the American Nurses Association is “monitoring closely” and the Arizona Nurses Association is working hard for the nurses of Arizona, but can’t support an individual nurse who is under investigation.

********

I’m not here telling anyone they need to support Amanda.

Whether you are for her or against her or couldn’t care less one way or the other, so be it.

This is a damn scary story.

What is scarier to me is the idea that Amanda should have shut up, kept her head down and just tried to get another job.

Is that what nursing is about? Are we so whipped by needing our paychecks that we don’t dare speak out about anything, anywhere, anytime?

The nurses in Texas spoke out and there was support from all over the country.

Does a nurse need to be arrested before anyone cares?

*********

Something bad is happening in Arizona.

From the halls of Banner Health, to the inner workings of the Arizona Board of Nursing, something is wrong.

You can ignore it, vilify Amanda, write her off as “oh there must be something else”, or make fun of those of us who do support her, but the fact is this is not right.

If I’m wrong, then I’m wrong and I’ll be the first to post it.

I’m not wrong.

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43 Comments

  • SeaSpray
    SeaSpray

    February 17, 2012 at 12:15 pm

    OMG Kim! She HAS to WIN this case!!

    Thanks to those of you in the profession that know better and shedding lite on this, especially WC ..she’s got a good chance.

    I am not one who believes in lawsuits unless something egregious and has to happen. They all should be sued ..even if she wins.

    The sad thing is that her reputation is still damaged and will never be back to 100% because there will always be those who believed what they read from unreliable sources.

    But, there is so much potential for significant and lasting good to come from all of this.


  • Marsha
    Marsha

    February 17, 2012 at 12:32 pm

    Thanks so much Kim for continuing to blog about this,it means so much.
    I think the AZBon’s panties are in a bunch because people not under their imminent threat regarding licensure are questioning and bringing into the light their questionable practices,and I’m sure AZ is not the only place that does this and is watching. Since they cannot discipline or threaten all of us to be quiet they are going after the one nurse they can reach,Amanda.
    But this bell can’t get unrung,nurses from all over are outraged at the treatment of Amanda and are finding an appropriate outlet for their anger at the horrible bullying in our profession that is and has been coming from the top all along. We are fighting for ourselves,for our fellow nurses and our profession;that other members of the health care team are trying to shove back into the “hand maiden age”,where it never really was,actually.


  • Enrico
    Enrico

    February 17, 2012 at 12:47 pm

    This is getting ridiculous. I already signed two petitions and I’m not even anything official in healthcare anymore. I hope all the nurses, CNAs, students, etc. don’t let up in spite of the rolling eyes, the whispers of “conspiracy theorist” that might be uttered behind one’s back, although I can’t imagine that will fly anymore given how egregiously smarmy these facts are bubbling up.

    They were talking about sunlight being a metaphorical disinfectant–well this abscess is buckling under its own pressure and I’m afraid it’s gonna get messy. I just hope that Amanda Trujillo has enough of a career/life/dignity left when it’s all settled and not some, “Oh sorry for all the trouble, but we were wrong…sorry we can’t turn back the clock but hey, we all learned something right?”

    And then the counterattack…not just by Amanda, but by the nursing profession.


  • Maggy
    Maggy

    February 17, 2012 at 1:43 pm

    Can someone tell me where I can read ALL of the source documents for this case? Thanks


  • Dan
    Dan

    February 17, 2012 at 6:47 pm

    I am not a nurse or a doc, and my (computer programming) job is only vaguely related to healthcare. Still, I’ve been following the Trujillo case with interest since it was first posted on (some blog. This one? Nurse K’s? I dunno). It fascinates me, because there’s definitely something going on beneath the surface that needs to be brought to light.

    Arizona is a weird state. How else can you explain sheriff as corrupt as Joe Arpaio? But still, this is weirder than usual.

    The “WC” that SeaSpray mentions is WhiteCoat, right?


  • Gail G, RN
    Gail G, RN

    February 17, 2012 at 7:02 pm

    Kim, you wrote a beautiful piece here, and put a whole new perspective on this. This is indeed very frightening. Something smells very, very rotten in Denmark (Arizona) and it angers me to no end all the way here in Ohio.

