ANA Finally Acknowledges RN Amanda Trujillo

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February 9th, 2012

By , BSN, RN

Yesterday, February 8, 2012, the American Nurses Association (ANA) finally, sort of, addressed the issue of Arizona nurse Amanda Trujillo and her firing by Banner Health for what they claim was a breach of her nursing scope of practice. This story has taken the nursing social media world by storm in the past few weeks since Trujillo reached outsider her home state for support.

Seeking the help of nurse bloggers across the country was not Trujillo’s initial response. Back in April, 2010, when the whole mess erupted she reached out to the organization she has been paying annual dues to for years and had even very recently donated $100 to for the ANA political fund.

”They never answered any of my emails for help or even acknowledged my emails,” Trujillo said this morning. “They didn’t return my calls either.” She flat out received no response from the national or state office—until yesterday.

So what sparked this sudden appearance of interest from an organization that claims to represent the 3.1 million nurses in this country? Bad press from the blogosphere is my guess.

Here is what the ANA said:

”The American Nurses Association is closely monitoring the case of Amanda Trujillo, MSN, RN, and has been in contact with her attorney. ANA strongly supports nurses and their right and responsibility to engage in patient education and advocacy.

”ANA appreciates how difficult it is for a nurse to undergo an investigation of his or her practice by the state board of nursing. To be clear, ANA expects the Arizona Board of Nursing to follow its standard procedure, to render an unbiased judgment in this case, and to be fully transparent in its findings.

”ANA is the professional association for the nation’s 3.1 million registered nurses (RNs). Since its inception in 1896, ANA has established, promoted and maintained professional nursing practice through the development of foundational documents such as the Code of Ethics for Nurses and Nursing: Scope and Standards of Practice.

”State nurse practice acts are the laws that define scope of practice with the intent of protecting the public. The laws also establish qualifications for practice as well as what constitutes unprofessional conduct or misconduct and associated disciplinary procedures when a complaint is filed against a nurse. The board of nursing is responsible for ensuring nurses are competent and do not exceed their scope of practice. Therefore, it investigates complaints, holds hearings, and renders findings.

”ANA advises that any nurse who has been alerted by the board of a complaint and an impending investigation retain legal counsel. It is the role of legal counsel to represent the nurse during the process. In addition, ANA cautions nurses and the public not to rush to judgments about complex cases based on social media postings or other media coverage.

”Professional associations, nurse practice acts, and state boards of nursing all play a vital role in protecting the public and the profession. ANA encourages nurses to seek out and apply resources that support them in their professional practice. “

Well, at least they are acknowledging there is a problem. The public, and in particular I mean the 3.1 million of us who are nurses and anyone who ever has been or will go to the hospital, has a right to know about this and they wouldn’t get all their info from “social media or other media coverage” if the ANA had spoken up sooner.

Please Explain

There are some questions that arise from this press release, the least of which is did the ANA really talk to Trujillo’s attorney? He never said so and he was recently let go by Trujillo in order to retain someone with more experience in these kinds of cases. So either the ANA never talked to him, or they did and he kept it to himself, or they tried to and he didn’t work for her anymore so really he couldn’t say anything.

And this is my favorite line, the “ANA encourages nurses to seek out and apply resources that support them in their professional practice.” Isn’t that what Trujillo tried to do by contacting the ANA?

It has now been 10 months since Trujillo lost her job for assessing that a patient, who was going to be worked up for a procedure, did not really understand what they were in for. There was a question in her mind as to whether the patient really had given fully informed consent. She provided the patient with teaching materials and requested a case management consult, including information about hospice care. That requested consult is the supposed breach of scope of practice.

Following her dismissal, Banner Health filed a complaint with the Arizona State Board of Nursing (ASBN) and now Trujillo sits, waiting to find out if she will continue to be a nurse in good standing or lose her license.

In all the months since Trujillo was let go, neither the ASBN nor Banner Health have chosen to comment on the situation except to say she is under investigation and the Banner does not discuss employee issues.

So, is it just sour grapes that she was being ignored that made Trujillo reach out to us, the nurses who write in public forums? I don’t think so and I asked her about it.

”Oh geez, no! I mean if it were about getting even who could hold out this long or have the energy for the campaign my daughter and I have been on for ten months now (she has been a very big part of this fight). And, for that matter who would put up with the number of doors that have been slammed in my face,” Trujillo told me.

