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Sunday, November 19, 2017
HomeHealthCeteraAmanda Trujillo and Informed Choices in Advance Illness

Amanda Trujillo and Informed Choices in Advance Illness

Amanda Trujillo, RN

Amanda Trujillo, RN

Would you want Amanda Trujillo to be your nurse?

Amanda Trujillo is a master’s-prepared nurse who was working the night shift at Banner Del E. Webb Medical Center in Arizona in early 2011. One of her patients was a critically ill 60 year old woman who had been scheduled for evaluation for a transplant.

According to Amanda, she assessed the woman’s knowledge of her illness and says that the patient didn’t understand her disease, the lab tests, medications, or the self-care that would be needed to recover from a liver transplant for which she was being evaluated. By Amanda’s assessment, no one had ever discussed hospice care with her, even though a consulting physician had noted in the chart that the only two options for the patient were transplant or hospice. Amanda believed that the attending physician’s failure to discuss this option with the patient was an ethical breach of the concept of informed consent.

Amanda had worked on a transplant unit for five years at another hospital and was used to having conversations with patients about preparing for the evaluation and post-transplant self-management.  Amanda says that, after talking with the night charge nurse, she accessed the current hospital’s educational materials and prepared a binder of information that she reviewed with the patient. When the patient said that she wanted to go home to be with her father and think about what she wanted, Amanda made a referral for a hospice case management consultation as she had done before without any objections from physicians or the hospital administration. She documented everything in the patient’s record and reported her ethical concerns to the charge nurse.

According to Amanda, she was fired by the hospital for her advocacy on behalf of the patient after the transplant service’s physician expressed his fury at the change in the patient’s decision. Amanda was told that had interfered with the patient’s surgery and that it was not in her scope of practice to make a referral to hospice case management for a consultation without the approval or order of the physician in charge of the patient’s case. The hospital filed a complaint with the Arizona State Board for Nursing.  Amanda, as a single mother, found herself unemployed and an “untouchable” in the eyes of other employers.

This story is told only through Amanda’s eyes. I spoke with her several weeks ago after receiving a viral email she sent to publicize her plight before the state board told her lawyer that Amanda should stop speaking publicly about her case. Initially, the board was to make a decision about her case around January 24th, but it instead required Amanda to undergo a psychiatric evaluation, which she told me she was happy to do. The board’s decision is still pending.

The Institute of Medicine’s report on The Future of Nursing: Leading Change, Advancing Health, recommends that all health professionals practice to the full extent of their education and training. While most of the attention to implement this recommendation has been focused on advanced practice nurses, Amanda’s case illustrates the challenges for staff nurses to do so. No where is this more important than when working with patients with advanced illness.

We know that patients who are faced with a terminal illness are woefully uninformed about their options. In fact, payers are more likely to pay for costly, aggressive care in intensive care units than for supportive hospice care. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/].

Research has documented that terminally ill patients are seldom fully informed of their options for care [http://www.ahrq.gov/research/endliferia/endria.htm].  It’s not something that many physicians want to discuss with patients. The patient may not know that the “new treatment” has been shown to extend a patient’s life only by 8 weeks but is accompanied by horrendous adverse effects that will seriously compromise his quality of life. So what is the nurse’s role in advocating for fully informed consent?

While some might argue that Amanda Trujillo’s responsibility was to share her assessment with the lead physician on the case rather than taking it upon herself to remedy the situation, she firmly believed it was within her scope of practice and a fundamental responsibility of the nurse as patient advocate.  I do, too. But it won’t be easy for physicians, hospital administrators, state boards for nursing, and even our fellow nurses to break out of traditional roles for nurses and patients. Nonetheless, we must make fully informed consent about treatment and care options a standard for all practicing health professionals.

If I have an advanced illness, I want nurses like Amanda Trujillo taking care of me. She understands that it is the patient’s right to be fully informed and the nurse’s role to speak up when that right is violated.

Latest comments

  • Thank you for this posting on Amanda’s situation. We conducted a tweetchat with her earlier this month #hchlitss . A summary of the chat can be found on http://hchlitss.blogspot.com/2012/02/amanda-trujillo-rn-vs-arizona-nursing.html

    I have also added a quote from her letter to a posting on End of Life care http://kdhhealthcomm.wordpress.com/health-advocacy/end-of-life/

    This is a deeply disconcerting situation along many aspects. One of them is the fact that the Arizona Nursing Board required her to go through a psychological evaluation. If this was an attempt to taint her with the stigma of mental illness (as is being done in the Military, see recent NYTimes Article http://www.nytimes.com/2012/02/25/us/a-military-diagnosis-personality-disorder-is-challenged.html ) it continues the use of the mental illness label as a way to defame instead of normalizing mental illness.

    Another distressing phenomenon is the active bullying that seems to have happened.

    Finally, of course, you have successfully addressed the ultimate concern, are patients, especially at the end of life, being provided with all the information that they need to make decisions. Even if there is an End of Life discussion, which I advocated in my post, will all the options be discussed when the time comes?

