Amanda Trujillo and Informed Choices in Advance Illness « CHMP #nurseup #nursefriendly #healthcare #hpm #patients #eolchat #eol

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 with alcohol-related liver disease. 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.

via centerforhealthmediapolicy.com

Thank you Diana Mason for raising awareness of this issue.

Original url:
http://centerforhealthmediapolicy.com/2012/02/28/amanda-trujillo-and-informed...

For more information, please visit http://www.nurseup.com

The Facts About The Amanda Trujillo, RN vs Del E. Webb Medical Center, Sun City Arizona Case:

Amanda's original call for help: Del E. Webb Medical Center, Sun City Arizona AKA Banner Health Nurse Incident @BannerHealth:"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."
http://nurseup.com/wordpress/2012/02/del-e-webb-medical-center-sun-city-arizo...

Patricia Iyer, former president of the American Association of Legal Nurse Consultants explains and prepared a video statement:"The story of Amanda Trujillo is a horrifying one. Briefly, she is a single mom who fought to get off welfare and fulfilled her dream of becoming a nurse. Not only did she become a nurse, she earned a masters and doctorate degree in nursing. One night while working at Banner Health in Arizona, she took care of a patient who was being asked to undergo a liver transplant. In talking to the patient, Amanda learned that the patient did not fully understand what was going to occur."
http://nurseup.com/wordpress/2012/02/amanda-trujillo-rn-fired-for-being-a-pat...

Why physicians should care about Amanda Trujillo-KevinMD by @jaydoe #rn #nurseup #mdchat #rnchat #s4pm #nursefriendly:"For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient was slotted for pre-transplant evaluation and had poor understanding of the disease process and treatment options. Trujillo filled in the gaps for this patient. Trujillo then requested, at the patient’s own wish, a hospice team consult, documented her actions appropriately, and left a note (it was night shift) for the primary physician."
http://nurseup.com/wordpress/2012/02/why-physicians-should-care-about-amanda-...

*********************************************************

Sincerely,

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

Visit our network of sites. Over 150,000 + Nurse Selected, Approved Nursing & Healthcare Resources:

10 Ways to Help a Friend With Cancer, Suleika Jaouad, Huffington Post, #oncology #healthcare #nursefriendly #bcsm #caregiving

If it takes a village to raise a child, you might say it also takes one to care for the sick. Cancer is at once personal and communal. Disease lives in the sufferer's body, but the experience of illness is shared, often intimately, by our loved ones. And yet, caring for the sick can feel like writing a travelogue about a country you've never visited. You can't know where you haven't been.

"What can I do to help?"

This is the sincere, often reflexive, response people have when they find out I have cancer. When I was diagnosed with leukemia last May at the age of 22, my boyfriend, Seamus, sprung into action as my CCO: chief caregiving officer, after my parents. As the news of my diagnosis spread, my friends, acquaintances -- and even some strangers -- formed a loving support network. It was a comforting reminder of how selfless people can be.

But while most of my friends and family would help me in a heartbeat, knowing how to help can be a daunting, even paralyzing, challenge. Over the past eight months, through seven hospitalizations and six rounds of chemotherapy, Seamus and I have sustained a running dialogue about what it means to be a caregiver and a care recipient; what it means to be in love with one another while my body's at war with itself.

This guide to helping a friend with cancer is built from parts of our many conversations on the subject of caregiving.

via huffingtonpost.com

--
Sincerely,
Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
38 Tattersall Drive, Mantua New Jersey 08051
http://www.nursefriendly.com info@nursefriendly.com Twitter: @nursefriendly
856-415-9617, (fax) 415-9618
Visit our network of sites. Over 150,000 + Nurse Selected, Approved Nursing & Healthcare Resources:

The Arizona Board of Nursing Thinks You’re Stupid - Nurse Ratched’s Place @motherjonesRN #nurseup #nursefriendly

I learned a long time ago that behavior is predictable. Past behavior is a good indicator of how an individual or organization will respond to current events. I don’t know why I was shocked to learn that the Arizona Board of Nursing is upping the ante on Amanda Trujillo. After all, she didn’t roll over and play dead when Banner Del E. Webb Medical Center and the BON tried to shut her down because she is talking about her story. Now the BON is charging Amanda with using false academic credentials. Amana used the letter “S” at the end of her professional designation to indicate that she was a student back in 2010, and she forgot to change the auto sign on her personal email account when she dropped out of school due to illness. This buffoonery about credentials is an old ploy from the BON playbook. Do you remember the case of the Heart Attack Grill?

