Del E. Webb Medical Center, Sun City Arizona AKA Banner Health Nurse Incident @BannerHealth – vdutton’s posterous
This is the original post which prompted us to mobilize and form the “Nurseup” movement. It reprints an email Amanda Trujillo, RN sent to Echo Heron, RN http://www.echoheron.com/
We are deeply grateful to Vernon Dutton, RN @nursingpins for bringing this issue to our attention and continuing to support it tirelessly.
Original URL: http://vdutton.posterous.com/94287821
Andrew Lopez, RN.
Registered Nurse in AZ needs support…..
This is a (must read) e-mail that was passed to me from Echo Heron. @EchoHeronAuthor
Hello Ms. Heron,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 families3) 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 shouldnt 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.RespectfullyAmanda Lucia Trujillo MSN, RN, DNSc-NP(s)Glendale, ArizonaPlease e-mail the Arizona State Board of Nursing and let them know you are following this case email@example.com
Amanda Trujillo on twitter – @NURSEINTERUPTEDMUST SEE LINKSThe American Journal of Nursing posts on Amanda TrujilloThe American Journal of Nursing post on Facebook
Nurse Up for Amanda Trujillo (Facebook page)
Arizona Nurse Amanda Trujillo’s State Board of Nursing Hearing Delayed for a Psychiatric Evaluation 1/24/12
The president of the Arizona Nurses Association (email the Executive Director, Robin Schaeffer: firstname.lastname@example.org) is the nursing director of Banner Del E. Webb Medical Center. Hence the deafening — and telling — silence of that organization.
ROBERT CHELLE LAW, PLC
2256 N. 15th Ave.
Phoenix, AZ 85007
(602) 257-0774 fax
Attorney for Amanda Trujillo
BEFORE THE Arizona STATE BOARD OF NURSING
In the Matter of Registered Nurse License No. RN137552 issued to:
RN/LPN INVESTIGATIVE QUESTIONNAIRE
DESCRIPTION OF EVENTS
(Nurse Practice Consultant, Ann Schettler)
Respondent Amanda Trujillo, by and through undersigned counsel, submits this Description of Events in response to a complaint filed against her in June of 2011 with the Arizona State Board of Nursing (“Board”) by Banner Del E. Webb Medical Center (“Webb”).
Description of Relevant Events
The allegations contained in the complaint arise from events that occurred on (Date), when Ms. Trujillo was caring for a patient with end stage liver disease (On the Unit) of Webb. Ms. Trujillo had been a registered nurse with Webb for approximately six months prior to the date of the alleged conduct and she normally worked the night shift from 7 a.m. to 7 p.m.
After assessing and communicating with the patient, Ms. Trujillo’s evaluation led her to believe that the patient did not fully understand what (pt) had consented to when (pt) agreed to go forward with an intensive transplant evaluation scheduled to begin at Banner Good Samaritan Medical Center the following day. Based on her nursing assessment, Ms. Trujillo gathered patient education materials and spoke with the patient regarding the transplant evaluation, the waiting period and the commitment needed in following a lifelong self-care regimen. After their discussion, the patient expressed a desire to learn more about hospice care because (pt) was uncertain (pt) was willing to take the necessary steps to maintain a successful organ transplant. Thus, the patient inquired into whether (pt) could speak with a hospice representative. Ms. Trujillo then placed an “order” for a case management consult with a hospice representative. Ms. Trujillo did not believe that requesting a case management consult was a medical order requiring physician permission; she believed the consultation was for educational purposes in order to give the patient a broad understanding of her options.
As a result of the additional information given by Ms. Trujillo, the patient determined (pt) did not want to go through with the liver transplant evaluation or resulting transplant procedure. When the doctor treating the patient found out about the patient’s wishes to forgo the evaluation he was unhappy that the patient had changed (pts) mind and determined that the education given by Ms. Trujillo was the underlying cause of the patient’s change of heart. He accused her of going beyond her scope of practice by entering a physician order without permission (“ordering” the case management consultation). As a result of the accusation, Ms. Trujillo was placed on administrative leave by her nursing director, Venus Gaines, and was eventually terminated by Webb.
