This is a post from the Nerdy Nurse and really you must read the entire article and see what has happened here. When you read through here and see the story as told with the nurse educating the patient about a hospice choice as I am guessing it was near that time, the doctor was upset that the surgery plans were messed up, 
in other words he was not going to do the surgery after the patient heard about hospice.
This is kind of what we are all talking about right? Giving the patient their options and allowing dignity here and not putting people through hell as they near the end of life? Again I am guessing that was the situation here as otherwise hospice would not have been mentioned. She is using all areas of media to get her story across and I felt compelled to add it here as well as this does not make sense at all. Is this yet another fall out of economic times with doctors needing the money too? It does make you stop and think in that direction and it sounds like this is nurse we need to have employed and not lost in the world of politics and out of work. I post quite a few stories here about nurses striking and many of them are not about money but rather working conditions and patient safety, example of one last year, about safety and patient care and there were more. BD
Nurses Hold One Day Strike at Kaiser's Sunset Boulevard Medical Center (Los Angeles) To Bring Attention To Patient Safety
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.
Instead of initiating the hospital policy of consulting with an ethics committee to sort out the situation the hospital fired me instead. The doctor was angry that the patient had changed their mind about the surgery and my nurse manager was angry that I “messed up all the doctors’ hard work and planning for the surgery.” Since then, my career has been destroyed, no one will hire me because of the complaint on my license. Despite almost three nursing degrees after my name, my education and experience–at this time–is considered “null and void.” I’m a single Hispanic mother who fought hard to get off of welfare and to make it through school into a career I love.
I never dreamed a complete stranger could strip our lives away, and under such a circumstance in which I was doing my job and protecting the patient’s rights to full disclosure about the surgery and their right to choose their course of care. Today, we are back on welfare, we can barely keep food in the house, have almost lost our house 4 times, and I cant get health insurance for my daughter who has severe asthma. This situation can happen to any nurse and any patient–and it is happening with more frequency throughout the United States. Nurses are afraid to speak up when they see unsafe or unethical practice taking place with their patients’ lives.
The nurses at the hospital I worked at have told me they don’t teach their patients anything anymore and they don’t report things that concern them for fear of losing their jobs and their lives like I did. There have been similar cases in recent years–most notably in Texas and in Maryland. It boils down to this–without nurses speaking up in dangerous or unethical situations there will be more accidents, more medical mistakes, and more lives lost. Nurses everywhere turn the other direction now because of the threat of retaliation. I’m a strong advocate for patients and families who are at the end of life. The sunset of life is an 
extremely important developmental milestone in the life of a person and their loved ones. Its a time that should be spent the way the patient and family want it to be spent—and where they want it to be spent. More and more, as I have advanced into nursing, I have seen people lying in hospital beds for weeks on end, suffering debilitating pain, air hunger, bed sores, muscle wasting, and their dignity is not respected–as their family members stood by horrified. No family should have to remember their loved one’s last days and weeks as images of torture.
Nine times out of ten my patients were not even aware that they had the option to go home if they wished–they were just told they “had to keep trying something else.” We as healthcare providers do not have the right to omit that information or option from people and their families, we don’t have the right to refuse a patient the right to visit with hospice to ask questions and learn more, and we certainly don’t have the right to deprive a person of the ability to complete very important developmental tasks at the end of life that involve family. The statistics out there about how many people die in hospitals each year are staggering–and they are dying badly. At this time only 18 states have laws in place to protect patients and nurses. I have been working tirelessly with Senator Nancy Barto here in Arizona to get legislation passed to:
1) Ensure that the rights and choices of patients at the end of life or the end stages of disease are respected and fulfilled without question.