Let me refresh your memory. I first wrote about this story in 2006. It all started when the Heart Attack Grill—a theme restaurant whose specialties included the Quadruple Bypass Burger and Flatliner Fries, cooked in pure lard, opened for business. The waitresses, who are called “nurses,” wear skimpy, cleavage-baring outfits, high heels, and thigh-high stockings while serving artery-clogging meals. The BON took one look at the waitresses and sprang into action because it apparently thought that the public was too stupid to figure out that the waitresses weren’t really nurses. I wouldn’t think that the young woman in the picture was a nurse. Would you? The nursing board asked the Arizona attorney general to put the kibosh on the grill’s use of the word “nurses,” saying, “Only a person who holds a valid and current license to practice professional nursing may use the title ‘Nurse.’”

via nurseratchedsplace.com

Thank you Terri Polick, @motherjonesrn for the great article.

Original url:
http://www.nurseratchedsplace.com/2012/02/the-arizona-board-of-nursing-thinks...

For more information on Amanda Trujillo, RN and her situation with Del E. Webb Medical Center, Sun City, Arizona, please visit:

http://www.nurseup.com

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

Del E. Webb Medical Center, Sun City Arizona AKA Banner Health Nurse Incident @nursingpins #nurseup @BannerHealth – vdutton’s posterous | Nurse Up!

February 23, 2012 in Amanda Trujillo, Banner Health, Banner Health Arizona, Best Selling Authors, Nurse Leaders, Nursing Blogs, Uncategorized Edit this entry

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. 

 

 

Banner Health Nurse Incident @BannerHealth

     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 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 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.

Respectfully

Amanda Lucia Trujillo MSN, RN, DNSc-NP(s)

Glendale, Arizona

            623-249-3138 

Please e-mail the Arizona State Board of Nursing and let them know you are following this case    arizona@azbn.gov

 

Amanda Trujillo on twitter –  @NURSEINTERUPTED

MUST SEE LINKS

Video of Amanda

Could What Happened to Amanda Trujillo Happen To You??

 

What’s Missing in the Amanda Trujillo Story?

The Public Has the Right to Know About the Amanda Trujillo Case

ANA Finally Acknowledges RN Amanda Trujillo

American Nurses Association: Supporting Nurses, Until You Need It

Amanda Trujillo - Emergency Physicians Monthly

Why Nurses are Furious about the Amanda Trujillo Case

Nursing & Healthcare Directories on: The Nursefriendly
Amanda Trujillo, RN, Arizona Patient Advocate, #Nurseup #AmandaTrujillo 

The American Journal of Nursing posts on Amanda Trujillo

The American Journal of Nursing post on Facebook

Interview with Nurse Amanda Trujillo 

Banner Health, Arizona Board of Nursing: A Personal Vendetta?

Amanda Trujillo on PHOENIX (CBS5)

Medical Ethics and Me

The power of social media #NurseUp

Standing with Amanda Trujillo

Banner Health Strikes Blow Against Patient Advocacy, Fires RN

Support your fellow nurse

Amanda Trujillo on RN FM radio

The Nurse Stands Alone…

The Persecution of Amanda Trujillo

Nurse Up for Amanda Trujillo (Facebook page)

What Threatens One Arizona RN Threatens Us All

 

Amanda Trujillo: A Fellow Nurse on the Ropes

 

via nurseup.com

Why physicians should care about Amanda Trujillo - Pharma - eWallstreeter @jaydoe #nurseup

Why physicians should care about Amanda Trujillo

From: KevinMD.com - 6:31am - February 25, 2012

For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient [...]

Continue reading this article »

via ewallstreeter.com

Why physicians should care about Amanda Trujillo | News for Dallas, Texas @jaydoe | Dallas Morning News

Kevin, M.D. 13 hours ago

Why physicians should care about Amanda Trujillo

Many physicians might sympathize with Trujillo’s arbitrary firing, or see in her case a reflection of their own professional concerns about the role of large health corporations in their day-to-day practice. But for me, as a nurse, the issue boils down... Full Article at Kevin, M.D.

via topics.dallasnews.com

Why physicians should care about Amanda Trujillo-KevinMD @jaydoe #rn #nurseup #mdchat #rnchat #s4pm #nursefriendly #amandatrujillo

For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient was slotted for pre-transplant evaluation and had poor understanding of the disease process and treatment options. Trujillo filled in the gaps for this patient. Trujillo then requested, at the patient’s own wish, a hospice team consult, documented her actions appropriately, and left a note (it was night shift) for the primary physician.

