#NurseUp

Remember the name Amanda Trujillo.

Amanda Trujillo is a transplant nurse and patient advocate in Phoenix, Arizona. That is, she was.

Trujillo was fired in Spring 2011, lost her license, and cannot at present hold another nursing position in Arizona. And it seems that she was fired for being a transplant nurse advocating for a dying patient. Calling it ironic doesn’t do it justice.

Trujillo’s advocacy was either in defiance of, or at least without regard for, a transplant physician who had other plans for the patient that involved surgery and certain realities of post-surgical care about which the patient was not aware. Trujillo admits that the physician’s concerns were not hers, and she clearly has strong feelings about how unaddressed revenue pressures can compromise institutional ethics and practices. What also is clear is that the best interests of the patient were Trujillo’s priority. Which is pretty much what I want in a nurse.

Trujillo apparently informed the patient about alternatives. More to the point, she had an open and honest dialogue about the patient’s wishes. What would seem to be a requirement for informed consent was somehow against the practices of this physician and Banner Health, the corporate owner of the hospital. And the physician became irate that the patient wanted to pursue alternatives to surgery.

Before the age of social networking, it would be easy to imagine this story never seeing the light of day, and Trujillo struggling in anonymity as an unemployed mother. But the blogosphere and Twitterers have recently become sufficiently engaged in Trujillo’s case to force postponement of a hearing that was scheduled Tuesday at the Arizona State Board of Nursing.

There is something of an Occupy Patient Advocacy building among social networking nurses, and at their center are Kevin Ryan and his colleagues at innovativenurse.com, whose open letter of support for Trujillo to the Arizona nursing board has gone viral, as has Trujillo’s own letter. Search the hash tag #NurseUp for a sense of this movement.

Ryan wrote: “It appears that Amanda Trujillo evaluated the health status of her patient based on her own clinical assessments and also data collected while being treated by the medical team at Ms. Trujillo’s place of employment during this time. It also appears from the information that Amanda Trujillo provided health teaching, counseling, and advocacy for her patient, which to my understanding of the Nurse Practice Act is well within her scope of practice.”

Ryan added: “I am not in any way assuming that the treating physician was negligent, however considering that this is, and should have been a collaborative approach in the patient’s care, Amanda Trujillo was making her own nursing diagnosis based on her clinical assessment, which again to my knowledge is within her scope of practice as a registered nurse. She apparently discovered a deficit in her patient’s knowledge about their treatment options, and it appears that she acted ethically in supporting her patient’s wishes to seek additional information, and referred the patient to a case management specialist as per protocol.”

Trujillo says the hearing was postponed so that she could undergo a psychological evaluation. 

I’m blogging about this today as I try to clear space to listen in on the Conversation Project at Boston’s Institute for Healthcare Improvement, an effort to promote the end-of-life conversation. The Conversation Project essentially exists because Americans are so inept at discussing death. That today’s program takes place while a nurse fights for a career cut short because she engaged in such a conversation is more than ironic. It’s tragic.

I listened to an MP3 of an RN.FM interview with Trujillo, and found her to be eloquent, thoughtful, and to make a strong case for her personal ethics. At intervals throughout the interview, her young daughter competes for her attention in the background. 

Trujillo has been cut off from her former employer, and says “none of my colleagues will have anything to do with me.” She heard that her patient was denied a hospice consult. In the process of being fired, Trujillo says, she was grilled about definitions of hospice and palliative care. And she was told she was responsible for “messing up the hard work” of the doctors and staff -- by informing a dying patient about options.

Her story offers a troubling look into how a system discourages advocacy and open communication, with economics lurking in the shadows.

Wrote one nurse in a comment on Ryan’s blog: “How can the business of medicine or healthcare even consider replacing primary care physicians with nurse practitioners if no one can stop a doctor from intimidating a nurse, and having her fired because she educated or gave the patient a choice he or she didn't. What good is more education for nurses if we are going to be stopped and chastised when we do what our code of ethics demands that we do. That is to advocate and educate a patient.”