2.) Protect nurses from retaliation for reporting unsafe or unethical practice that could jeopardize the life and safety of patients and their families
3) Specifically define the role of the nurse in end of life teaching/counseling so that ALL physicians understand and honor that part of our job (its our duty and its legal–but every physician has a different opinion and were subject to that when we shouldn't be)
My goal is to get to Capitol Hill. I was making good progress with the Senator until recently when all communication stopped without explanation. I have learned through sources that “politics got involved” and put a stop to my efforts. I was also advised by a rep from the Arizona Nurses Association that they would not support any nurse reported to the board no matter what the cause because it would “damage their image and reputation”. Our profession is well known for not supporting one another. Nurses who once called me their mentor and friend wont have anything to do with me because it will jeopardize their jobs and 
reputations. So in essence, this fight has been one that I’ve continued on my own. Now that I have learned that “politics” squashed my efforts at protecting people and nurses I am turning to the public to help me get over that wall. I would appreciate any of you out there writing to Arizona’s legislators: Steve Pierce (President Elect of the Senate); Senator Nancy Barto, Representative Cecil Ash, Governor Jan Brewer, Senator John McCain, or Congressman Trent Franks. I will list their emails at the end of my letter. In the meantime, I need your help and support to get this message out there to the public. Pass my story on to your friends and family on Facebook (Im on there campaigning)–tell them to ask more questions, to speak up when they have concerns, to ask if there are other options. This is real, this is happening, and as the healthcare crisis continues to spin out of control and nurses are pressured “to do more with less”—even less attention will be paid to important safety and ethical issues that can endanger lives and basic human rights. I have written to every media outlet in my state but no one will take my story, I’ve written to 20/20, Dateline, Oprah, Dr. Oz, The Joint Commission, The American Nurses Association, The White House, President Obama, and the Center for Medicare and Medicaid Services.
I have attached the legal brief for your review so you have a better understanding of what happened–understandably some information has been blacked out to preserve privacy.
The nurse investigator on my case reviewed everything I did and said that she had never seen documentation and care so thorough and “above and beyond the call of duty.” Despite her recommendation to dismiss my allegations, the letters of praise from Mayo Clinic Physicians I worked with at one time, nurse coworkers, and patients, the allegations were not dismissed as I had expected them to be. This means I have to wait until January 24th-25th 2012 and go before the board to “explain myself.”
I can accept that my short career as a nurse is over—what I cant accept is that the end of my career will mean nothing. If this is the end of my hard work and education I want it to stand for something, I want it to be for good. I want to know that at least no other nurse, their families, or patients and their families will ever have to experience this kind of horror. I took an oath to “First do no harm.” if I walk away without a good fight, then I’ve become part of the problem and I don’t deserve the RN after my name.
Im growing tired of fighting alone so I have reached out to you……….I have to stay the course because its the right thing to do and because I HAVE TO SET THE EXAMPLE for my daughter Anaya to stand up for whats right no matter how difficult the journey….Please, tell my story to your friends, loved ones–and tell them to tell others. There is strength and change in numbers……..
Thank you for your time in reading this long email…..as you can imagine, its been a long year.
Respectfully
Amanda Lucia Trujillo MSN, RN, DNSc-NP(s)
The following blog post is related to an email that was originally sent to @EchoHeronAuthor. It was then posted on Vernon Dutton’s Posterous, Amanda Trujillo case will go before the Arizona State Board of Nursing on January 24th, 2012.
Her story is one of an archaic medical model in which the doctor’s word is supreme and we are all just nurse maids here to do their bidding. This is an indication that there are many who do not wish to continue to advance toward collaborative healthcare in which we work as a team to provide patients with the best care possible. This is also an example of persons who may not be in medicine for the right reasons.
Success in healthcare is not defined by how many treatments and tests you can perform on a patient. Success is defined by the ability to help a patient make informed decisions on their path in health an life. If that path includes surgery, then so be it. If that path does not, and we have informed the patient of all the options and they are capable of making an informed and rational decision, then we have been successful.
I’m really disgusted that a healthcare organization would bow to the tantrum of one very arrogant and immature physician. If there was one example of a surgeon with a God-Complex, this is one.
She got what she deserved. It is not the place of a far less educated nurse to be making decisions about the care of a patient. A nurse has no where near the education, experience, nor complex medical decision making capability to intervene as she did. Ms. Trujillo did nothing more than inject her own personal "end of life" views on the patient. It was neither her place, her patient, nor within her scope of practice. She should at the least re-train, be educated on her scope of practice or be forever stripped of her credentials.
ReplyDelete