Nurse Ratched’s Place

I can’t believe that this is really happening, but maybe again, I can. Banner Health fired an Arizona nurse because she did the right thing, and now the Arizona Board of Nursing is threatening her nursing license because she is an excellent nurse. The whole incident smacks of unbridled greed and hubris.

The nurse is Amanda Trujillo. I found out about Amanda’s plight via Vernon Dutton’s twitter feed , and by reading this story that was posted at The Nerdy Nurse. This is Amanda’s story in her own words:

My name is Amanda Trujillo. I’m a registered nurse of six years , specializing in cardiology, geriatrics, and end of life/palliative care. Back in April of this year I was caring for a dying patient whom I had discovered had no clue about what they were about to participate in when they agreed to get a major invasive surgery. When I properly educated the patient using the allowed materials by my employer they became upset that the physician never explained details of the surgery or what had to be done after the surgery (complex lifetime daily self care). The patient also had no idea that they had a choice about whether they had to get the surgery or not or that there were other options. They asked about hospice and comfort care and I educated the patient within my nursing license and the nursing code of ethics. The patient requested a case management consult to visit with hospice to explore this option further in order to make a better decision for their course of care. I documented extensively for the doctor to read the next day and I also passed the info on to the next nurse taking over, emphasizing the importance of speaking with the doctor about the gross misunderstanding they had about the surgery. The doctor became enraged, threw a well witnessed tantrum in the nursing station, refused to let the patient visit with hospice, and insisted I be fired and my license taken. He was successful on all counts.

A very wise nurse once told me, “Put a dollar sign at the end of any question you have about hospital policy, and you will find your answer.” Truer words were ever spoken, especially in the case of Amanda Trujillo. Amanda’s only “crime” was affecting the hospital’s bottom line. The transplant surgeon lost out on a huge billable, threw a temper tantrum, and the hospital threw Amanda under the bus to appease the physician. Apparently Banner Health and their holier-than-thou surgeon don’t understand than patients have the right to know all their treatment options, and that nurses are mandated by our code of ethics to tell them the truth. Why isn’t Banner Health going after the doctor who threw his fit and refused to allow a patient to visit with hospice? Oh wait, I just need to look at that dollar sign at the end of my question. I’m sure it’s less expensive to provide comfort care to a dying patient than it is to perform surgery and put them through needless suffering. I guess they think that it’s more important to deplete a patient’s bank account than it is to give compassionate care.

Then comes the question about where the Arizona Nurses Association and the American Nurses Association stand in all of this. They stand in silence. I couldn’t understand why until I read this post written by Kim McAllister from Emergiblog. Kim wrote that Robin Schaeffer, MSN, RN, CNE, Executive Director of the Arizona Nurses Association is affiliated with Banner Health. No sir, no conflict of interest there. I thought nursing associations were supposed to represent, you know, nurses, not big business. The whole thing is so incestuous.

Now to add insult to injury, the Arizona BON postponed Amanda’s hearing for two months and ordered her to get a psychiatric evaluation. Why? Because she has the grit to fight back and tell her story on the Internet. If fighting for the right to practice nursing the right way makes you crazy, then we should all be so insane. I stand with Amanda Trujillo and I hope you do too.

Amanda Trujillo’s full story can be found at Vern Dutton’s website.

Please read The Persecution of Amanda Trujillo to learn more about this case.

Visit a Facebook page set up to support Amanda here.

Email the Executive Director of the Arizona State Board of Nursing, Joey Ridenour, RN, MN, FAAN: jridenour@azbn.gov

Complain to Banner Health here.

I received an email the other day from Erika Stewart, an account executive for an onlinemarketing agency. As the propritor of a nursing blog, I get a lot of letters from people like Erika everyday. They want me to write up a blurb about their clients. I hit delete, delete, delete. Erika’s letter was different. Yes, she’s a publicist, but she wrote a compeling article that deserved a second look.

Erika sent me a short write-up discussing how the Federal Health Care reform will effect nurses and how we practice bedside care. She asked me to read her article and comment on its contents. She wanted my honest opinion about how this reform will affect nurses. This is what Erika wrote:

“The effect of health care reform on nurses set to go into effect in January 2012, the provision for Accountable Care Organizations seeks to improve the outcomes and cost effectiveness of health care in the United States. This is one of the major provisions of the hotly debated healthcare reform law. Nurses will play a critical role in implementing the changes.

All health care organizations in the country must become ACOs in order to receive Medicare reimbursements. The ACO will consist of a team of physicians, hospitals and ancillary care providers responsible for the care of a patient. A set amount will be paid per Medicare recipient, and the ACO must provide services to at least 5,000 Medicare patients over a three-year time period. Payment will be adjusted upward for the care of those with severe or chronic illnesses. Patients with private health insurance will also be served by ACOs.