Ms. Trujillo believes she was well within her scope of practice to assess the patient’s understanding of (pts) plan of care. She was not acting outside her scope of practice by educating the patient (deferring all questions outside of her scope to the medical team), once she determined the patient had a gross misunderstanding of what (pt) had agreed to participate in. Ms. Trujillo believed that the case management “order” she placed on the patient’s behalf was not a medical order that needed physician permission. Each step of the treatment provided by Ms. Trujillo to the patient will be analyzed below.
It is standard practice for Ms. Trujillo to ensure her patients understand their medications, plan of care and treatments. While fully reviewing the patient’s medical record Ms. Trujillo read a progress note entered by the patient’s primary care physician from earlier in the day that noted a “transplant evaluation is the only viable option outside of Hospice.” Utilizing the standard nursing process of patient assessment (assessment, diagnosis, planning, intervention, evaluation), Ms. Trujillo asked the patient a number of open-ended questions regarding (pts) hospital stay, medications, liver disease, procedures, etc. Ms. Trujillo asked the patient if (pt) had received any information or teaching regarding the proposed transplant evaluation. The patient, to Ms. Trujillo’s surprise, responded that (pt) did not understand (pts) disease, plan of care or what a transplant evaluation entailed. The patient asked Ms. Trujillo if she could provide some information regarding the disease and any less invasive choices that would allow (pt) to go home and be with (pts) family. Based on this request Ms. Trujillo determined the patient had a knowledge deficit regarding (pts) disease and the choice to receive palliative care.
Having assessed the knowledge deficit related to the patient’s routine medications, disease process, associated tests and procedures, the plan of care for transplant evaluation and palliative care options, Ms. Trujillo proceeded to print out patient educational material from Banner’s website that addressed those areas. Additionally, she printed out education materials from Banner’s transplant website pertaining to what to expect during a transplant evaluation and what to expect after a transplant. Ms. Trujillo also provided materials related to hospice care per the patient’s request. Ms. Trujillo, concerned about the patient’s lack of understanding of (pts) treatment regimen and the option for comfort care, discussed her education of the patient with her clinical manager, Frances Fausto, who readily supported Ms. Trujillo’s plan of care and interventions.
Ms. Trujillo and the patient reviewed the materials over the course of the night. After a full review of the materials the patient stated, “Had I known everything I would have to go through and the commitment I would have to make, I would not have agreed to the transplant evaluation.” The patient inquired into whether there was anything else (pt) could do besides enduring more tests, procedures or surgeries. Ms. Trujillo then explained hospice care services and the differences between symptom relief care and end of life care. The patient expressed serious concern that (pt) would not be able to commit to an extensive aftercare regimen following the transplant by stating “at this stage in (pts) life (pt) just wanted to be around family.” The patient requested to visit with a representative from hospice in order to ask some questions and gain additional information that would assist (pt) in making a more informed decision regarding (pts) course of care.
Ms. Trujillo placed a note in the chart pertaining to the assessment of knowledge deficit, the specific education provided and the palliative care discussion, in addition to, the patient’s request to see a case manager from hospice. She used the SBAR (Situation, Background, Assessment and Recommendation) format of report required in Banner policy when she handed off care of the patient to the dayshift nurse, alerting the nurse that the patient requested more information prior to being transferred to another facility for a transplant evaluation. She also alerted the dayshift nurse that there was a nursing note in the record for the doctor to read that detailed what occurred over the course of Ms. Trujillo’s shift with the patient.
Case Management Consult
As a relatively new nurse to Banner, Ms. Trujillo self-educated in order to work within Banner’s policies and procedures. She found no specific policy or procedure regarding end of life care that prohibited her from obtaining case management consultations for her patients. She also could not find any policy or procedure that gave a formal definition of a “physician order” or what nurses could order and what they could not. In fact, Ms. Trujillo had ordered hospice consultations for her patients on numerous occasions prior to this incident without any objections from other physicians or Webb administration. She entered the “order” with a note stating, “per patient request, patient wants to visit with hospice representative for more information.” In fact, the computer system in place at Webb allows her to click a box that further specifies “Nurse Ordered,” which she did on this occasion.
