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Fired for educating a patient?
May 2012 -- On February 1, the Phoenix CBS affiliate KPHO-TV ran a short but good item by Peter Busch about veteran local nurse Amanda Trujillo, who said she had been fired by Banner Del Webb Hospital and had a complaint filed against her with the state board of nursing because she had educated a patient about the risks of an upcoming surgery and scheduled a consult about hospice. A hospital spokesman reportedly said that "the doctor, ultimately, is the focal point that directs care for patients" and that "company policy" forbids nurses to order a case management consult. The report does not mention other accounts suggesting that these events were set in motion because the patient's surgeon was displeased that the patient had decided against the surgery. Trujillo's case has itself become a "focal point" for nurses concerned about policies that discourage them from doing what they are trained to do, namely educate and advocate for patients and help them make informed decisions about their care--and about the failure of some in authority to support nurses who stand up for patients. As of this writing, more than a year after Trujillo spoke to her patient in April 2011, it appears that the Arizona Board of Nursing has yet to decide on her case. A "Notice of Charges" with a curiously wide-ranging list of apparent allegations against Trujillo, going back to 2009 and including her work with other employers, appeared online in March. The Notice purports to be signed by the Board's director but it is undated, and it is unclear if the document is genuine or represents the Board's position. At the same time, Trujillo's case has become a national rallying point for nurses concerned about nursing disempowerment, with some questioning the accuracy of the apparent allegations against her and the alleged relation of the Board to Banner Del Webb, and others questioning the accuracy of Trujillo's account or hesitating to prejudge the matter while the Board is apparently still considering it and many facts remain unclear. In any case, we thank KPHO and Peter Busch for this report.
The article "Nurse says she was fired for educating patient" explains that Trujillo says she spoke with her patient on "the eve of their surgery" at Sun City West's Banner Del Web Hospital in April 2011. Trujillo, "a licensed nurse since 2006," told the TV station that she "discovered that [the patient] had a very big misunderstanding about what [she was] about to participate in." The report says Trujillo "advised the patient of possible complications" and "ordered a case management consult for the patient to be educated about hospice care." The patient reportedly delayed the surgery to "reconsider ... her options." KPHO rightly consulted the hospital about the case.
"The doctor, ultimately, is the focal point that (sic) directs care for patients," said Banner spokesman Bill Byron, who said company policy prevents nurses from ordering a case management consult.
Trujillo responds:
"This is what we go to school to do. We are licensed to teach our patients, we are licensed to advocate."
The item reports that Trujillo said she was fired right after speaking with the patient "and a complaint was filed against her with the Arizona Board of Nursing." The piece notes that Trujillo says she is "fighting to clear her name - not just for herself, but so other nurses aren't afraid to do their jobs."
"What this hospital is doing is establishing a culture of fear, and what the board is doing by supporting that is they're setting that example that the education of a nurse is not valued," said Trujillo.
The piece notes that the Board of Nursing "said they will discuss Trujillo's case at their next meeting in March," but it is not clear to us what the current status of the matter is and the Board's website does not seem to contain any statement about it. An 11-page "Notice of Charges," which appears to contain the signature of the Board's director but is not dated, surfaced online in late March 2012. It is not clear if this Notice is genuine or if it represents an accurate statement of the Board's views or claims against Trujillo. The Notice is a long and curiously wide-ranging list of claims that Trujillo failed to meet her professional responsibilities in incidents dating back to 2009. It includes Trujillo's work with other employers and goes well beyond the Banner Del Webb incident that is the subject of the KPHO report. We cannot judge the accuracy of any of these claims, how they became public, or why the Board might have conducted such a wide-ranging investigation. We do note that some nurses have suffered retribution for voicing concerns about patient care that threaten existing power structures. Meanwhile, Trujillo has undertaken a national campaign to organize nurses to come to her defense, and many have done so by joining a letter-writing campaign to the Arizona Board of Nursing and starting a legal defense fund.
Whatever the specific details of this case, it raises critical issues about the ability of nurses to protect patients in settings in which both nurses' practical power and the general understanding of the nursing role appears to be limited. Patients can suffer greatly where nurses are inhibited from speaking to them, to other providers, or to those in authority about serious risks to patient care, as was made clear by the 2010 case involving whistleblowers in Texas who actually faced criminal charges. Potential solutions to these problems include the kind of whistle-blower protection legislation sought by Trujillo and supporters of the Texas nurses, as well as greater education of health colleagues, policy makers, and the public at large about the true abilities and duties of nurses. In particular, nurses are a vital check on potential harmful actions of other health workers, as the work of Johns Hopkins physician Peter Pronovost has made clear.
We thank KPHO and Peter Busch for their contribution to these goals.
See the article "Nurse says she was fired for educating patient" by Peter Busch posted on the KPHO site on February 1, 2012.
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