  • Thank you for the article and shedding further light on the Amanda Trujillo, RN situation. I feel the actions of the physician and hospital administration in firing Ms. Trujillo are unconscionable, and were fully intended to harass and intimidate her into silence.

    We are investigating an alleged pattern of nurse abuse, where Banner Healthcare routinely fires, then files charges against nurses to make it difficult for them to find employment elsewhere.

    Give tremendous Kudos to Ms. Trujillo for having the courage to stand up and speak out. Think it is appropriate that we as her fellow nurses spread her message as far and wide as is possible via Social Media.

    This case could have happened anywhere nurses are giving patient care. We strongly encourage nurses to call their nursing associations, ask if they would be supported in cases like Amandas.

    We’ve heard first hand from the American Nursing Association and the Arizona State Nursing Association that “By policy, we do not get involved in state board cases.”

    For the first 10 months of this battle for her career and livelihood, Amanda had no help, no support. Her letters to Banner Health & nursing associations largely ignored. Her complaint to the State Medical Board against the physician for ethical breaches was dismissed.

    It is the opinion of the members of Nurseup, that the next 10 months will be drastically different. For more information, kindly visit http://www.nurseup.com

    If you’ve been fired from Del E. Webb in Sun City, Banner Health Arizona, and can confirm these allegations, kindly contact us.

    Sincerely,

    Andrew Lopez, RN
    Nursefriendly, Inc. A New Jersey Corporation.
    38 Tattersall Drive, Mantua New Jersey 08051
    http://www.nursefriendly.com info@nursefriendly.com ICQ #6116137
    856-415-9617, (fax) 415-9618

  • Maybe I’m missing something, but i’m pretty sure I read in one of the articles that after providing the patient with the educational tools made available at Banner, the PATIENT requested the hospice referral so she could learn more? If this is so, how can anyone say that the nurse overstepped her bounds? In this country, America the beautiful, we have the right to choose how we live our lives (as long as it is within the law). We can decide to accept care or reject it and we have a right to be educated regarding prescrbed medical procudres.

    Since when does a patient need a doctors permission to find out more about their healthcare options? I dont even understand WHY there needed to be ANY order for the hospice referral to provide info. They were not treating..they were providing education the patient herself requested.

    Is the hospital (and the healthcare industry for that matter) now saying a patient cannot have access to education without MD approval? If this is so, we have bigger problems in our healthcare system than lack of insurance coverage! When did doctors and hospitals become GOD? Who gave them permission to decide who lives and who dies and when it will happen? THIS is the bigger question! Not to belittle what Amanda is going through, but more to point out that it is much bigger than she or I or any of us as RN’s. This is about our freedoms that we are entitled to as citizens.

    If that patient had searched the internet, called a local hospice provider and began asking quesitons on the phone about end of life care, no one would have or could have stopped her. She wouldnt need a doctors order to make that call, why would the same not apply to a face to face educational session by a hospice liason? She wasnt doing a hospice EVALUATION, she was educating. What is so hard to understand here?

    What exactly are we signing when we sign our consent for admission and treatment to a hospital? Are we giving up our rights to dignitiy, decision making abilities and the right to be informed? What happened to explaining all procedures before they occur in detail? By dismissing the charges of ethical breech of informed consent with the MD, the Medical Board took away every patients rights to be knowledgeable about our own medical care. He violated the standards of care regaring informed consent.

    Another key point is that if the patient HAD been properly informed of her options for treatment at time of consent, she would not have changed her mnd when presented with the educational tools Amanda gave her.

    I refuse to get off my soap box until Americans understand the reality of what goes on behind the scenes of corporate healthcare! The power we give to these docs and healthcare monsters (big business hospitals) is a travesty.

    Healthcare needs major revisions and its not all about insurance. We, as nurses, need to advocate for giving power back to our patients and taking it away from corporate healthcare in America.

  • How can anyone file an unwarranted BON complaint? Its easy and risk-free, actually.

    After extensive research, I can offer the answer. WIth absolutely no limit on BON complaints, no culpability and full anonymity for those who file complaints, Arizona has provided the unscrupulous with the ultimate weapon: when they fire people, regardless of justification or the lack of it, employers can use the AZ BON as a weapon to devastate the reputation of those fired and reduce legal liability by slandering the victim, all completely legal.

    Arizona, it seems, is truly willing to go back to the future: the goal is the 19th century, in which power and wealth ruled without limit, and employees and customers had no rights whatsoever. Under such conditions, I would not consider EVER risking becoming a patient in Arizona, under any circumstances. Ever. The risk of abuse, and the lack of any protection from abuse, seems to me completely untenable.

    I would not retire there, move there, work there, or travel there unless fully confident I can avoid its health care system for the duration. I would consider anything less than such strong caution foolhardy: we all depend on Nurses to protect us from error, neglect, and abuse, whether or not we appreciate this fact, and any environment hostile to such protection is far less safe for all patients.

  • Greetings! Veery helpful advice in this particular post!
    It’s the little changes that will make the most significant
    changes. Thanks a lot for sharing!

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