February 11, 2012, 2:26 am

Hush, Hush…Keep It Down Now, Voices Carry

Back in the days before budget cuts, and long before the rise of the Internet, the California Board of Registered Nurses would publish a regular newsletter/report.

Every registered nurse in the state received a copy.

In the back, they would list the names of the nurses who had received a disciplinary decision on their license.

I used to read that, seeing if I recognized anyone I knew.

I never did.

But I would look and see just what it took to get dinged by the BRN.

Felonies and/or drug associated activities were about 99.9% of the cases.

It takes pretty serious stuff for the CA BRN to hit your license.

*****

The thing that bothers me most about the Amanda Trujillo case; the thing that makes me furious when I stop and think of everything surrounding it, is this belief that a nurse accused is required to, pardon my bluntness, keep their mouth shut.

Now, let me try and work this out…

Anyone can place a complaint with a Board of Nursing.

Anyone.

For any reason, any motive. In this case it was Banner Del E. Webb Medical Center who filed the complaint with the Arizona Board of Nursing.

This complaint is public record. The fact that you have a complaint on file with the Arizona BON, and the date it is filed is public record.

But…ask the Arizona Board of Nursing for a copy, and you are told you cannot disclose what the complaint says. Can’t fax it. Can’t copy it. Can’t quote it.

Keep your mouth shut.

*****

So, ten months pass, during which the nurse investigator assigned to the case tells you your charting, care plan, nursing diagnosis, and nursing care are above and beyond the call of duty and recommends that your case be dismissed as this is no danger to the public.

The Board says no, and proceeds to investigate/interrogate your entire career up to that point, with a fine tooth comb.

They don’t find anything.

So, this nurse reaches out to an author she admires (Echo Heron) and the story makes the Internet via the nursing blogs and all hell supposedly breaks loose.

Keep your mouth shut!

The Board isn’t happy she is speaking out.

She posts her response to the complaint with the patient information redacted.

Her attorney is mad! She’s a bad nurse! Bad, bad nurse!

Keep your mouth SHUT!

You are accused. We will tell you if you are relevant. We will tell you when and if you may speak.

Stand back and shut up, for you are the accused.

*****

When you speak up, or have others speak up on your behalf, you are considered to be “retaliating“.

This buys you a psychiatric evaluation, courtesy of the Board.

For that, they want releases from every single physician you have seen for the past six years.

All your HIPAA stuff? They’ll own it.

Now step back and think of everything you have asked your physician about in the last six years. You comfortable with that in the hands of a state Board of Nursing, with ties to national nursing organizations and a member who works for Banner Health? You comfortable with that in the hands of a Board appointed psychiatrist?

That’s what you get for not keeping your mouth shut.

And to top it off, after ten months, someone on the Board will call your university directly and inform them you are under investigation.

Keep your mouth shut.

*****

Even nursing colleagues have doubts.

“She must have done something else.”

“No one gets fired for just one thing.”

“We don’t know all the facts.”

“There’s two sides to every story.”

And…

“She ought to keep her mouth shut.”

Does anyone even think for one minute how gutsy it was to go public…

and NOT keep your mouth shut?

*****

That’s the problem.

Nurses do keep their mouths shut. All the time.

Because they are afraid. Isolated.

Fear of retribution by their employers. Doctors. Corporations who wave HIPAA like it’s the national flag.

And I’m sorry, but hospital corporations like Banner Health and state Boards of Nursing do NOT work in secrecy and isolation.

A nurse was FIRED and her LICENSE put up for investigation by an employer. THIS IS HUGE, PEOPLE. To fire a nurse for allegedly not following your policy is one thing. To go after her license is quite another.

You say you want the whole story?

The only way you are going to get the whole story is to get it out of the secrecy of corporate hallways and state boardrooms and start talking about it.

Stop keeping your mouth shut.

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February 9, 2012, 1:34 pm

American Nurses Association: Supporting Nurses, Until You Need It

I have always considered the American Nurses Association my professional organization.

And I mean “my” organization.

I didn’t always agree with the political candidates they backed, the health care legislation they promoted, or the fact that my dues paid for political lobbying I might not agree with.

They didn’t support the National Nurse for Public Health, a very grass roots movement started by staff nurses and a cause very near and dear to my heart.

But, bottom line, they were for nursing, and I was a nurse, so they were there for me.

And while I most definitely took advantage of the online benefits, I never really needed the ANA for any personal, professional help or support.

Which was good.

Because it won’t be there if I do.

*****

When Amanda Trujillo was first fired and then reported to the Arizona Board of Nursing by Banner Del E. Webb Medical Center for patient advocacy, she reached out to both the Arizona Nurses Association and the American Nurses Association for help and support.

She heard nothing.

But lately, lo and behold, there have been statements.

Here is the statement from the American Nurses Association, taken from their Facebook page:

“The American Nurses Association (ANA) is closely monitoring the case of Amanda Trujillo, MSN, RN, and has been in contact with her attorney. ANA strongly supports nurses and their right and responsibility to engage in patient education and advocacy.

ANA appreciates how difficult it is for a nurse to undergo an investigation of his or her practice by the state board of nursing. To be clear, ANA expects the Arizona Board of Nursing to follow its standard procedure, to render an unbiased judgment in this case, and to be fully transparent in its findings.

