March 21st, 2012
By Jennifer Olin, BSN, RN
I have started this blog this way several times in the past. I am an OR nurse. What I don’t usually add here, but do in conversation with other nurses, in job interviews for nursing positions and sometimes even in casual “what do you do?” conversations is say my specialty areas are plastics and head and neck (or ENT). Apparently, if I said this in Arizona I could lose my license.
At yesterday’s Arizona Board of Nursing (AZ BON) Regular Meeting Amanda Trujillo, RN, was on the agenda. She is the nurse we have been talking about for weeks now, who was fired and reported to the BON by her former employer who claims she overstepped her scope of practice—despite evidence to the contrary brought out by the BON’s own investigator.
One part of the reading of the charges brought against Trujillo addresses a concern that she misrepresented herself to the public. This is related to what I said about myself earlier. I am not certified in either plastics or ENT but I have spent the greater part of 10 years in the operating room doing very little else.
These are areas in which I have developed a passion for providing care. I have learned and continue to study and ask questions about these specialties. I read articles and research, I confab with my colleagues and take every teaching moment I can get with the surgeons. And, when one of my coworkers who don’t normally work in one of these areas is assigned to one of our cases or surgeons, I am one of the people they will ask for advice. My knowledge in these areas is acknowledged.
At every interview for every travel position I had over five years the interviewer (usually the OR Nurse Manager) would ask my specialty area and I would respond as above. No one has ever asked it I was certified in that specialty.
This brings me back to Trujillo. “At the meeting today, the BON decided to issue a notice of charges, so Amanda's case will be set for an evidentiary hearing,” reported Chimene Hawes, a supporter of Trujillo's who lives in Phoenix, on Facebook, Tuesday, March 20, 2010. “The board read all the ‘allegations’ in open meeting. They also stated that Amanda is representing to the public that she is an end-of-life specialist, for which she has no certification.”
This just makes no sense. Trujillo may be interested in end-of-life issues, she admitted herself that she had provided such information to patients previous to the one involved in this incident with no objections from physicians or hospital management. In fact, that evening, she even cleared her plan of care with the clinical manager.
This is not claiming to be a certified specialist. We are nurses. We are expected to know quite a bit and, more importantly, how to find information for our clients and ourselves. The information Trujillo provided was pulled straight from the information banks of the hospital’s own computer system.
Who Gives The Orders Here?
The AZ BON is also accusing Trujillo of making requests as if she were a physician. “The board stated that Amanda wrote the order using the doctor’s name, as if the doctor wrote the order,” Hawes said.
Yet, if you read the Investigative Questionnaire answers Trujillo proved to the AZ BON, it says she “entered the ‘order’ with a note stating, ‘per patient request, patient wants to visit with hospice representative for more information.’ In fact, the computer system in place at Webb allows her to click a box that further specifies ‘Nurse Ordered,’ which she did on this occasion.”
According to follow up from Trujillo’s then attorney, “accommodating a patient’s request for a consultation with a hospice case manager does not require a physician’s order. No medication was requested, no equipment was needed, and no procedures were required. A patient simply wanted to speak with an expert regarding her options for comfort care and end of life care…”
He continues, “It is standard knowledge that the Cerner electronic health records system in place at Webb contains a box that states, “Nurse Ordered.” There’s one of the big pieces that is in direct opposition to the BON’s claim. If this were not allowable for nurses to order, that option would not be available to them through the computer system. That’s how our EMR (electronic medical record) systems work.
They Plan a Hearing; Let's Hope They Listen
Hawes also told me the AZ BON is planning an evidentiary hearing for Trujillo. According to USLEGAL.com, “An evidentiary hearing is a formal examination of charges by the receiving of testimony from interested persons, irrespective of whether oaths are administered, and receiving evidence in support or in defense of specific charges which may have been made.
”Where an evidentiary hearing is held, the parties are entitled to know the charges and claims involved, have a right to meet such charges or claims by competent evidence, and the right to be heard by counsel upon the force of evidence put forth and upon the applicable law.”
So, it seems that down the road, since the AZ BON has not yet announced a date, Trujillo will be going before a panel at the BON. It will not be a real court of law but a panel of AZ BON representatives who do have to the power to recommend whether or not Trujillo keeps her license. This story seems to never end.
So, come April it will be year since Trujillo was fired. I believe it is the U.S. Constitution that says we are guaranteed a quick and speedy trial in a court of law. Apparently in a court of nurses this does not apply.
To come full circle, you need to be careful in how you describe yourself. I have always felt very confident in the way my resume is written and how I tell others what I am able to do. Also, know your scope of practice and what your state says is acceptable for self-description, as a nurse or this story could be yours.
We’ll keep you posted on any further developments.