    As a nurse of 34 years, you think you’ve seen and heard it all…but no, women are still given the big kick in the teeth, damned if they do, damned if they don’t.

    Thanks for writing this…it’s excellent.


  • sallie
    sallie

    February 17, 2012 at 9:20 pm

    Now additional investigation about INITIALS? That is just silly. Sure, AT should have updated her siggy, but a reminder from the AZBoN would be more than enough for such an oversight.


  • amanda trujillo
    amanda trujillo

    February 18, 2012 at 1:32 am

    Agreed Sallie….was going through so much at the time–call this experience trial by fire in everything nursing. i hate all of this.


  • Orfyn RN
    Orfyn RN

    February 18, 2012 at 3:25 am

    To anyone who has studied the history of Physicians, Hospitals ans Nurses, this savage attack on an RN should not be a surprise. Nurses have always been seen as entities that must be controlled and kept in their place. The real tragedy is that nurses have always bought into the idea. For example, how many nurses out there know who JCAHO is? Answer: The AMA and AHA. How many nurses out there know where JCAHO came from?
    Answer: When Medicare was enacted in the mid sixties the Johnson administration was going to set up a federal agency to certify hospitals for medicare payments. The AMA and AHA said “Oh no! We will do it on a voluntary basis and save the taxpayers a bundle.” The Johnson administration came back with aq proposal that this commission be based on a tripod of the AMA,AHA and ANA. The AMA and AHA came back saying they would have no part in having the ANA aboard. What? Give nursing a seat at the table and (God forbid) some power? Absolutely not! Most of the shared governance deals I have run across which have become the rage in many hospitals are actually toothless shams designed to give nurses the illusion of having a stake in how things are run.


  • Granny RN
    Granny RN

    February 18, 2012 at 8:45 am

    Orfyn is correct about the historical treatment of nursing. The Magnet business is a joke. A hospital pays $50,000 or so to the ANA Certification body to come in and ‘inspect’ the place to determine whether Magnet Designation can be ‘conferred’ upon the institution. When THAT kind of money is laid out-the hospital WILL get what it wants no matter who has to be tossed on the burn pile.
    Amanda Trujillo can still sue the State of Arizona for violation of her civil rights, discrimination or whatever if all else fails.
    And it IS true that ‘where there is Smoke, there is Fire!


  • Greg Mercer
    Greg Mercer

    February 18, 2012 at 11:18 am

    This story has become the first of many thousands I’ve read over the years that has led me into public advocacy. The details are not at all surprising except for one crucial detail: it happened not in the Soviet Union, where such abuse of Psychiatry was standard practice as a tool of oppression and deceit. I have read that such use of Psychiatry as a harassment tool is on the rise in America: some call it Orwellian, but it’s not clear to me that even Orwell, in his darkest visions of human defredation, would have imagined Nurses acting this way toward each other in a democracy.


  • Joe3
    Joe3

    February 18, 2012 at 12:08 pm

    Thanks Kim for summarising the case, there are details here that I’ve been interested in seeing. I’m behind Amanda 100% for being fairly treated…and from what I’ve read, she’s done nothing wrong – up to the initial issue(and that remains weather that is even an issue) – and I’m not a clown car member either, but do understand there are two sides to every story and I’m waiting for the other…the Banner spokesman? in a TV interview did mention the ordering of Hospice a MDs decision, but that just clouds the real issue.
    Someone mentioned a ‘witch hunt’ along the way, and this case just feels to have taken that perspective from here.
    And thanks to all the comments left here, I have learned much about the history of nursing and hospitals.