”If this were about revenge, I would not have had the sheer determination to endure the challenges of this past year. It’s about lives; nurses and patients. I took an oath to get the RN after my name, and walking away from the battle would mean knowingly turning away from what I know was wrong and damaging to my patients—the lack of information they had and the denial of the very basic right to self determination when they were refused the right to see hospice,” Trujillo continued.

”If I stay silent; if I turn my back; if I ignore what happened and call it a day; collect my paycheck and go home—that is the day I need to walk away from nursing. That will be the day I have placed my own needs, wants, desires, well-being, and protection above those in my charge,” she said.

”We all nurse differently. I respect that and love that about our profession. We all have such amazing things to bring into nursing, and this is what I have to bring to the table; I make no apologies for it. I stand for what I believe is right and just—especially when there is potential harm on the horizon for both my colleagues and patients and our profession as a whole,” she continued.

”If we do not do something now, this is going to keep happening. I mean, it’s happening right now as we speak. I can’t collect a paycheck at the expense of the lives of my patients and their families. I understand the publicity with the Texas nurses was scary. I get the publicity the Nevada pediatric nurses received was even scarier—who would want to report after seeing all of our stories.

”But if nurses like me don’t put their foot down and do the right thing—not the easy thing—then people will get hurt, people will die, and our profession will suffer enormous consequences. It all comes down to one thing: when you consider whether to fight for what is just and what is right, if you are thinking of the moral imperative to do what "is right for the sake of doing right" and nothing else then the solution is easy. You keep talking, you keep knocking on doors, you keep emailing, you keep sending letters, you keep tweeting, you keep trying, and you keep fighting "UNTIL." The choice to act, the decision to stand up and speak loudly only becomes difficult when you allow the interests of "self preservation and protection" into the equation. “

Everything Trujillo says sounds very noble. And unless like me, and select group of others, you have heard it from her directly you may not buy it. What I can say is she is very passionate about what happened to her and could have happened to her patient. And, she deserves to at least be acknowledged by her peers and the organizations she has dutifully belonged to for years.

18 Responses to “ANA Finally Acknowledges RN Amanda Trujillo”

  1. Greg Mercer Says:

    As expected for a large traditional organization with too much to lose to take any risks, ANA offers mostly standard boilerplate likely approved by liability attorneys as safe prior to any public release. Also as expected, we are told to trust the system in all it’s facets, and distrust anyone with the audacity to suggest otherwise. It seems traditional organizations in most all their variety have one thing in common: sustain and distrust, and perhaps fear, of Social Media upstarts increasingly encroaching on formerly unquestioned prestige and influence and power. The world is changing, and disapproval will not change that fact. It is wiser, in my humble opinion, to learn to put new realities to best use than it is to try to fight them – ask the buggy whip makers who tried to hold on as those pesky new-fangled automobiles came out. Passing fad? Social media is the next big thing – hop on or recede into history.

  2. Naomi Says:

    “ANA strongly supports nurses and their right and responsibility to engage in patient education and advocacy.”

    Do they, really? Is this not what Amanda did?? Why doesn’t the ANA support their nurses like the AMA supports their docs?

  3. aidel Says:

    Amanda did the right thing. It is no surprise that the ANA is not being supportive. If patients getting proceedures were giving truly INFORMED consent, there would be a whole lot fewer proceedures happening, which is bad for business which is why we won’t see any meaningful change in this area. Physicians, hospitals, drug companies and insurance companies (all for different reasons) have a long history of lying to patients. Morally indefensible but TRUE.

  4. Nancy Wilson Says:

    It is becoming increasingly obvious that we cannot rely on our professional organizations to support us when the chips are down. It is time for nurses to take a stand for each other and for our profession. If we don’t others will do it for us and we won’t like the outcome.

  5. Annie Says:

    Because the doctors bring in patients which equals money for the hospitals. It always boils down to money and power.

  6. Naia McCoy Says:

    My brother did not get proper informed consent and he is now dead because of severr Prozac side effects. I will not go into the details. I am not sure I understand what has happened to the medical field but if they cannot even protect their “own” (nurses)…then something is terribly, wrong and unjust in this country. Time to practice the art of nursing in another more caring place.

  7. Shahina Lakhani MSN RN Says:

    Jennifer, you have made some great points in this article. The fact that it took 10 months for Amanda’s case to be finally recognized is a proof to how unsupported the nurses are. If it was AMA a doctor would be innocent until proven otherwise, but for nurses it is guilty from the beginning and often without a chance of a fair investigation. Social media has brought nurses together like never before. Our challenge now is to create and maintain alliances at larger scale with each other, nurses for nurses. It is a great shift but one that is desperately needed so nurses can come out of this big hole of being treated as maids and gofers and finally claim our rightful place as partners in healthcare.