ANA advises that any nurse who has been alerted by the board of a complaint and an impending investigation retain legal counsel. It is the role of legal counsel to represent the nurse during the process. In addition, ANA cautions nurses and the public not to rush to judgments about complex cases based on social media postings or other media coverage.”

So, let me get this straight.

The ANA is “closely monitoring” the case. And they strongly support nurses…etc. BUT, if you are an RN who is under investigation they aren’t going to back you as an individual for one second.

Then again, if you are exonerated, their support is no longer needed!

What a win/win for the ANA! They can give lip service to your right to practice, but if you are being dragged through the mud by your state board, their lips are sealed. If you aren’t guilty of anything, well, hey! Great! Now you don’t need their support anyway!

Oh, but they appreciate the difficulty!

Ah, but they don’t have all the facts, you say.

Please. Nobody died in the Banner case. Nobody was harmed in the Banner case. A box was checked on a computer that sent an order for a case management hospice consult. Didn’t sign a patient up for hospice, just arranged for a nurse to talk to a patient.

For that, a one sentence complaint accusing an RN of practicing outside her scope gets sent to the Arizona Board of Nursing.

And the ANA can’t find it within themselves to commit to supporting the individual nurse.

They sure had no problem ramping up the support for the RNs in Texas! And that was BEFORE all the facts were in!

*****

The next part should send chills up your spine.

“…and has been in contact with her attorney.”

The American Nurses Association has never contacted Amanda Trujillo about this at all. EVER.

She never gave them permission to contact her attorney. Never got a note or a call saying, “Hi Amanda, legally, we can’t speak with you about the case directly, but we would like to call your attorney, can we have his number?”

How did they get his contact information? Wasn’t from Amanda.

And the contact? Whatever it was had nothing to do with supporting her through this ordeal.

That’s a given.

*****

And finally:

“…ANA cautions nurses and the public not to rush to judgments about complex cases based on social media postings or other media coverage.”

Yeah, I just bet they do.

Well, folks, this is a social media posting.

You aren’t going to get the story from the Arizona Board of Nursing. All they do is threaten you if you speak out and ask for your entire medical history for the last five years so they can do a psychiatric evaluation because of retaliatory behavior. No story from them.

You aren’t going to get the story from Banner Health. Remember, they fired a nurse for patient advocacy. Not something you want to shout from the roof tops.

You aren’t going to get the story from the Arizona Nurses Association because their President happens to be the Director of Professional Practice at Banner Del E. Webb Medical Center, and they are connected to the ANA.

You aren’t going to get the story from the American Nurses Association because Amanda is under investigation, so they aren’t taking a stand.

So it looks like social media postings for now.

I apologize for my shortcomings.

Look for “other media coverage” to be hitting soon.

*******************

Jennifer Olin, at RN Central.com writes about this topic here, at ANA Finally Acknowledges Amanda Trujillo.

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February 2, 2012, 11:37 am

(Not) Everybody’s Talkin’

Looks like someone has some explaining to do.

This photo has a very “Twilight Zone” feel to it.

The only thing missing is Mr. Serling.

Unless he’s standing at the other end of the table…

<cue theme music…>

**********

The nursing blogosphere is on fire with the Amanda Trujillo story, but there haven’t been too many comments from our physician blogger colleagues.

Dr. Dean over at the Millionaire Nurse Blog, dedicated one of his The Best in Nurse Blogs: Amanda Trujillo Edition to the topic, and followed it with a discussion of nurse/physician/healthcare team communication.

Today, I found this post by Dr. Terry Simpson at Your Doctor’s Orders, entitled Transplant or Hospice. Dr. Simpson has some valid opinions as a physician.

Unfortunately, they are buried in a lack of understanding of a registered nurse’s scope of practice, overwhelming arrogance and the use of an image of the book “Angel of Death” to make his point.

Everyone needs to go read this post.

Go ahead. I’ll wait.

This is what nurses are up against on a daily basis.

Not all physicians.

Not most physicians.

But enough physicians.

**********

The idea that nurses are supposed to just “take care” of the patient and defer all questions and education to the physician is mind-boggling.

Dr. Simpson posits that there is a time and a place to discuss end-of-life care.

And that the doctor is the one who makes that decision.

Seriously?

What happens when the patient asks about it?

“There, there Mrs. Smith, don’t worry your pretty little head about stuff like that. Doctor Welby will be in first thing in the morning and he’ll take care of everything. You just get some rest.”

Don’t worry that you will be transferred. Don’t worry that you will be undergoing extensive testing. Don’t worry about what a transplant entails or what it means for your life. Don’t worry about how old you might be or how involved your care might be or what resources you have.

We know what’s best.

Well, the doctor knows what’s best.

In your depressed, ill state, you can’t possibly know what you want or understand what it all means, or have the strength to make the right decision.

The doctor will decide when it’s time for you to know what you need to know.

Some doctors call that autonomy.

Whose autonomy?

**********

So, I guess as patients, we have a choice.

We can wait, and only ask questions of our physician, who may, like Dr. Simpson, tell us what we need to know when we need to know it based on their professional judgement.

Or, we can ask questions of the entire healthcare team, including our registered nurse, and receive information and education that will enable us to have a discussion with our physician about our health and what we should do.

You know, exercise our autonomy.

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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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