The only reason Ms. Trujillo’s actions turned into allegations of unprofessional conduct is because the primary care physician on this case, The Dr. initiated an angry public display when he found out that the patient had changed (pts) mind regarding the transplant. Ms. Trujillo was surprised when the nursing director, Venus Gaines, went so far as to tell Ms. Trujillo that the physician was angered because she had, “messed up all of the work they had done, and that the doctors were nowhere near going down the hospice route.”
This was not a medical order. This was a nurse trying to help a patient become better informed about a life changing procedure and (pts) right to choose what direction (pts) care would go. Ms. Trujillo’s actions were well within her scope of practice and she conscientiously kept her line of teaching within the boundaries of her scope of practice by taking care to utilize the proper channels to obtain patient teaching materials and advising the patient to ask the doctors about more complex questions she was unable to answer as a registered nurse.
The patient had the absolute right to self-determination regarding her course of treatment, as illuminated in Senate Bill S. 1052, the Bipartisan Patient Protection Act, after receiving additional information regarding her disease. Ms. Trujillo, working within her scope of practice and the nurse’s code of ethics, honored and protected that right when she abided by the patient’s requests to the best of her ability.
Accommodating a patient’s request for a consultation with a hospice case manager does not require a physician’s order. No medication was requested, no equipment was needed, and no procedures were required. A patient simply wanted to speak with an expert regarding her options for comfort care and end of life care, so that (pt) could make the best decision about (pts) future.
It is standard knowledge that the Cerner electronic health records system in place at Webb contains a box that states, “Nurse Ordered.” Why would this box exist if nurses were never allowed to “order” anything? The Complainant contends that Ms. Trujillo overstepped her scope of practice by ordering the consult; however, it is standard practice of the hospital to allow nurses the freedom to do the exact thing alleged in the Complaint.
Ms. Trujillo was allowed to order case management consults on numerous occasions prior to this and was never told by the hospital that this practice was not allowed or outside the scope of her practice. It is apparent that the hospital is simply trying to appease and placate an angry physician by filing this Complaint against Ms. Trujillo.
She looks forward to discussing this matter with the Board, if necessary, and hopes to conclude this matter expediently.
SUBMITTED: July 11, 2011
ROBERT CHELLE LAW
Attorney for Amanda Trujillo
about 1 month ago
lolshannon71 (Twitter) responded:Please list the contact information and case documentation again as it isn’t available thru a link via Twitter.
Good luck and God bless!This is horrible! I would love to help if there’s anything I can do from TN. Did you say you have gone to the AZ nurses association?25 days ago
nursedirectorjohn responded:Banner Health should be ashamed! I don’t think it is a healthy place to work, with poor management like this, they will be unionized before you can say “unfair labor practice”
I would never let my family member be cared for either by the offensive MD or this Hospital Group!22 days ago
akramer responded:i honestly could not even believe this i am disgusted.. what a disgrace of a company. i sent in an email and i hope you get some where with this.21 days ago
QuiGonJinn (Twitter) responded:Arizonarn,
“for having 3 degrees” she isn’t making legal argument, she tells a story. She sounds credible. I think she was wronged and the hospital decided to hang the RN than the MD. They display no guts. She has a lot of support, you may not be aware of it.19 days ago
NURSEINTERUPTED (Twitter) responded:ArizonaRN
Posting evidence and reference for the facts in this case would be a direct violation of the nurse practice act as well as the patient privacy law. The complaint filed by Banner reads this “RN went out of scope of practice.” You and anyone else may request a copy at the State Board of Nursing, in fact, I encourage it. And your statement about a group of RN’s who have “collectively decided” I shouldnt keep my license is exactly why I had to go OUTSIDE THE STATE OF ARIZONA–we dont take care of our own In AZ we just tear eachother up. Your statement is a direct reflection of the current state of nursing in Arizona and it saddens me deeply. As for the stuff leading up to transplant. I was a heart transplant nurse for almost six years. I took care of patients months prior to transplant, right after their transplant, and down the road when they came in for aftercare. We had to be very adept at the principles of transplant teaching—–there is actually a transplant nurse certification book out there that I have kept at my side for many years–look it up. I just so happened to have the knowledge to teach the patient these things and the experience to back it up. My note up there does not mention that I provided the patient a huge binder of patient