  8. Carolyn Nelson, RN,BSN Says:

    Money is the root of evil. And this is no exception. I, too, have been sited where I work of saying the truth to our patients and being placed on 3 days off. Amanda did the same as I and of the many nurses who have in the past. Go Amanda.

  9. Jessica Ellis Says:

    Yes, well…it’s all so clear, isn’t it? The ANA and other prof orgs are all about protecting themselves and their revenues. They can’t possibly take sides and support nurses through difficult times until proven either innocent or guilty. Seems that “guilty until proven innocent” is more the reality in the nursing world…and it takes going viral in social media to get even a NEUTRAL-sounding response from the orgs.

  10. Diane Levine RN,BSN Says:

    Amanda,You know in your heart you did the right thing. As nurses we are responsible and obligated to be sure patients understand why they are there, what is happening to them, and how the physician can treat it if possible. It is also important the patient is well aware of the risks and the benefits either way. If their physician has not explained it fully or in a way the patient can comprehend its our responsibility to step in at this point and be sure we can help them to be educated. Nurses are teachers too. In fact its one of the jobs we do that I enjoy best! This whole incident sounds to me as if the physician was scared you were talking his patient out of his surgery where he could be a HERO! Second,it sounds as if when you speak of hospice as an alternative with a patient you are discussing death. Death is a very scary topic to anyone. Always was, probably always will. Something about the unknown that scares us, even though theres so much peace and tranquility to be learned and understood as well. We need more nurses like you to help us all in that journey! You Go Girl!!! Whoever hires you will be one very Lucky Employer!! Remember…Gods time Not Your time. Good Luck.

  11. Debbie Says:

    I will no longer be participating with the ANA. I will no longer donate a penny to them. I will no longer be a paid member. How dare they turn their back on a nurse who was just doing what she was taught to do. To teach our patients and let them make an educated desision regarding their care. And what about this surgeon? Was he upset the patient no longer wanted the transplant and HE would be out a lot of money??? Along with the hospitals losing their share? This is just horrible. This doctor should be boycotted and thrown under the bus on facebook and any other social network site so patients and others will know what he is about. Shame on him. WHO IS THIS DOCTOR??? WHAT IS HIS NAME??? Does anyone know? If they are saying she wrote an order and checked RN…what is the problem? This was not a medication and even the hospital says she was within her rights to write that type of order to have hospice come and TALK with the patient. Why didn’t the doctor discuss all of the patients options with her? Why was she not informed on ALL the choices she had? Doctor did not want to bother? I commend Amanda for doing what she did. I somehow believe she will KEEP her license and anyone hiring her in the future would be getting one GREAT RN. Good job Amanda.

  12. Chris Says:

    Wow! Had no idea about the ANA basically turning their backs on Amanda T. You would think that they would be rushing to defend her actions from the nursing perspective. I’m glad I stopped contributing to them 8 years ago, and I’ll definitely pass the info to my nursing friends. The old dinosaurs the run the nursing profession simply need to go. I still cringe when I remember the one time I was sitting writing my patient notes, a doctor came in, charge nurse told me, “Doctor is here. Find another place.” I looked at her and pretended I didn’t hear. Lady was in her 50′s and still wore the nursing white cap. Got written up for it too. hah!

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  14. Ellen, NP Says:

    I am distressed that our professional organization did not respond to attempts by a member to contact them. I am disappointed, although not surprised, that a physician would take action against an RN for attempting to educate a pt about a planned procedure. We are ethically, if not legally, required to speak out if we believe that a pt has either not been informed or has not understood information that could have an impact on decision making. The hospital may, indeed, have a POLICY that precludes RN requests for medical consultation. In my facility, staff RN’s cannot make an request for medical consultation; howver, the can contact consultants directly once the consultation has been requested by a clinician. It is not clear to me what a case management consultation entails. I suspect that the accusing physician believes that he should have been contacted directly regarding Amanda’s concerns. I believe that I would have 1st contacted the pt’s physician and would have pursued consultation with support of my manager had the physican NOT been responsive to my concerns. That said, I don’t believe that Amanda exceeded her scope of practice. She may have violated some hospital policy, but policies are not laws, and I don’t even have enough information to know that she violated anything. if the hospital truly said that Amanda had the right to request that hospice speak with the patient. As a clinician myself, I would be concerned if the RN didn’t seek me out to express the concerns IF I WAS AVAILABLE. In my absence, I would hope that my coverage would be responsive to a staff RN’s expressed concerns. I would also accept and RN’s decision to seek support from his/her supervisor if they continued to have concerns about the pt’s need for additional information. I hope that staff RN’s question me if they either don’t understand or are concerned with my care for OUR patient. I welcome the dialogue and value RN’s who are willing to advocate for patients. I will be rethinking my own response to the ANA regarding their involvement in this case. I certainly hope that the ASBN will be rational in their investigation and decision making in this case since the hospital and physician certainly have not been.