These actions — the education and the hospice team consult — drew the wrath of both the primary physician, who demanded her dismissal and her license, and also her nursing director, who told Trujillo she had ”messed up all the doctors’ hard work and planning for the surgery.” The patient-requested hospice care consult was cancelled. Trujillo’s employer subsequently fired her, and reported her to the Arizona State Board of Nursing for exceeding nursing scope of practice, though in fact, nurses previously had ordered a hospice care consult without consequence. In short, many nurses believe Trujillo was fired for educating and advocating for her patient.

These are the bare bones of the story. Further details can be found on WhiteCoat’s Call Room and on Nurse Up for Amanda Trujillo. The debate among nurses — sometimes heated — has common themes around the limits of nursing practice, the meaning of nursing advocacy, and how nurses in trouble are left high and dry by the professional organizations that purport to represent them. Well and good. But why should physicians care?

via kevinmd.com

Thank you Jay Doe RN, for the great article.

Thank you Dr. Pho for raising awareness of this issue.

Original url:
http://www.kevinmd.com/blog/2012/02/physicians-care-amanda-trujillo.html

For more information, please visit http://www.nurseup.com

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

Andrew Lopez, RN, Really is Nurse Friendly | Notes from the Nurses' Station, @rncentral @jolin2 #nursefriendly #nurseup

February 22nd, 2012

By Jennifer Olin, BSN, RN

I first met Andrew Lopez, RN, when the Amanda Trujillo story broke out in Arizona. He was one of the first nurse bloggers to run with the story on Facebook and Twitter. In short order, a group of nurse-writers gathered together on line and adopted Trujillo’s fight as their own. I don’t think anyone in that group would disagree that Lopez is one of the ringleaders of this band of RNs out to right Trujillo’s wrong and hopefully bring some changes to nursing: how we see ourselves, how we are seen and how our professional organizations represent and stand up for us.

Andrew, you have been so passionate about Amanda’s case since the first minute anyone heard about it, and you continue to stay at the forefront of the effort to help her…why is this so important to you?

”With Amanda, I continue to help because I'm in a position where I can. Am I a ringleader because I'm around, because I contribute my time, efforts? If that qualifies me, then yes, I'll accept the role.

”Amanda is in a difficult spot. She is there because she advocated for a patient and the doctor didn't like it. He decided to destroy her career, he was so upset. Her employer, Banner Del E. Webb Medical Center went right along with it. They even filed the charges with the Arizona State Board of Nursing, as the doctor requested. Amanda, for the first ten months of her ordeal, had no support.

”Her situation is wrong on so many levels. It is something I've seen repeatedly in my Nursing career and often felt powerless to do anything about. It is empowering to be able to act on Amanda's behalf and have a group of like-minded nurses with the same mission. Together we can do some serious damage to the powers that be. It is almost worth the risks that we each take by getting involved.

”Since we received her initial call for help, we've had a consistent stream of dedicated, enthusiastic and supportive nurses willing to help. It is a very good feeling to be fighting for something you believe in. It is one thing to "Save the Whales" it is another to fight a war that can significantly improve not just one nurse’s life, but hundreds, thousands, tens of thousands.”

We’ve established you are a revolutionary, rabble-rouser and ringleader….how did you get here? Tell me about becoming a nurse.

”From the beginning I was attracted to the health sciences. I liked biology, psychology, wanted to be in a helping profession. Went to school to be a laboratory technician, got a four-year degree in it. While doing clinicals I found my favorite part of the day was the patient contact I had at 5 a.m. every day drawing labs. While I was doing phlebotomy, got to see and talk to the nurses on the floors. I saw what they were doing and caught the nursing bug.

”Nursing school was two years including pre-requisites. The hospital where I was working had a school of nursing on site. I could work, go to school, and live in the dorms, it was perfect for me. I signed up for an accelerated program using my laboratory degree credits and was a nurse inside of two years. I’ve been a nurse for 14 years now.”

via rncentral.com

Please click on the "VIA" link to read the full article.