The ACO system seeks to incorporate the more successful aspects of HMOs without restricting patient choice. The goal of the ACO is to increase quality of outcomes and patient satisfaction while reducing costs. Nurses will be vital members of the team. Dean of Health Sciences and Nursing at Sentinel University, Dr Catherine Garner, DrPH, MSN, MPA, RN, FAAN wrote a series of articles on this topic for Links: HealthCareers.com. She anticipates that the measure will enable nurses to move into managing care, rather than simply providing care. This empowerment will expand the role of the nurse in ensuring appropriate and effective delivery of services.

As the ACOs are established, there will be a high demand for nursing case managers who can help to coordinate services for patients under their care. The case manager will work directly with the patient to educate and provide comprehensive care. This approach should lead to more positive health outcomes and fewer unnecessary hospitalizations. According to the American Nursing Association, nurses will be instrumental in transforming the current “sick care system to a true healthcare system.”

Anticipating an increased demand for RNs, especially those with advanced skills, the healthcare reform law put into place several provisions for supporting the education of nurses. Chief among these is the reauthorization of Title VIII Nursing Workforce Development Programs, the major source of federal funding for nurse education. Money is provided to assist both entry-level nursing students pursuing an associate’s or bachelor’s degree and those seeking advanced training.

The healthcare reform law establishes a new $50 million grant program to prepare nurses to manage private health insurance clinics that can care for underserved populations. It also raises the funding for the National Health Service Corps from $75 million to $300 million. The healthcare reforms being put into place to give all Americans access to health insurance and care rely heavily on well-prepared, dedicated nurses to provide both leadership and management of patient care. These new opportunities carry with them a great deal of responsibility, a welcome change in the field of nursing. The potential of nurses to improve patient care has long been overlooked. Nurses are able to spend the time needed to work closely with patients in planning and executing their health initiatives.With the added incentives of higher paying and more responsible positions, nursing is becoming increasingly attractive to bright, energetic students who are ready to enter this dynamic field. The role of the nurse will be central in the development and maintenance of a successful ACO.”

Erika wrote a very nice article. Unfortunately, there is a huge downside for patients and bedside nurses in the brave new world of healthcare. Hospitals are going to be paid based on patient care outcomes and patient satisfaction. This means that nurses who are already overworked due to a lack of licensed nursing staff are going to be put under more pressure to produce. As a result, many healthcare organizations plan to bring in unlicensed healthcare workers to provide more of the bedside nursing care. Some nurses like Dr Catherine Garner’s, DrPH, MSN, MPA, RN, FAAN applaud this move. I take issue with Dr. Garner’s opinion. I was disturbed by Dr. Garner’s belief that these measures will enable nurses to move into managing care, rather than simply providing care. Bedside nurses are not empowered by this move. Nurses provide superior bedside care, and relegating this responsabilty to unlicensed staff is unsafe. I don’t want untrained caregivers working under my nursing license, nor do I want to be tied down to a desk filling out endless paperwork all day long. I am already an important memeber of the healthcare team and there is nothing wrong with simply providing bedside care.

Well, there you have it. That’s my opinion. Erika, I hope you aren’t too disappointed with my response to your article. Feel free to write to me again. I promise I won’t delete your email.

It just seems like yesterday. Blogging was new and we were all learning about blog carnivals like Grand Rounds. Now our carnival is being hosted by USA Today. I want to thank Dr. Val Jones and the editors of Healthy Perspective for making this happen. I hope that USA Today will continue its support of Grand Rounds.

Val had so many submissions for this edition of Grand Rounds, so she created four categories to help readers navagate through the entries. They are:

Each will be published through the day as a separate post here on the Healthy Perspective blog, so check back in to make sure you read each category. It’s a great day for Grand Rounds!

Cutting our wedding cake in 1998. David died in 2010.
I entered a parallel universe two years ago after my husband, David, passed away in his sleep. This new universe looked familiar. I was cleaning the same house, driving the same route to work every morning, and going to sleep in the same bed at night, but everything felt surreal. One day I was a wife and then I was a widow, and that shift came with a new set of circumstances and emotions that I had never faced before. People are keen on giving you advice before you get married, but no one knows what to say to you when your husband dies before you do. I had so many questions. How do you survive when you outlive the man you love?

Riding out Grief

I was confronted with overwhelming grief when my husband died, so I scoured the Internet looking for advice on how to deal with it. My advice is to ignore all the advice. Everyone grieves in their own way and in their own time. There are no rules about grieving, however, there are a few facts you need to know about the grieving process.