  15. Cindy Rn Says:

    I have been an Rn for 23 yrs……the changes that are occuring anymore are just unbelievable. The doctor should have been reported to the Medical Board for ethic’s violation……
    It is all about money. Not quality care,and the person who pays the price are the patients. Period. The organizations and facility’s have lost all common sense….just put it in your pocket, it is not needed in this day and age of healthcare……
    Do I sound bitter,frustrated…..yesThis is not why I became a nurse.
    I feel like a glorified waitress and unappreciated.
    Our administration where I work almost encourages bad behavior….the “common practice” at our hospital is for the nurse to have the patient sign a blank consent….as to save time for the physican,or the physican fills it out and never explains anything to the patient and writes an order for the nurse to have consent signed and witness it….when I refused it was a big problem…..what was wrong with me, etc. I stood my ground and it was dropped this time…..I don’t see it happening in the future. My point is, this is not how it is suppose to be. We are to be advocates for our pt.”s…we are the liason for the pt and doctor……we explain things in layman’s terms for the pt so they understand. It is our JOB!!!! If the doctors would spend more than 2 min with the pt and really TALK to them,maybe there would not be questions after they leave. Of course with a life changing event/decision ppl are going to ask questions. But they prefer we lie I guess.
    The ANA as far as I am concerned is just an extention of the problem. I will not be supporting them in the future.
    I do support Amanda and all the other nurse’s who do the right thing….it does not put food on the table unfortunatly.
    Just know Amanda….you are not alone!!!!!
    Everyone should boycott Banner and the physican involved…..hit where it hurts….the POCKETBOOK!!!!!!

  16. Patty Hedrick RN BSN BA CRRN CCM CLCP Says:

    I am very disappointed to hear ANA was not there to support Amanda Trujillo from the start, or that they have not taken a more active stance even now. They should be very vocal now, or I anticipate they will lose a lot of members. What is the point of belonging to an organization that doesn’t support us, when we most need it?

    I haven’t heard any recent updates on her case except that she has a new Attorney. It seems to have moved to the back burner. Is there anything else we can do to support her or continue to get her message out?

    Did Arizona Board of Nursing review her case? If not, when are they expected to?

  17. Cyndie S RN MS Says:

    I agree about the ANA. I have not been in support of them for many years due to an issue with a nurse in Arkansas and their lack of response regarding the attempt by the International Ladies Garment Worker’s Union’s attempt to unionize nurses at all levels in Arkansas.

    I hate to sound jaded but I am, after 32 years as an RN. I LOVE nursing but I don’t believe the ANA is really about nurisng. Has anyone gotten AJN lately? This month it is 76 pages! The first 9 are ads and the Table of Contents, 9 more ad pages and the 2 page index of advertisers. The list price is $84.00/year. (I won’t be re-upping my subscription) I almost threw it away as a sale circular!

    Folks it is a presidential elections year. The ANA could have very well come out for Ms. Trujillo to get some press. I think in their minds this translates to more memberships/donations which will allow the ANA to take political positions on more issues and perhaps even donate to Super PACs. If I understand this correctly only the ANF (American Nurses Foundation) is a 501c corporation (not-for-profit.) Which makes donations to that arm tax deductible. I believe that allows the main arm to have the ANA PAC http://nursingworld.org/MainMenuCategories/Policy-Advocacy/ANAPAC

    I ask each of you whether you are a member, have ever been a member, or not…has the ANA ever asked for your political opinion for their PAC? I doubt it. This is one of many reasons I left ANA. They DO NOT represent me or most of the nurses I know. They represent themselves and possibly those who can afford to go to conventions all over the US every year.

    Yup-I’m jaded.

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