Thank you so much to Jennifer Olin, BSN RN for the opportunity to interview.

I support Amanda Trujillo, RN - For more information, please visit http://www.nurseup.com

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

Visit our network of sites. Over 150,000 + Nurse Selected, Approved Nursing & Healthcare Resources:

For Health Information you can use, Follow, Connect, Like us on Facebook, Google +, LinkedIN, Twitter, StumbleUpon (Most Invites Accepted):
http://www.nursefriendly.com/social/

In the Footsteps of Rosa Parks | Nurse Up! Terri Polick, RN @motherjonesrn, #nurseup #amandatrujillo

In the Footsteps of Rosa Parks

February 20, 2012 in Amanda TrujilloEdit this entry

“You must never be fearful about what you are doing when it is right.” Rosa Parks.

Nurse K, the proprietor of Crass-Pollination: An ER Blog just wrote a post about the Amanda Trujillo case. She and I have very different opinions about Amanda’s case, but I encourage you to read her post because she reflects the opinion of many nurses about Amanda’s situation.

Nurse K gives an accurate blow by blow description on how corporate nurse leaders wage war against their nursing staff. She explains how nurse managers orchestrate the demise of nursing careers. Make management angry and you get the axe, and there isn’t a nurse alive that hasn’t witnessed or experienced the wrath of hospital management.
Nurses scatter and go underground when someone gets in trouble, and conventional wisdom states that a nurse should be contrite and take their punishment when they are abused by those who hold power. Many people are wondering why Amanda didn’t follow the same path. Some, like Nurse K, are suggesting that Amanda is committing career suicide. Other’s have told Amanda to “shut up.” The American Nurses Association and the Arizona Nurses Association won’t support an individual nurse who is “under investigation.” Egregious comments and actions are coming from the Arizona Board of Nursing. Kim McAllister from Emergiblog writes about the board’s actions here.

Rosa Parks made history when she refused to move to the back of the bus and she was persecuted for her actions. She wasn’t trying to start a movement when she refused to move. She said that she was tired and just trying to get home. Amanda Trujillo wasn’t trying to start a movement either. All she did was write to fellow nurse Echo Heron about being fired from Banner Del E. Webb Medical Center, and her situation with the Arizona BON. Echo passed the letter on to Vernon Dutton and from there her letter went viral. Now Amanda is being persecuted for her actions. A lot of people have asked me why the Amanda Trujillo case resinates with nurses. It’s because nurses are tired of being treated like second class citizens. Nurses have few rights and little protection in the workplace. We are abused and bullied by nurse executives who cherish corporate profits. Frankly, we’re tired of being told to go to the back of the healthcare bus. And God help the nurse who says no, they aren’t moving. He or she is ridiculed, fired, dragged before the state board of nursing and threatened with the loss of their nursing license. Now, with the support of others, Amanda is fighting back. She’s isn’t doing this for herself, she fighting for our patients and the nursing profession. Great changes begin with one person.

Rosa Parks said that you must never be fearful about what you are doing when it is right. Amanda is doing the right thing and she will win, and by doing so, we will all win in the end.

 

← Grand Canyon University Student Nurses Association: Comment, Like, Post, Share the Amanda Trujillo comments please :)

via nurseup.com

Thank you Terri Polick, RN @motherjonesrn for your support and moving post regarding Amanda Trujllo :)

For more information, please visit:
http://www.nurseup.com

--

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

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Nurse Abused by Banner Health

Nurse Up for Amanda Trujillo (Support for Amanda on Facebook)
www.facebook.com/NurseUpforAmandaTrujillo

(Amanda's Story) vdutton.posterous.com/94287821

(Nurse Up!) nurseup.com/wordpress/

Comments and faves

1. 

   nursefriendly (31 minutes ago | reply)

   Thank you Vernon for all your support in the Amanda Trujillo case :)

   Andrew Lopez, RN
   www.nurseup.com

via flickr.com

The Nurse and The Golden Goose - Guest Post by Carol Gino RN, @icoachnurses @hopefulhealer

The Nurse and The Golden Goose

- Guest Post by Carol Gino, Nurse and #1 New York Times Bestselling Author

When I was working the night shift, one of my patients- a 44 year old man, had just gone for an angiogram. He had been brought back to the floor afterwards, but began hemorrhaging from his femoral artery. I’d added pressure dressings, laid on heavier sandbags, and then called the intern.