education materials printed off from the hospital that would educate them about their disease, medications, signs/symptoms, the transplant evaluation process and the complex aftercare regimen that would have to be adhered to the rest of their life. My note also doesnt talk about the notebook, pens, and highlighters I gave the patient with the instructions to write down all the questions they had for the doctor so those could be reviewed the next day. My statement up there also does not reflect the urgency with which I talked to my immediate charge nurse and nursing director to relay my ethical concerns and to ask for an ethics committee. And wow, what a powerful example you set for all thats wrong here in AZ with your judgement ” she did not deserve to keep her license.” Its a sad day in our profession when we seek to harm eachother instead of preserve the integrity of what we do and the future of our practice. Im happy knowing I can sleep at night, Im happy I didnt turn my back on my patient knowing the danger ahead, collect my paycheck, and go home as if it didnt matter. That could have been your mother or grandmother or father or grandfather—and even though you were mean spirited enough to say those things up there—Id do the same thing for you or your loved ones if it were them in that bed that night.19 days ago
NURSEINTERUPTED (Twitter) responded:AZRN–Might I suggest some books for you to read that may help provide a new perspective about our profession and what we can do to improve our current work environments and the profession we hand the new grads coming up underneath us: (you may even want to take my course someday when I start teaching–because Im making it my business to make nursing a more supportive profession to be in, in the state of Arizona. The younger nurses will not have to deal with what we do to eachother now)
Transforming Nurses’ Stress and Anger: Steps toward Healing, Third Edition [Paperback]
When Nurses Hurt Nurses [Paperback]
Cheryl Dellasega (Author), Sigma Theta Tau International (Edito
Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other [Paperback]
Stabotage!: How to Deal with the Pit Bulls, Skunks, Snakes, Scorpions & Slugs in the Health Care Workplace [Paperback]19 days ago
gigirn1957 (Twitter) responded:Not sure what happened to my original post, but I was referring to the statements you infer about “Texas and Maryland”. If you decide to add arguments in your support, you should reference them so that people may validate it. While reading your letter, all I heard was an emotional rant, and it did not motivate me to join your campaign. You are very emotional, and you should try to change the tone of your posts so that the reader doesn’t have to make an effort to cut through the subjectivity to get to the facts. I was trying to give you constructive feedback. I feel like the AZ Board of Nursing is extremely supportive of retention, and gives nurses several chances including interventions (ex. the CANDO program). If your allegations are true, I do not believe your employer had the right to fire you. It is very common for RN’s to write consult orders, and I hope you win your lawsuit. However, if this many nurses have collectively decided not to give you a job or a clean license, we may not be hearing the entire story. This is an honest opinion from a seasoned ICU nurse of 10 years, And, I will never take a course from you.I read this over again, and you didn’t order a normal case management consultation. You specifically ordered a Hospice consult??? Wouldn’t that be the same as ordering a Cardiology consult or an Infectious Disease consult? I know it gets difficult when you feel like you know exactly what your patient needs, but you should have included the other members of that patients team aka the physicians. Most Hospice consultations involve a case manager that comes from an outside company that does not work for the hospital. Everyone works hard for their patients, including their Dr.’s!!!!! You blind-sighted them, and in a haste didn’t use your communication skills.……and every time I read another link to something you have written, I get disappointed with your immature choice of words.Amanda,
Know you have the support of reasonable RNs who read your circumstances. Those who dissent with the concensus, do so for other reasons, mostly connected with jealousy, rivalry, powerlessness and he other reasons we in nursing can’t get along.It’s not a matter of getting along, and there is no measure of consensus. I’m not going to support someone just because we share the same credentials. She called in a hospice company to sign up a patient without talking to the medical team. And on top of that, she did it on a night shift when there was no one for her to discuss it with. She went about it the wrong way, and should have waited to discuss the patients concerns when the team rounded the next morning. She made a mistake. That’s all. But it is unfortunate that the system is unforgiving.To Arizonarn,
You seem to have intimate knowledge of the situation. Was Amanda working as a staff RN? Or an APRN? Was she acting for the family? If her practice was out of the scope of practice, so be it, however the story seems to have more facts than are presented.