  • Ellie
    Ellie

    February 18, 2012 at 2:06 pm

    It’s petty and bizarre, I agree, and is the kind of behavior I file under “W” for WTF…
    If AZ has title protection specifically for nurse practitioners which includes that academic degree- NOT the licensure -, it seems like they can make an actual ‘thing’ out of it if she signed the DACNP (s) at Banner and at least a mild fuss if it’s used in much official (or any patient) correspondence. If it was truly only a sig which was auto-attached, I would imagine that there is precedent here. Because the initial email on the post appears directly signed on a casual read (not separated out, etc.), that may be the problem. It’s pretty clear on my system when I’ve had an autosig and when I haven’t, even accounting for mail sent from phones, etc.
    This is why our hospital does *not* allow the (s) designation – it is equivalent to the very sketchy “PhD (ABD)” which results in much eye-rolling. You have a PhD or MS or DACNP, or you do not. You will note that med students do not write MD(s)… or never have in any of the universities or hospitals I’ve known. EHR signatures say “RN, Student Nurse Practitioner.” Ink signatures can be abbreviated to RN, SNP after it’s written out once.
    I live in a state with title protection for the academic credentials as well as the licensure, and the BON will go after any appearance of ‘misrepresentation.’ A good faith error gets you a nasty note. Not changing an autosig for 2 years? Um, that might be a tough sell, although, honestly, I have things in my car I have been intending to take to the alterations place for >2 years, and so I completely believe that things slip by – and I don’t have kids, etc., as Ms. Trujillo does.
    HOWEVER: it’s completely irrelevant to the core issue of this scope of practice question, and very sleazy for the BON to go after it now if they’re not attaching it to this incident somehow. She requested a CM consult on pt request in the service of pt education. This was apparently within the scope of nursing orders for that facility (as it is at mine) and it doesn’t exceed anything in the nurse practice act, apparently.

    ***

    Not to be snotty… that’s not true, I’m being snotty… but the BON can order her to have a psychological evaluation with a PhD/PsyD (board certified), or a psychiatric evaluation with an MD/DO/ANP. But she can’t, technically, have a psychiatric evaluation with a “board certified PhD.” Since precision in use of credentials is so very important to the BON, someone might want to point this out.


  • Kim
    Kim

    February 18, 2012 at 4:05 pm

    Hi Ellie,

    In the post, I refer to a board “appointed” PhD, if that is what you are referring to. Meaning that the Board is the one who decides who will do the evaluation.

    Kim


  • Nurse K
    Nurse K

    February 19, 2012 at 4:18 am

    Even if the Board of Nursing didn’t tell the school about her license being under investigation and the school found out from some other source, hello, she told the entire Internet and the local news station that her license was under investigation herself, so big whoop. Obviously they’re going to find out one way or another.

    Also, kind of curious why one would have student nurse credentials on one’s personal email autosignature, especially when you’ve never attended a single NP school class. I can’t remember ever signing or wanting to sign anything “SN” outside of charts of patients that I worked on in school. Is this common?

    Again, I don’t think disciplining anyone for that is anything that needs to be done, but, sorry, it’s just weird having student nurse credentials on your personal autosig in general and specifically when you’ve never attended a class for that program.


  • Nurse K
    Nurse K

    February 19, 2012 at 4:26 am

    What is scarier to me is the idea that Amanda should have shut up, kept her head down and just tried to get another job.

    Assuming you’re at least somewhat referring to my post here, keep in mind that Amanda claims to be receiving welfare checks as a result of this, so she is obligated by law to be actively seeking employment.

    99% of people who lost their jobs were “wronged” by someone or something (when’s the last time anyone ever said they deserved to be fired), and you can either dwell on that forever collecting welfare checks at taxpayers’ expense or work on supporting your child. Advocating can wait until you’re off welfare at the bare minimum.


  • amanda trujillo
    amanda trujillo

    February 19, 2012 at 4:46 am

    Wow. …..Im actually in school full time working on my doctorate nurse practitioner and trying to get a nurse advocate business off the ground….


  • amanda trujillo
    amanda trujillo

    February 19, 2012 at 4:48 am

    Ive been in school for a while now. Did I say anything to offend you at all? I dont recall openly engaging you or speaking with you….If I offended you somewhere I do apologize.


  • amanda trujillo
    amanda trujillo

    February 19, 2012 at 4:50 am

    I was actually enrolled in an FNP program and had to drop it due to a severe illness and surgery–I got halfway through it.


  • amanda trujillo
    amanda trujillo

    February 19, 2012 at 4:52 am

    If youd like my school history id be happy to provide that to you via private email. please send me an email at fyrhoneybsn@yahoo.com for further inquiry….


  • Nurse K
    Nurse K

    February 19, 2012 at 12:34 pm

    Amanda, I’m responding to the post as written by Kim.

    Also, yes, you’ve responded to me personally on Twitter. I’m @ernursek on Twitter.