The intern took a while to get to the floor and all the while the patient kept bleeding heavily. When the intern just shook his head and did nothing, I called his resident. When the resident didn’t respond, I called the attending. Now I knew I was in big trouble. It didn’t matter that the patient’s blood pressure was 60/40 by the time I called, it mattered that I had broken protocol.

Because I knew this Directress of Nursing was good and fair, when she called me into her office, I decided to try to listen to her with an open mind, even though the whole thing made no sense to me.

She was sitting at her big oak desk and she hardly looked up as she waved her hand, indicating that I should sit in the chair across from her.

“You’re a good nurse,” she said, “that’s not the problem.” She smiled just a bit when she added, “I’m even beginning to believe that you’re a good person.” She looked straight at me when she added, “But you’re difficult to deal with. You’re headstrong – a lot for a supervisor to handle. Though you’re supposed to be part of a team, you often make independent decisions that I have to be responsible for.”

“No one else was available. That patient almost bled out and not one of those doctors paid any real attention,” I said. “And how often have I been wrong?” I asked.

“That’s not the point,” she said, her voice soft, patient. “So far you’ve been right. But what if we let every smart young nurse make independent decisions-how well would that work for the organization, for the business of medicine? Who will be liable?”

“So what am I supposed to do?” I asked defensively. “Stand by and let the patient die until I get an okay?”

She stiffened. Her voice was steely when she spoke now. “That’s one alternative,” she said. “The other is to go back to school and get more education. Get enough degrees that you can run your own show and take your own responsibility.”

When she saw I was really listening, she added, “You’re not going to do anybody much good if you behave in a way that gets you fired.”

So I went back to school and got more degrees, as many other women and men have done, based on the promise of nursing in an evolving health care system. We, as nurses, understood the value of education for autonomy, and knew what we needed to do as professionals. In other words, we grew up.

But today, thirty years later with many more nurses with degrees, have any of the organizations, who are supposed to back us, grown into “professional organizations” that can support us?

Are we paid as independent professionals who’ve been trained to think, consider treatments, help patients and their family through the difficulties of life and death, if necessary?

Have doctors suddenly begun to treat us like colleagues, with any real understanding of what a better education has done to change our role and the way we can work together?

Has the business of medicine stopped stacking us with the bedpans and the gauze pads as part of their budget so that we can’t be “cut” whenever they have a budget shortage?

And while– for budgetary reasons –they are even considering putting us in the place of primary caregivers because there are fewer doctors who are willing to work for the wages the corporations (that we now call healthcare) are willing to pay, who has our back?

Nurses have  gotten better educations, they’ve grown up. They’ve done their part.

But what about the rest of Healthcare?

Are they going to grow up too and let the patients know how important nurses are to their well-being? Are they going to pay us and treat us with the respect we deserve?

Or is the business of medicine going to watch the mass exodus of the smartest and best nurses as they hit the road for a profession that offers respect for work well done, autonomy to go with responsibility, decent pay without intimidation, and most of all for caring for what happens to another?

If not, if they stay stuck, what happens to the patients? All those mothers, fathers, husbands and wives, all the sick children and new babies to whom life deals a tragic blow and who depend on us to keep them safe and advocate for them? Who will be there to observe, educate, nurture, comfort, call, soothe and help them through the hardest times? Who?

To Congress and to the Business of Healthcare I say:

“This is not the Golden Goose, it is the Golden Calf.  Beware.”

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via icoachnurses.com

To visit Anna Morrison's site, please click on the via link.

--

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 

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The Winkler County Nurse Trial, An Alleged Massive Conflict of Interest, and Morgellons : The Questionable Authority #nurseup

The Winkler County Nurse Trial, An Alleged Massive Conflict of Interest, and Morgellons

Category: Medicine
Posted on: February 9, 2010 10:32 PM, by Mike Dunford

As some of you might know, there is a very scary criminal case currently underway out in West Texas. A registered nurse named Anne Mitchell is currently standing trial. She's been charged with misuse of official information, which is a felony carrying a 10-year maximum sentence. She allegedly committed this crime by sending a complaint to the State Medical Board, because she was concerned about what she believed to be a pattern of sub-standard care and ethics on the part of Dr. Rolando Arafiles, a physician at the hospital where she worked.

