It might be hard to believe in this day and age of "participatory medicine" and empowered patients — or in any day and age, really — but the fact is that an Arizona-based nurse was fired from her job recently for simply providing a patient too much information on his treatment options.
The nurse's name is Amanda Trujillo, a single mother living in Phoenix, and licensed nurse in Arizona since 2006. She specializes in cardiology, geriatrics, and end of life/palliative care. The supposed sin she committed was setting up a consultation on hospice care for a patient suffering from end-stage liver disease, who was scheduled for surgery. This "interference" angered the patient's physician, who then had Amanda fired and reported her to the Arizona State Board of Nursing, where she is now in danger of losing her nursing license. Fellow health care professionals and patient advocates are flooding the blogosphere in support of her cause!
Envisioning this in "our world" for a moment, imagine that a nurse or diabetes educator gets thrown to the wolves this way just for helping you learn about your alternative choices for dialysis treatment or in-home diabetes care.
"This issue isn't only about Amanda, it's about the American public," writes one prominent nurse-blogger. "The health care industry is trying to bully nurses into not talking about abuses in the system and they will stop at nothing to achieve their goal. We will not be silenced. Strong patient advocacy makes for stronger patients who have more control over their own health care decisions. The American public has a right to know."
Apparently the issue was that the patient in question "had no clue about what they were about to participate in when they agreed to get a major invasive surgery," Amanda writes. "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 primary physician at Banner Del Webb Hospital in Sun City West (where Amanda worked) saw it otherwise, as did the nursing director who eventually fired her. She told Trujillo she had "messed up all the doctors' hard work and planning for the surgery." Thus, the patient-requested hospice care consult was cancelled.
Hospital spokesman Bill Byron says their company policy prevents nurses from ordering a case management consult. "The doctor, ultimately, is the focal point that directs care for patients," he said
As someone concerned with patient advocacy myself (shouldn't we all be?), all that comes to mind here is WTF? Who cares if the doctor or nurse orders the consult, as long as it's in the patient's best interest? This sounds like a case of big swinging doctor egos, if you ask me.
Indeed, the complaint filed with the Arizona State Board of Nursing states that Amanda "exceeded her scope of practice." If the Board finds that this is true, Trujillo could lose her license, and will be unable to work as a nurse. Can you imagine...?
Over at KevinMD, one of the most respected physician blogs, a nurse guest blogger writes: "The issue boils down to whether the health care industry can tolerate highly educated, vocal, critically-thinking, engaged
But it gets even more upsetting:
Since her firing in April 2011, Amanda has brought attention to her own case with a letter-writing campaign, and reaching out to other nurses and bloggers.
The Arizona State Board of Nursing has issued a statement claiming that Amanda's campaign to defend herself constitutes "retaliatory behavior" and has therefore ordered a psychiatric evaluation. Can you imagine...? So now they're claiming she's just nuts?
And what's more, the Arizona State Board of Nursing also chose to notify the doctoral program in which Amanda is studying of the investigation — although they waited 10 months to do so. Sources say that is never proper procedure while any investigation is underway.
This whole case has spurred a huge debate about nurses overstepping their bounds, and possible "abuses of power."
But 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 in the Amanda Trujillo case." They're now charging her with using false credentials because she had added some medical alphabet soup to the end of her personal email signature — albeit with an "S" designating student. In other words, they're pulling out all the stops to disgrace Amanda into silence.
"Let's remember what brought this all on," writes Kim at the popular nursing site Emergiblog. "An informed patient. A change of heart. A fuming physician."
I don't know about you all, but if I were on my death bed and had questions about my care options, I'd want someone like Amanda by my side.