    I am, actually, a bit offended that you take welfare checks rather than look for another job while you’re in school and decide to further ruin your chances for work by going around on the Internet like this.

    You told me that you don’t want to work for anyone else again. Kind of a big thing to say when you’re on welfare, in my opinion.

    There’s a time and a place for the type of stuff you’re doing, but it’s not when you have a child and you’re on welfare. Children first.


  • Jennifer Olin, RN
    Jennifer Olin, RN

    February 19, 2012 at 9:41 pm

    Kim,

    Your writing is so strong and it is sad that you have so much material to work with. I do know that it appears the AZ BON is on a witch hunt and they are ready to drown Amanda. Hilary Clinton said “it takes a village to raise a child” and I think it will take a “village” of nurses to bring this behavior that reeks of bullying to light. Nurses teach, they tell us that in the first classes of nursing school. Nurses advocate, they tell us that the first day. I guess now it is our turn to advocate for Amanda and teach the BON that this kind of behavior is unacceptable.


  • amanda trujillo
    amanda trujillo

    February 19, 2012 at 11:06 pm

    Nurse K, thank you for taking an interest in the case and for your recent feedback and input–it’s well received.


  • amanda trujillo
    amanda trujillo

    February 20, 2012 at 3:08 am

    Jennifer, the “village” that continues to grow daily is still so amazing to me. The emails from nurses all over the country telling me their “stories” and how they rebuilt their lives as business owners in nursing after quitting the bedside or getting terminated for reporting give me a sense of peace and hope for me and anayas future. I received a letter this past week from a nurse advocate program offering me a place when all this is done. What is encouraging is the fact many of the emails are from healthcare consumers themselves and the fact “patients” are now taking up the cause speaks to the confidence the public has in nursing! So as the “village” continues to grow I just give thanks for it—after almost a year fighting alone in this state to set things straight it has been so wonderful to meet all of you, talk every day, and make plans for the “great big meet up” when this is done. Ive made new friends in all of you and without that I dont know that i would have had the strength to finish the race. You guys are some of the strongest nurses Ive met in my career. :)


  • In the Footsteps of Rosa Parks | Nurse Up!
    In the Footsteps of Rosa Parks | Nurse Up!

    February 20, 2012 at 6:23 am

    [...] Nurse K gives an accurate blow by blow description on how corporate nurse leaders wage war against their nursing staff. She explains how nurse managers orchestrate the demise of nursing careers. Make management angry and you get the axe, and there isn’t a nurse alive that hasn’t witnessed or experienced the wrath of hospital management. Nurses scatter and go underground when someone gets in trouble, and conventional wisdom states that a nurse should be contrite and take their punishment when they are abused by those who hold power. Many people are wondering why Amanda didn’t follow the same path. Some, like Nurse K, are suggesting that Amanda is committing career suicide. Other’s have told Amanda to “shut up.” The American Nurses Association and the Arizona Nurses Association won’t support an individual nurse who is “under investigation.” Egregious comments and actions are coming from the Arizona Board of Nursing. Kim McAllister from Emergiblog writes about the board’s actions here. [...]


  • Beenthere!
    Beenthere!

    February 23, 2012 at 8:34 am

    Banner Del Webb Medical Center will turn on ANY professional that speaks up for the patient. That includes doctors. This is not just a typical physician VS nurse situation. It is far more than than. BDWMC has been intimidating their staff (the ones that are true patient advocates) for awhile now. They love to request a Psych eval for any professional that speaks up FOR the patient. I know many nurses and yes, doctors that have been reported to their boards from this facility. Something stinks in Sun City West, you got that right! The public needs to know.


  • Karen
    Karen

    February 27, 2012 at 7:37 am

    I am a nursing student and I have heard some of my teachers saying that the BON does not exist to protect nurses, rather, they exist to protect the public from the nurses. Reading this article, I guess it’s true. So, if the BON protect the public against the nurses, who protect the nurses then? Don’t we have a governing body who will be there for us when we need protection? Or are we on our own?


  • [...] her peers seem to stand in overwhelming support of her, in apparent agreement that the Arizona Board of Nursing “has gone from ridiculous to abusive [...]