Dr. Arafiles, according to the complaint filed by Mitchell and a colleague, engaged in a wide range of questionable activities. Even though he did not have surgical privileges at the hospital, he performed a skin graft in the emergency room. (The graft failed.) He sutured a rubber cap to a patients crushed finger to help protect it (yes, that's about as nutty as it sounds). He also repeatedly attempted to get patients to purchase - from him - various herbal remedies.

If you want to see the good Doctor at his questionable best, I just found (via a comment at another blog) some YouTube clips of an appearance that he did for something called "God's Learning Channel", which appears to be some kind of local access program. In this program, Arafiles is discussing Morgellon's - a condition which most physicians believe is nothing more than delusional parasitosis. Dr. Arafiles does not seem to share their view:

via scienceblogs.com

--

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

Visit our network of sites. Over 150,000 + Nurse Selected, Approved Nursing & Healthcare Resources:

For Health Information you can use, Follow, Connect, Like us on Facebook, Google +, LinkedIN, Twitter, StumbleUpon (Most Invites Accepted):
http://www.nursefriendly.com/social/

4nursing.com:"In this Nursing Portal you'll find information on Nursing Jobs, Nursing Schools, Nurse Degrees, CNAs, LPNs, RNs, Travel Nursing, Prescriptions Drugs, Medications, Nursing Associations and much more."
http://www.4nursing.com

InspirationalNursing.com:"InspirationalNursing.com. Touching Poems, and Inspiring stories that touch the heart and occasionally bring a tear to your eye. Affection, Ambition, Angels In Our Lives, Animals, Babies, Bereavement, Caring, Caring, Children, Christian Stories, Christmas, Computers & The Internet, Death, Dependability, Determination, Dying, Easter, Emergency Medical Services (EMS), End of Life, Etc., Friendship, God's Creatures, Grief, Holiday Thoughts, Honesty, Hospice Poems, etc."
http://www.inspirationalnursing.com

Jocularity.com (Former home to the Journal of Nursing Jocularity (JNJ)):"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."
http://www.jocularity.com

Legalnursingconsultant.com:"This website is intended to be a resource for Legal Nurse Consultants, Attorneys looking to use their services, and nurses looking to enter the field of Legal Nurse Consulting. On our site you'll find a directory of LNCs by state and specialty."
http://www.legalnursingconsultant.com

Nursefriendly.com:"Nationwide Nursing Resources: In this Nursing Portal you'll find information on Nursing Jobs, Nursing Schools, Nurse Degrees, LPNs, RNs, APNs, Nursing Associations and much more."
http://www.nursefriendly.com

Nursinga2z.com:"It is our intent for this Alphabetical, A to Z index to be a comprehensive listing (In Progress) of Nursing-related resources on the Internet. It is indexed by Google and fully searchable."
http://www.nursinga2z.com

Nursingdiabetics.com:"Welcome to NursingDiabetics.com. Here you will find information on all aspects of Diabetes, a disease that afflicts millions of people world wide. I'll be adding pages as fast as I can research the information so remember to bookmark this page and return."
http://www.nursingdiabetics.com

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http://www.nursingdiscussions.com

Nursingentrepreneurs.com:"Nationwide Nursing resource to nurse entrepreneurs looking to nework and start home based businesses. On it you will find links to small and large business related resources."
http://www.nursingentrepreneurs.com

Nursinghumor.com:"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."
http://www.nursinghumor.com

When Nurses Attack At the Highest Levels: A Blatant Abuse of Power // Emergiblog

When Nurses Attack At the Highest Levels: A Blatant Abuse of Power

I am not a conspiracy theorist.

I am not militant.

I am not a bleeding heart, I don’t embrace every cause du jour, nor do I hop on what someone termed a “clown car of supporters” for whatever happens to run across the blogosphere on a given day.

I am as straight-arrow, by-the-book, trust-the-Establishment as you will find in this world.

So when I say that I am reeling; when I say that I would take to the streets about something that has happened…when I say that I am questioning everything I thought I knew about authority, power…and nursing…

I’m not bluffing, over-reacting or being hysterical.

Pardon my unprofessional language, but there is some bad s*** going down in Arizona.

**********

The Arizona Board of Nursing has gone from ridiculous to abusive in the Amanda Trujillo case.

