Hear ye, hear ye, the great and magnificent ANA has made a statement about the Amanda Trujillo case. Well it’s about time. It only took a firestorm in the blogosphere to make you speak. Your slow response was noted. I’m sure you needed extra time to precisely craft your statement about Amanda’s case because you’ve really screwed things up.
This is their comment about Amanda’s case:
“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.”
Seriously, ANA? What a cop out. Amanda wrote to the ANA MONTHS ago and heard nothing from your so called leadership. But that’s OK. I’m sure that your leadership were far too busy to deal with Amanda because they were chumming around with Teri Wicker, the president of the Arizona Nurses Association and one of the Banner Health Care nurses who fired Amanda. I wish someone from the ANA would explain how they could have contacted Amanda’s attorney since she doesn’t have one right now because she is looking for one that has more experience in this type of case. And besides ANA, I think it’s really creepy that you would contact Amanda’s attorney without talking to her first. I guess you forgot that she is a member of your organization. And that whole thing about social media? Get ready ANA. The firestorm is just beginning. People are listening to nurse bloggers and the media because they can’t get the truth from any other source. I know that must really scare you because you can’t handle the truth.
A reader left a comment over at Emergiblog in response to a comment that I left about the Amanda Trujillo case. I mentioned that some doctors I know think that the surgeon involved in Amanda’s case is a huge jerk and they are sympathetic to Amanda. In response, “T” wrote:
“These doctors that are watching this – where the hell are they? Why aren’t they speaking up? They’re too afraid for their precious fukking careers- the cowards!”
I think there are two things going on here. The first thing goes back to my old country doctor. Doctors traditionally stay out of nursing issues. They stay in their lane and let nurses duke it out amongst themselves. There is also another tradition. Doctors don’t bash each other in public. It’s hard to support Amanda without ridiculing the surgeon involved in the case. That doesn’t make them evil. That makes them doctors. They have their own code of conduct, and that’s just what they do. Doctors, I wish you would speak up. Nursing wants to hear from you. We’d like to hear what you have to say.
Talk to us. We promise we won’t claw your eyes out.
I wrote a letter to the Arizona Nurses Association when I learned that the association was not coming to the aid of Amanda Trujillo. If you haven’t heard, Amanda was fired from Banner Del E. Webb Medical Center after she educated one of her patients about their upcoming liver transplant. I wrote about it here and here. I couldn’t understand why the association was twiddling its thumbs until I learned that Teri Hill, the president of AzNA is also the Director of Professional Practice at Banner Del E. Webb Medical Center.
This is what I wrote:
“I’ve been a registered nurse for 35 years and I had thought I had seen everything until I read about the persecution of Amanda Trujillo. I wondered why the Arizona Nurses Association wasn’t backing her until I learned that you are affiliated with the hospital that fired Ms. Trujillo. Shame on you for throwing a nurse under the bus just to appease a doctor that obviously has an anger management issue. Sorry the hospital lost out on a billable procedure, but the patient had a right to know about all of their treatment options. I hope your membership throws you all out of office for not backing Ms. Trujillo. You are a disgrace to the nursing profession.”
Yes sir, I was pissed. I assumed that the association would delete my email and get on with their business. Imagine my surprise when I received their response. This is what they wrote:
“Amanda Trujillo, RN, is a member of the Arizona Nurses Association (AzNA). The Arizona State Board of Nursing is currently investigating Ms.Trujillo’s Registered Nurse license per its regulatory mandate. The Arizona Nurses Association understands that it is difficult for a nurse to undergo an investigation of his or her practice by the board of nursing. However, we support the Board’s authority and obligation to regulate the profession in the state including investigating complaints. Therefore, AzNA does not get involved in complaints of nurses submitted to the board nor does the association comment on the specifics of any investigation. Ms. Trujillo has chosen to share the details of her case publicly and to imply that the AzNA has taken a position about her case. The fact is that AzNA is neutral and does not get involved in matters before the board of nursing. As of January 24, the state board’s investigation of Ms.Trujillo remained open. No disciplinary action has been taken against Ms. Trujillo’s license at this time, which remains active and unrestricted during the investigation. Further questions about this case should be directed to the Arizona State Board of Nursing.”
What mandate are these people talking about? Amanda didn’t break any state laws when she provided patient educations. It’s her job. It’s what all nurses are suppose to do. Furthermore, Ms. Hill’s involvement in this mess makes the AzNA far from neutral in this situation. They are collaborators. They know full well that a nurse can’t get a job while their license is under review. The “we are as pure as the freshly driven snow” tone in their letter makes me gag.
I continue to support Amanda Trujillo and I urge all nurses to write to Ms. Hill and tell her that you do, too. And if you are a member of AzNA, you can also tell her to step down as president of the association. You can contact her at firstname.lastname@example.org
Do you remember when patients came first? This picture was taken in New Orleans at Marine Hospital in 1942. Back then a hospital administrator looking at this picture would have seen a patient, a doctor, and a nurse. The administrator would have acknowledged the importance of each person, but he or she would have viewed the patient as the most important person in the room. This picture depicts teamwork and patient centered care at its best.
Fast forward to 2012, the year of hospital budget cuts and the bottom line. Today, a hospital administrator looking at this picture would see a revenue earner, a cost, and a RGU. That stands for revenue generating unit. The doctor is the revenue earner. He performs procedures and brings in money for the hospital. The nurse is the cost. The hospital has to pay her even though she can’t bring in money like a doctor can, therefore she is viewed as a liability to the hospital. Then there is the RGU. Sadly, that’s the patient. Hospitals love patients with superior healthcare coverage. Unscrupulous doctors and hospitals will perform expensive procedures on lucrative RGUs, and keep them in the hospital as long as possible for the sake of the institution’s bottom line.
I wrote about how the Amanda Trujillo situation impacts nurses in my last post. Now I want to focus on how it affects patients. We are all patients. All patients are human beings who deserve to be treated with respect and dignity. Banner Health lost a huge revenue stream when Amanda saw a knowledge deficit and educated her patient about other treatment options. Banner Health’s administrator looked at the picture and saw a tyrannical money making doctor screaming for Amanda’s job and license, a nurse, or should I say a liability that upset the financial apple cart, and the patient who was now a less valuable RGU. The picture was clear. Banner Health opted to eliminate the liability to pacify their revenue-making physician, and attempted to make the RGU more valuable by refusing the patient access to hospice. Banner Health’s behavior toward the patient is unconscionable. As a patient, I want hospitals to provide care that is in my best interest, not motivated by financial gain.
I’m afraid that what happened at Banner Health is just the beginning of a frightening trend. Patient care is going to become more profit driven as more people become uninsured and as states slash Medicaid reimbursement. No patient should be ushered into the most expensive treatment option for the sake of the all mighty dollar. And no nurse should be fired for protecting his or her patient from unethical practices. The Amanda Trujillo case is about all of us. Patients are not RGUs. It’s time to put hospitals like Banner Health in check.
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.
Email the Executive Director of the Arizona State Board of Nursing, Joey Ridenour, RN, MN, FAAN: email@example.com
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.