January 28, 2012, 12:03 pm
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.
January 27, 2012, 9:32 am
Information.
So much of what I do as an ER nurse involves information.
As an RN, I am responsible for providing patients with information about their illness/injury, their medications and their follow up instructions.
Patient education is paramount; I find out what they know, then provide education to fill the gaps.
If they cannot access medications or follow up care, I provide information on how to access those needs.
That is called patient advocacy.
It’s the backbone of nursing, everywhere. Every hospital, every state, every country.
*****
So you can imagine how confused I was to find out an Arizona nurse Amanda Trujillo, RN, MSN had been fired by Banner Health Del E. Webb Medical Center for doing exactly that, advocating for her patient by PROVIDING INFORMATION.
That’s right. Very simply: during a shift, she discovered a patient knew nothing about the details of a major invasive surgery. Not what the surgery entailed or what life would be like after the surgery (“complex lifetime daily care”). They did not know they had the option not have the surgery or that other options were available to them.
The patient requested further information and Ms. Trujillo provided it, including arranging for a case management consult, and documented all of this to the hilt (even the nurse investigator noted this).
*****
The patient changed her mind, didn’t want the surgery. The doctor blew a gasket, threw a tantrum in the nurses station (sound familiar, nurses?), demanded Trujillo be fired, and her license revoked.
Bingo! Instead of supporting their nurse, Banner Health fired her.
For providing information and giving the patient the opportunity to learn more about their condition and their options.
For empowering her patient.
Within her scope of practice.
Within the nursing code of ethics.
*****
As I said in my last post, I’m sputtering angry.
But my anger was turned onto the physician – and that is misplaced anger.
Let the doctor throw his anger all over the place, he will do what he will. If an empowered patient angers him, that’s just sad.
The problem here is Banner Health.
For not supporting patient advocacy.
For not supporting that particular patient’s right to decide.
For not supporting their nurses.
For firing a nurse for doing what she was supposed to be doing.
Her ethical duty.
*****
Next post: this goes viral and how to support registered nurses’ right to advocate for patients.
Because next time, that patient could be you.
January 24, 2012, 12:15 pm
No funny, vintage picture today.
An Arizona nursing colleague is in danger of losing her license for acting as a patient advocate within her scope of practice.
Her hearing, initially scheduled for today, has been delayed for two months so this registered nurse can undergo a psychiatric evaluation.
*****
Yes, that is correct.
Providing appropriate patient education in the face of a major knowledge deficit, and obtaining information for the patient, at the patient’s request, is now grounds for a sanity check.
Especially if you piss off a doctor.
<Taking a breath. Centering. Doubling up on BP medication>
*****
The nurse is Amanda Trujillo. Her story, Arizona Nurse Has License Threatened By Doctor After Providing Patient Education is at The Nerdy Nurse, complete with original email and brief.
The psych eval is beyond belief. If you can’t bring ‘em down on practice issues, intimate that they are mentally ill and delay the process.
Where is the American Nurses Association? What on earth are you there for if not to support the practice of nursing? If this isn’t a hit to the heart of what we do every day, please define what it is we ARE all about!
The Arizona Nurses Association has done nothing, and this has gone on for almost a year (in fact, Amanda notes in a comment that the President of the Arizona association is a Director at the hospital she was fired from!) By the way, hit the link and look at their Mission Statement.
I’m not very proud of my profession right now.
Nurses not only eat their young, but God help you if the almighty Medical Establishment gets ticked off.
Nurses talk a great game. In the Halls of Academia and the Ivory Towers of Those Who Claim to Advance The Profession, it’s all “Nursing Is An Independent Profession” and we tirelessly “Fight For Our Right To Practice To The Full Extent Of Our Education And Training”.
Unless you’re down in the trenches doing patient care every day and someone gets angry that you have dared to advocate. And if that Someone is a Doctor, well, the bigwigs scatter to the four corners of the ring.
Musn’t create controversy.
Hell, they aren’t even standing on your side of the arena.
*****
I guess all that support for the Texas nurses was a fluke.
Hope we enjoyed it while it lasted.
I salute my fellow nurses who are able to blog about this with clear heads and calm words.
I guess I’ve been doing this for too long, seen too much and just cannot believe this is happening in the 21st century.
To realize once and for all, bottom line, that if you are a staff nurse, no one has your back.
Even if you do the right thing by your patient. The right thing by the nurse practice act. The right thing by hospital policy.
One temper-tantrum throwing physician can derail your career!
Un.Freaking.Believable.