It wasn’t bad enough that they felt clicking a box on a computer that would order a case management hospice consult should mean enduring:

(a) a detailed interrogation about every facet of your entire career,

(b) or that talking about your situation should lead to a psychiatric evaluation, including obtaining signed releases from all your physicians for the last six years and seeing a board appointed PhD. Yep, clicking that box meant giving up all your protected HIPAA information! I can’t repeat that enough, it’s that appalling.

But that’s old news, isn’t it?

Here’s the new stuff.

********

Amanda received a letter from her university stating they were informed by the AZBoN that her license was under investigation.

Still, old news, you say? But wait!

A Board staff member wrote a letter denying it!

via emergiblog.com

Please click on the "VIA" link to read the full article.

Thank you Kim, for calling attention to Amanda's situation.

For more information on Amanda Trujillo, please visit: http://www.nurseup.com

Sealed "Rape Kit" Reopened By Nurse. Evidence Inadmissible?

Sealed "Rape Kit" Reopened By Nurse. Evidence Inadmissible?

---

See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

Summary: Documentation of observations and findings are basic to nursing practice. Our practice is governed by standards of practice and "protocols" to be followed. In this case, a nurse admitting a rape victim collected and placed in a "rape kit" DNA samples, evidence to be submitted for laboratory analysis. The evidence submission protocol would inadvertently be broken by the nurse. The defense for the rapist would argue this breach made the evidence inadmissible.

The nurse was caring for a sexual assault (rape) victim on the night in question. Herpatientwas one of a number of patients in for the same reason.

Rape is a "reportable" crime in most states. This means when a healthcare worker suspects in the course of their duties that an individual has been a victim of sexual assault, it must be reported. Procedures are in place in hospitals and other facilities for the reporting of rape victims.

"The facts about sexual violence are:

Victims of sexual violence do not invite or cause the assault to happen. Only the person initiating the sexually violent act is responsible.
Sexual assaults are committed primarily out of anger and/or a need to feel powerful, to control and dominate another person.
Victims of sexual violence are forced, coerced or manipulated to participate in unwanted sexual activity.
Victims are usually traumatized by the assault. Friends and family members may also experience trauma reaction.
Sexual assault is a reportable crime. It is important for adult victim/survivors to consider reporting so sexual offenders can be identified by the system and the community.

In Colorado, professionals are mandated to report the crime if the victim:
Is a child. Goes to the emergency room. Was assaulted by someone in a position of authority or trust. (i.e. coaches, psychotherapists, scout leaders, teachers, priests, etc.) Is physically, emotionally or mentally disadvantaged."1

In the process of her examination protocol, she collected several specimens that would be submitted for DNA analysis. These specimens could later be used as "evidence" in the event of a trial.

"a party seeking to introduce an item of physical evidence must prove that the item was that which was taken from a particular person or place which makes the item relevant as evidence in the trial. Such proof is provided by testimony identifying the item as having been taken from that person or place, and by evidence tracing custody of the item from the time it was taken until it is offered in evidence. This latter evidence is necessary to avoid any
claim of substitution or tampering."2

The collection of specimens by a nurse in a hospital must be treated as a strictly legal process. Often nurses are called upon to draw blood alcohol specimens from suspected drunk drivers, blood or urine drug screens from prospected employees to suspected drug abusers or as in this case semen and skin scrapings for later use in a rape trial.

Any such specimen must be handled with extreme care and with attention paid to established procedures.

After collecting the samples and preparing the documentation, the nurse sealed the package. Per policy, the "kit" once sealed could not be reopened except by the laboratory personnel receiving it for analysis. The nurse was unsure whether the documentation had been prepared properly. Unsure, the nurse broke the tamper evident seal and double checked the paperwork. Satisfied that it was in order, the package was resealed and sent for analysis.

"Specimens are sealed in packages and any tampering with a sealed specimen would be noticed by the laboratory and documented on the specimen chain of custody. In addition, as a practical matter, couriers, express couriers, and postal service personnel do not have access to the specimen chain of custody form since the form is inside the sealed package. Section 2.2(i) of the Mandatory Guidelines that discusses the transportation of a specimen to a laboratory has been revised to clarify this point."3

The defendant in this case was being charged with not one, but several counts of violent crimes.