You will go through the stages of grief, which are denial, anger, bargaining, depression, and acceptance. Denial is the first stage of grief. It works as a filter and allows us to process our loss just a little bit at a time. Then comes anger. Be willing to embrace your rage. It’s all right to be angry with your husband because he left you, and it’s OK to be angry with God for taking him in the first place. Feeling anger is part of the healing process and it’s an expression of your own pain. Next comes bargaining. We want things to go back to the way they were so we can say all the things that should have been said, and complete all the tasks left undone. Logically, you know you can’t to go back into time, but your heart is not logical, and you will long for the past.

After bargaining, depression rolls in. This was the worst stage for me. I felt empty inside and experienced grief at the deepest level. Yes, I thought I was going to die. I couldn’t eat or sleep, I walked around in a fog, and I wept until I ran out of tears. You will think that you are going crazy when you enter this stage, but please keep in mind that this type of depression is not a sign of mental illness. It is a normal and horribly painful response to a huge loss. I say this with a caveat. Suicidal thoughts and impulses are not a normal response to grief. They are signs of clinical depression. Seek help if you have thoughts of self harm.

You will eventually enter a stage of acceptance. That doesn’t mean that you’re OK with your loss. It just means that you accepted the cold stone reality of your new situation. I keep focused on the here and now, and know that David would want me to be happy. Just remember that life goes on, the pain fades, and the memory of your spouse will live on in your heart forever.

In the 1976 movie Network, actor Peter Finch, who played the part of Howard Beale, a frustrated newsman, belted out the immortal words, “I’m mad as hell and I’m not going to take it anymore!” Those words pretty much sum up the Occupy Wall Street Movement. People are sick and tired of corporate greed at the expense of the 99%. Not surprisingly, nursing organizations are speaking out against Wall Street, and their members are marching in the streets on behalf of the American public.

Well, almost every nursing organization is speaking out against corporate greed. I wanted to know more about the Occupy Wall Street Movement, so I googled the words “occupy” and “nursing,” and the ANA was woefully missing from the list of nursing organizations that are taking part in nationwide protest marches. Thousands of nurses represented by the California Nurses Association and National Nurses United have staged walkouts, and nurses represented by SEIU have gone to jail for refusing to abandon a first aid station during protests in Chicago. It’s not that the ANA has been inactive. Instead of doing something productive for the public, they’ve been busy ousting the New York State Nurses Association (NYSNA) from their ranks for “dual unionism.” The ANA alleges that leaders of a competing union—the Massachusetts Nurses Association—are in control of NYSNA’s operations. The NYSNA responded by saying that the ANA’s claim of impropriety is baseless, and that the NYSNA is being managed on a temporary basis by the executive director of the MNA, based on her experience in strengthening and revitalizing that labor organization. The NYSNA membership reached out to another organization for help because the ANA was ignoring their needs.

The timing of this expulsion leads to an important question: Why is the ANA choosing to undercut one of its own state nursing associations instead of using its resources to fight Wall Street corruption? Is the ANA ignoring corporate greed because it is more interested in maintaining its power within the nursing community? The ANA is losing its clout as more state nursing associations cut their ties with the national office and join forces with other organizations. I’d like to see the ANA focus on more important issues and join forces with the California Nurses Association, National Nurses United, and the SEIU to promote economic justice. Failure to do so will have long term consequences for the ANA.

A Little History:
It’s 1958 and Ensign Thomas Eggleston is giving an inservice to US Navy Nurses LT. Frances Hogan, LCDR Magie Ziskovsky, and LCDR Edna Schnips about the Van Der Graaff teletherapy machine. The nurses were participating in the Nuclear Nursing Course at the National Naval Medical Center, Bethesda, MD. This machine was considered a medical breakthrough in its day. It looks antiquated now doesn’t it? I can only imagine what these Navy nurses were thinking while they stood next to this medical wonder.

Things have changed since I became a nurse. There were no CAT Scans or MRI machines when I graduated from school. There were no IV pumps either. We ran our IVs by counting drops that flowed into a drip chamber, and we monitored the hourly flow rate by glancing at a strip of medical tape that we marked off in CCs and ran down the side of each IV bottle. The nursing text books were different back then, too. There was no mention of AIDS and a diagnosis of Cancer was a death sentence. It was before the Digital Age, so doctors wrote their illegible orders in paper charts. Like the nurses who came before me, I was amazed by each new technological breakthrough, and I wondered about the things to come.

And indeed, things kept changing throughout the years, and sometimes it was hard to keep up. For example, I remember the first time I worked with patients who received TPN hyperalimentation. It’s commonplace now, but back then TPN was viewed as a futuristic medical intervention. The doctors educated the nurses about TPN. They brought in medical journals for us to read, and they gave us inservices about the new lifesaving fluids. Every day the doctors would write new TPN orders in the charts, and we would transcribe the orders onto TNP recipe cards and add the appropriate amounts of insulin and electrolytes to each patient’s IV bottle at the nurses station. We didn’t mix our IV fluids under a laminar air flow hood. I know that sounds really barbaric now, but back then that was standard nursing procedure.