Can you enlighten us more? What the record reflects will go a long way to deciding the outcome. Was this a case of practicing beyond the legal scope of practice or calling out an unethical MD and dealing with his/her acting out over being exposed, or was it simply a difference of opiniion about what was best for the patient. If the last, only the patient or the patient’s family can decide and only when given complete education about the situation.If the family wanted a hospice consult, then it doesn’t matter what the MDs want. The patient is the customer, and Medical and nursing staff the “hired hands”.19 days ago
Emergiblog (Twitter) responded:There was no Banner policy prohibiting an RN from order a case management consult (read the response again), and everything was well documented so that the next shift would know what was done (read the response again).
No secretive stuff here.
Prior orders of the same consultation did not lead to disciplinary action (read the response again), but then again, perhaps the physicians did not throw temper tantrums the next day.
This was also a patient request.
Unfortunately, Banner Health is staying mum, so it’s hard to fault Amanda for only having “one side of the story”, isn’t it? Her response above is actually in response to the original complaint, so we can figure out that she is addressing what was IN the original complaint.
I’ve asked the AZBoN for a copy of the original complaint, as it should be public record.
If you have more facts, ArizonaRN, please let us know.In rereading the lawyer’s response, the MD would have been breaking the law by perfoming any procedure without the patient having granted consent. True consent can only be given by the patient having complete knowledge of the process they are agreeing to have performed.
It has been a longstanding practice for MDs to throw a consent form at a patient without doing complete education as to procedure, prognosis, and what the patient can expect as to rehab. Even as an RN, I have had MDs minimize what rehab I would have to go through following surgery.
When the patient changed his./her mind when given additional information, tough beans to the MD and the “team” who had done so much work in a certain direction! The boss has spoken, boss being the patient.
Granted, the “team” planned on making money for the MDs and hospital by performing whatever prodedure, this is what is criminal and should be investigated. Not some RN who followed the family’s wishes and their change of mind.
Also, for the MD “team” or individual MD to have a “hissy fit”, this is a reportable safety incident as per The Joint Commission, who now describes MD acting out as a patient safety goal, and is reportable.I have worked in the inpatient setting for over 10 years, and i have a lot of experience with these situations. I don’t have any intimate details, I have just read all of her posts along with most of the publications. I believe she became immediately overzealous and it cost her her career. Even though her brain is working as one, she is not a mid-level provider yet and forgot to put on the brakes. The patient was not having a transplant that day, and there was plenty of time to open dialog with the team of people caring for that patient. I feel bad that she has to go through all this, but it may have turned out differently if she had admitted that she made a mistake.35 years experience here, 3 degrees, adjunct professor for 2 schools of nursing, . I have held Director positions for 4 different hospitals and would not have acted as the DON did there. I, too, have had considerable experience and simply disagree with you.
I don’t really care about the posts, but the lawyers position is what makes sense. I don’t think she made a mistake other than to take a position at that hospital. As the MD and hospital can profit from a possible transplant, I believe they have a conflict of interest. I have seen this before, as they say, been there, done that and have a t-shirt and tattoo for the troubles!
The whole matter should have gone before an ethics comittee. I beleive she was well within her scope of practice.