"Blain Southern, who was charged with several counts of kidnapping, burglary, theft and "sexual intercourse without consent," went to trial on the charges filed against him"4

During the trial the defense would argue against the admissibility of the evidence contained in the kit. They stated that the samples may have been "tampered with," when the seal was broken.

The court disagreed. The defendant was convicted of all charges against him.

The defendant appealed.

Questions to be answered:

1. Did the reopening of the rape kit, constituting a breach of protocol, raise the possibility of evidence tampering?
2. Was the nurse negligent for her breach of procedure in handling the kit containing the DNA specimens?

The defense presented expert witnesses who testified that any "tampering" of the kit could potentially violate the integrity of the samples within.

The court ruled that because the kit was opened to "check the paperwork" that a claim of "tampering" could not be supported. It was noted that none of the specimen boxes themselves, containing the DNA samples, had been re-opened.

"The court stated that "tamper" means to interfere with something improperly, meddle with it, or make unwarranted alterations in its existing condition"4

The nurse in her testimony had clearly stated that her purpose in re-opening the kit was to check the "documents" inside. She did not disturb or re-open the actual sample containers. This satisfied the court.

The defense could produce no clear evidence that the integrity of the "specimens" as opposed to the kit had been violated. The court of appeals affirmed the ruling of the lower court.

It is important to note that most nurses are not specifically trained to recognize and deal with "chain of custody" issues. It is likely that the nurse on duty that night was unfamiliar with the process.

It is important to recognize as well that if the "kits" directions had been followed properly, the issue of "evidence tampering" might never have been raised.

Commonly, attorneys (plaintiff or defense) will "latch on" to any deficiency present in submitted evidence. If a single error or omission or breach of protocol is present, it is their hope that others will be found as well. It raises the possibility of additional error and damages the credibility of the evidence and witnesses involved.

"Opposing counsel will often attack the admissibility of evidence in terms of its relevancy and chain of custody. Especially in the early stages of an investigation, the relevance of a piece of evidence may not be evident. As a result, every item recovered should be treated as though it is relevant."5

This can be applied to sloppy charting just as easily as to "chain of custody" in evidence submission. A chart with incomplete documentation of patient care raises the possibility that care was not given. Regardless of what really happened, it only takes a single discrepancy to raise issues of doubt.

Related Link Sections:

Abuse: Domestic, Physical, Verbal Links:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Chain of Custody, Medical Legal & Law Enforcement Resources on: The Nurse Friendly:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/chain.of.custody.htm

Direct Patient Care Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Drug Testing, Medical Legal & Law Enforcement Resources on: The Nurse Friendly:
http://www.nursefriendly.com/nursing/directpatientcare/drug.testing.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Emergency Department Nurses on the Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Related Malpractice Cases:

June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.
Child abuse is a "reportable" crime. This means when a healthcare worker suspects in the course of their duties that a child has been abused, it must be reported. Procedures are in place in hospitals and other facilities for the reporting of abused children. In this case, it was the expert documentation of a child's statements by a nurse, physician and field agent that made the conviction of an abuser possible.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htm

June 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Official tolerance for verbal abuse and sexual harassment is approaching zero. It is clear that both are still prevalent in healthcare settings today. Enforcing and reporting instances of abuse are critical to an end being put to the situation. In this case, a physician had a "history" of verbal abuse in the facility involved. It was the documentation of previous events that made formal action and administration of a suspension feasible.
Gordon v. Lewiston Hospital, 714 A.2d 539 - PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm

Sources:

1. FortNet - The Community Information Network. No date given. "Information about Sexual Violence and Sexual Assault." Retrieved September 7, 1999 from the World Wide Web: http://www.fortnet.org/sava/info.html

2. Vercammen, Kenneth A. No date given. "Proof Of Chain of Custody In A Criminal Case." Retrieved September 7, 1999 from the World Wide Web: http://www.njlaws.com/chain.htm

3. Substance Abuse and Mental Health Services Administration. September 1, 1994. Mandatory Guidelines for Federal Workplace Drug Testing Programs. ." Retrieved September 7, 1999 from the World Wide Web: http://www.health.org/GDLNS-94.htm

4. 40 RRNL 3 (August 1999)

5. Zulawski, David E. and Wicklander, Douglas E. February 26, 1996. "Evidence." Bank Fraud Newsletter. Retrieved September 7, 1999 from the World Wide Web: http://www.w-z.com/evidence.htm

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursefriendly.com/nursing/090599.htm