  • Greg Mercer, MSN
    Greg Mercer, MSN

    March 9, 2012 at 2:15 pm

    Important news! – Some of Amanda’s supporters have recently posted a Change.org petition to boycott Arizona until we see some BON changes – please check it out & help us spread the word.

    Amanda’s next Hearing is 3/19 and AZBON reauthorization is still in the Legislature – we’re running out of time on this unusually opportune time for positive 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

    Thanks for your support,

    Greg Mercer, MSN


  • The Angry Medic
    The Angry Medic

    March 16, 2012 at 12:31 pm

    What in blazes is going on here? I thought this type of steaming dung was only served up by doctor?s associations here in Britain, but NURSING associations in the US? And pedantry to th point of checking e-mail signatures? Bloody hell I’d make a tired George Orwell joke, but this IS a tired George Orwell joke.

    Off-topic (but you?ll forgive me because I bat my eyelashes at you) my latest post is about nurses and how doctors view them. (well, us NICE doctors anyway) Have a look at http://angrymedic.blogspot.com/2012/03/stuff-they-dont-teach-you-in-medical.html and please, go easy on the rotten vegetables :P


  • Jeffrey Solis
    Jeffrey Solis

    March 19, 2012 at 12:17 am

    Again, I don?t think disciplining anyone for that is anything that needs to be done, but, sorry, it?s just weird having student nurse credentials on your personal autosig in general and specifically when you?ve never attended a class for that program.
    http://liftserumprofacts.com


  • Nurse K
    Nurse K

    April 14, 2012 at 6:41 pm

    Dead blog?


  • Kim
    Kim

    April 14, 2012 at 7:22 pm

    LOL! No, not dead, just resting. Life intruding. Spent a month in Portland with new grandson. : )


  • S.T.
    S.T.

    April 27, 2012 at 7:11 pm

    WOW!! This is quite a scary story. It is such an abuse of power and it makes me so sad! Thank you for getting this story out there to inform people of what is going on.


  • Chris
    Chris

    May 17, 2012 at 11:43 am

    Thank you Nurse K for this great article. Is there a site that has the full story? Keep up the good work


  • Jackie Parish
    Jackie Parish

    May 17, 2012 at 4:39 pm

    Nurses eat their young. I have been a nurse for over 50 years and nothing has changed. The administation will never look at all the facts or consider the circumstances. It seems they will never change. I always felt sorry for the new nurses. They seemed to get it worse than anyone else. They had not developed the thick skin the rest of us have. I had nurses come to me to say they could not take it anymore and were going to leave the profession. I retired 3 years ago and miss it everyday. Once you are a nurse you are always a nurse.


  • Fiona
    Fiona

    July 6, 2012 at 4:12 pm

    A witch hunt for sure. You’d think the BON would want to spend its time on real issues. Thanks for sharing.


  • Jane Morai
    Jane Morai

    August 4, 2012 at 7:02 am

    Oh gosh. This is my first time hearing about this case. I will have to get up to speed on this case but from what i’ve read it really does sound like quite a shame to put that girl through so much for standing up. Quite an interesting and scary story.


  • Priya Sen
    Priya Sen

    August 31, 2012 at 7:04 am

    Yes seniors hurt their young juniors but that’s not the end, we the members of patient party also hurt then by forgetting to say a single thanks after their stressful overnight duty.


  • Nina from Online-CNA-Classes.org
    Nina from Online-CNA-Classes.org

    September 17, 2012 at 7:14 pm

    This was not leaked. It came from the board. Megen asked for the document and it was sent to her directly from the board. She has named the AZBoN contact on her blog in the comments (and confirmed it to me.)


  • Dan W.
    Dan W.

    December 3, 2012 at 12:04 pm

    This type of behaviour should not be tolerated and or ignored. I don’t think your a conspiracy theorist, I just think that some people want to have more power than they should. It’s really a shame. Thank you for bringing this to the masses. I hope that the things in 1984 don’t come to pass, but lately it’s been getting scary.


  • 30 Great Blogs for Nurses
    30 Great Blogs for Nurses

    December 10, 2012 at 11:14 am

    [...] Highlight: When Nurses Attack at the Highest Levels: A Blatant Abuse of Power [...]


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    modem vs router

    February 14, 2013 at 3:37 pm

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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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