Johnoh dear…..i must assure everyone that I didnt call any hospice company in to see the patient….i requested, on the behalf of the patient request, for a case manager from a hospice to come in and give expert education to the patient in a way I was not prepared to do…..the hospice standard of care dictates that a patient–at anytime, may self refer by phone, have f amily member or friend call, or alert the nurse they want to visit and ask questions. hospice of the valley relayed that all it takes is a note on the chart from the nurse stating the patient wishes to visit with a hospice rep for more information. a physician’s permission or certification of life expectancy is not required for a visit with a hospice rep to ask question in order to garner more information—-the act of admitting a patient to hospice or discharging a patient on hospice is another matter—that being said, if you call any hospice they will tell you even physicians have an extremely difficult time predicting the trajactory of diseases such as copd and chf due to their elusive nature and patient by patient case—so there are multiple “recertification periods.” A physician may predict that end of life will occur within less than six months of the disease is left untreated, but with the knowledge the patient may very well live beyond that six months—hence the recertification periods, where a doctor has to reevaluate the situation at that time, and make another prediction as to life span. What I did, was act on the request of my patient for more education….that and I documented with a jury in the back of my head because I sensed my patient’s rights were at risk. I should reinforce once again, I consulted two other clinicians–one of them being my nursing manager, prior to education my patient, so I could make sure I was acting in a way that any other prudent and knowledgeable nurse would. I do appreciate everyone’s candor.Labeling the physician group to be motivated by the money received for a transplant is a pretty serious allegation, and it sounds like someone is throwing anything that will stick, or pulling strings from the air. Yes, we work as a “team” (including the RN). Along with a transplant coordinator. From reading the details, the patient was just getting started in the process and was “about to be transported to another facility for a transplant work-up”. A lot of physicians may be overworked, have complexes and sometimes display outbursts but I believe in general, the patients best interest are at heart. I believe the bottom line is that she chose the wrong avenue to the right destination.P.S. If anyone is curious. the patient was to be transferred first thng the next morning, and I advised both the patient and day shift RN and night shift manager to ask for more time so the patient could make a decision they felt comfortable with…….ArizonaRN,
If you beleive that no MDs are motivated by money nor that a “For Profit” hospital is also motivated by money, then for the 10 years you have practiced, you have had your head in the sand! Not all MDs are so motivated, Most are not. I have seen docs fight each other over $. I have seen them attempt to keep other competition away by refusing to cover for them, thus ensuring a monopoly! My statement was simply that there was a “conflict of interest” and I stand by it.
Curious how you distort was was in print.
“Outbursts” are reportable to The Joint Commission as a patient safety issue. Didn’t you know that? Aren’t your administrators teaching that in prep for TJC surveys? To stand up for this unprofessional behavior is quite odd.
As you are aware this patient was to be “transported to another hospital” seems you do have details I am not aware about.P.S……transplant evaluations are and can be very very very invasive and painful—at the end of those three days a patient’s entire life–their entire body, and psyche has been dissected and explored and probed. ive had many patients literally melt down at the end of those three days. Its a very scary lonely time—and thats if youre prepared for it………………….I didn’t say that no MDs are motivated by $$. I just found it odd that it was brought up during this story. I work at a facility where MD’s are salary. That issue is being manipulated into this now because her story will not stand on it’s own, and in an attempt to gain national recognition. I believe irresponsible to link the two. Sorry you got offended John, I’m done reading this thread!…The only place Im aware of that im pretty sure physicians are salaried at is mayo hospital—-and this catastrophe would never ever occur there because of the level of respect everyone has for eachother and the collaborative patient centered framework. The physicians there are world class and some of the smartest people Ive ever met–two of which remain inspirations to me in my own practice.To clear up the noise, I stated that this issue should have come before an ethics committee as there was a conflict of interest. Whether the MD bills directly or is salaried makes no difference.
Amanda, arizonarn sounds like she works for Banner and to debate her directly probably would not make your lawyer happy. When confronted arizonaRN distorted what was said, she is zealous for the hospital and maybe even works there. Maybe she is the DON who overreacted when bullied by the MDs. Docs have the power because they make money for the hospital and nursing is a large cost.
Take this case, surgery makes both MD and Hospital Money, no surgery, no income. That sounds like a conflict to me!
You are not sounding like a rougue RN, only one who gets it and the patient’s welfare is better because of it. The board will take your actions and compare them to what a reasonable RN would do in the same circumstance. Listen to your lawyer and do exactly what your lawyer tells you, nothing more.
Be well and good luck,
John18 days ago
wez1975 (Twitter) responded:I am sorry this is happening to you. I am going to post this article on Facebook so we can share information in the hopes that someone sees this and can help you. I am really embarrassed that anyone in our profession would have allowed for this to get this far.
arizonarn: I am not sure where you work but I would challenge you to dig deep and rediscover why you became a nurse, what it means to you, and then reread the situation with new eyes.4 days ago
arizonarn responded:4 days ago
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Andrew Lopez, RN
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