Ms. Trujillo, a registered nurse of six years specializing in cardiology, geriatrics and end of life/palliative care, was caring for a patient who was being evaluated for a liver transplant in the hospital. According to Nurse Trujillo, the patient did not understand the complexity of what she would undergo, nor did she know there were other options. In the course of her assessment she reviewed the procedure and educated the patient with approved patient education materials. 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. The patient requested a case management consult with hospice to explore palliative care and the Nurse ordered it and documented the conversation in the chart. She also used the SBAR (Situation, Background, Assessment and Recommendation) format of report required in the Hospital policy when she handed off care of the patient to the day shift nurse. (this according to State Board Inquiry documentation)
The next day the physician was unhappy that the planned surgery was in jeopardy and he refused to let the patient visit with hospice. He accused Ms. Trujillo of acting outside of her scope of practice and the nurse manager became involved as did Hospital administration and Amanda Trujillo was fired for writing an "order" for case management.
This case went through the Arizona State Board of Nursing and her license has been suspended. As a single mother of three, she is unable to find work as a nurse and subsequently she was ordered to undergo psychiatric consultation by the Arizona State Board of Nursing. She has appealed revocation of her license and it remains "under investigation status".
I am amazed at this case. That an RN could be fired and have her license suspended for educating a patient and ordering a case management consult is a travesty. In my hospitals, if there was a difference of opinion, an official ethics consult would be obtained and objective professionals would help resolve any conflict. We put the "patient first" and that means whatever helps the patient achieve their life goals is what we support. It isn't about what the doctor wants and it isn't about limiting nurses in educating patients. Nurses and physicians should support this philosophy and, in the best of worlds, work together to deliver on it.
Amanda Trujillo has been dealt with unfairly. Plain and simple. And I wonder what happened to the patient?
Addendum: There are many sides to a story and the Trujillo case is complicated if you take into account the other allegations by the Arizona State Board of Nursing (ABON). Her license was suspended pending investigation of other presumed professional lapses along with this one. You can read it here.