Now that I am nearing my golden years, I wonder what future generations will see during their nursing careers. I bet they see advancements that we can’t even imagine. I even bet that they view our current cutting edge technology as quaint throwbacks to a simpler time. I wish I could be around to see the things to come.

I received this in an email from my mother. I wonder if Mr. Snowman’s health insurance carrier will deny his claim based of some preexisting condition. Happy Holidays!

This lady and I have a lot in common. We both answer a lot of correspondence. For instance, I just received an email from a reader who was really upset. I changed her name for the post to protect her identity. This is what she wrote:

Dear Mother:
My name is Sandy, I’ve been an RN for.. I don’t know, 15 years or so. I have an AD, and absolutely NO desire to obtain my BSN. (sounds like the opening line of an aa meeting, lol) I’m writing to see if you could help me find info, or send me in the right direction to find it. The hospital I currently work for has decided to implement an all BSN RN staff by 2018. The catch is, they are requiring ALL CURRENT employees, with a diploma or AD, to obtain a BSN to KEEP the jobs we already have. I’m a non benefited employee, so.. they have to pay nothing to help me obtain this degree they mandate. I’m beyond frustrated, and a little more than angry…. ANY advice, info, suggestions would be very appreciated. Thanks so much!!!

I had to give some thought before I could answer her question. I identify with her frustration. Honestly, I’m really sick and tired of the way bedside nurses are being treated by the nursing elite, AKA “Nursing Leaders.” Please insert eye roll. I can’t stand people who mandate higher education while they treat bedside nurses like the redheaded stepchildren of nursing academia, but I digress. Sandy asked a heartfelt questions and I wanted to answer it to the best of my ability. I answered her question later that evening after I bridled my emotions.

I wrote this response:

Hi Sandy. Thanks for writing. I’m really sorry about what’s happening to you and your coworkers. This is why I weep for our profession. It’s run by nursing administrators that don’t have a clue about what it takes to work as a bedside nurse.

Best, Mother Jones, RN

I’m sure that not everyone will agree with my advice and that’s all right. The last time I looked, we still live in a democracy, so it’s OK if you have a different opinion. But please, don’t discount the opinions of AD and diploma nurses just because we don’t have an advance degree. We know what’s going on in the trenches because we are bedside nurses. We don’t live in the Nursing Ivory Tower.

I believe in things that go bump in the night. I’ve been a nurse too long not to believe. Are you a nurse who has had a paranormal experience? If you are, the producers at Paranormal Witness want to hear from you.
I received an email from Helen, one of the Story Producers on the SyFy Show, Paranormal Witness after she found a post I wrote a couple of years ago about nurses and ghosts. Helen is working on finding stories for the next television season, and since I think most nurses have had some sort of experience with the unexplained, Helen called me from London, England and asked me to post a shout out for stories from the nursing community. Here’s Helen’s message:

Dear Nurses,
The successful show Paranormal Witness that goes out on the SyFy channel is looking for stories for season two. The story team behind the show are particularly keen to hear from nurses who have experienced events they can’t explain while caring for patients. Nurses are often dealing with events that lie at the very edge of human experience and it is these types of stories that we want to hear about. We feature the very best and the most credible stories that defy rational explanation. Those that nurses talk freely about but that are not out there in the public domain. We would love to tell such a story from a nurses point of view. If you have experienced something that you would like to talk about with the story team, please email your contacts and a brief description of what happened to:helen.lambourne@rawtelevision.co.uk or
paranormal.witness@rawtelevision.co.uk
We are in the research stage which means we would like a chat on the phone initially, in complete confidence.
Thank You
Helen
Story Producer

I don’t have cable or satellite TV at my house (yes, I’m a throwback to another time), so I watched a couple of episodes of Paranormal Witness over the internet. The shows aren’t creepy. They tell inspiring stories that give hope and meaning to life. Contact Helen if you have a story you want to share. She’s waiting to hear from you.

A VA nurse is being accused of an anti-gay tirade according to a news report. Esther Garatie, 28, a former Marine lance corporal, has filed complaints against the nurse practitioner, Lincy Pandithurai of Cedar Hill, with both the VA Medical Center and the Texas Board of Nursing.

I hope this really didn’t happen, but I guess anything is possible. It’s unacceptable if the nurse treated her patient in an unprofessional manner. Personally, I’ve never witnessed a nurse shoving their moral beliefs down a patient’s throat. My nursing colleagues usually act in a professional manner, even if they don’t approve of their lifestyle. I hope the Texas Board of Nursing jumps on this quickly and sorts things out. State nursing boards don’t take this stuff lightly. Here’s a link to Garatie’s statement about the alleged incident.