By John Ballard
This short post has a very long comments thread regarding the challenges nurses face informing patients when what they share may conflict with what the doctor has in mind.
All readers, not only medical professionals, will benefit from this narrative. It is especially significant that the nurse herself participates in the comments discussion.
For the past month, the case of Amanda Trujillo has resonated deeply among nurses, triggering an avalanche of postings on Facebook, Twitter and in the nursing blogosphere. Trujillo is the Arizona nurse who was fired in April 2011 after providing education and making a hospice care consult request for an end-stage liver disease patient. This patient was slotted for pre-transplant evaluation and had poor understanding of the disease process and treatment options. Trujillo filled in the gaps for this patient. Trujillo then requested, at the patient�s own wish, a hospice team consult, documented her actions appropriately, and left a note (it was night shift) for the primary physician.
These actions � the education and the hospice team consult � drew the wrath of both the primary physician, who demanded her dismissal and her license, and also her nursing director, who told Trujillo she had �messed up all the doctors� hard work and planning for the surgery.� The patient-requested hospice care consult was cancelled. Trujillo�s employer subsequently fired her, and reported her to the Arizona State Board of Nursing for exceeding nursing scope of practice, though in fact, nurses previously had ordered a hospice care consult without consequence. In short, many nurses believe Trujillo was fired for educating and advocating for her patient.
These are the bare bones of the story. Further details can be found on WhiteCoat�s Call Room and on Nurse Up for Amanda Trujillo. [Brace yourself before looking here. It's very impressive.] The debate among nurses � sometimes heated � has common themes around the limits of nursing practice, the meaning of nursing advocacy, and how nurses in trouble are left high and dry by the professional organizations that purport to represent them. Well and good. But why should physicians care?
Don't skip this one altogether.
It's okay to skim along til you get the gist of the arguments (there are hundreds), but do not neglect thinking about the issue.
This discussion has as much to do with you and I as patients as with the professionals to whom we look for our medical needs. We owe it to ourselves and them to be informed.