When I was a young, inexperienced nurse, I quickly learned one lesson: the cliché that Emergency nurses are fabulously assertive, mouthy, in-your-face pitbulls is absolutely true. I don’t mean ED nurses are bitchy or backstabbing eat-their-own-young types, though this was true also, at least for some of them. I mean this: the Emergency department is a ballet of constrained chaos most days, with many competing claims for attention for the physician, the charge nurse, and your colleagues; if your patient is sick, you need to be assertive, walk right up to the physician and say, “Doctor, this patient is sick. You need to come look at him right now.” This, admittedly, takes a considerable amount of confidence and an ego the size of a battleship, if you are a new graduate, but the alternative, i.e. the patient dies, is not considered good nursing practice.
A little later in my nursing career one of those battle-axe nurses we all dislike decided she had an issue with me — which is to say, she was nearly shouting at me in front of every nurse in the department — over a triage record she thought was incomplete. When she finished, I asked her quietly asked her to step in our to step into our psych quiet room. I said her behaviour was unacceptable. I asked her to speak with me privately if she had a concern about my practice. I informed her if she ever tried taking me out again, I would speak to the manager. For that point on, until she left the department, this nurse avoided me like the plague. This was good. I deserved to work in a toxin-free workplace, right? More importantly, my patients deserved a nurse who wasn’t stressed out by harassment.
Somewhat after that, I began this blog. After writing some funny stories about strange patients and some sarcastic stories about irrational physicians I began to realize there was far more potential — and interest, if truth be told, because stupid patients stories on the Intertubes are as common as erectile dysfunction spam — in writing about how all the things I saw in the Emergency department related to larger issues surrounding the nursing profession and health care in general. To advocate, in other words. I think I have done this, in some small modest way.
This is how I see advocacy then, as a nurse: first for our patients (Jennifer Olin has some good elaboration here), then for ourselves personally, then for our profession. Needless to say, I’m a strong advocate for all of these. I believe most nurses are, if they think about it.
This brings me to my point. Whatever your perspective on the case of Amanda Trujillo, you might think the whole controversy would be a great opportunity for a thorough look at some hard issues related to advocacy.
There has been a lot of off-topic criticism directed at supporters of Amanda Trujillo — myself included — for pushing the issue too hard. Mostly, this amounts to personal attacks on her advocates, or that her problems are merely a human resources issue, or that “people” are “tired” about hearing about the case, or that Trujillo is crazy or not credible or both, or that we’re all emotional, or that we’re engaging in bizarre conspiracy theories, or that we’re all drinking the Kool-Aid (because supporting Trujillo is like a cult and/or we’re mindless zombies) or that we all should just sit down and shut up, or that “real” advocates for the profession have advanced degrees and repose in legacy institutions like the American Nurses Association, or that we should trust Banner Health’s judgement (because health care corporations never screw up, I suppose), or we should wait for the disciplinary process at the Arizona Board of Nursing (because the Board investigates all cases correctly and without bias) or (my favourite) that we shouldn’t be “blowing up the Internet” because that will make things “worse” for Trujillo (God knows how, at this point) or lastly, that we don’t have all the facts. (I stipulate to the last, but I don’t think it’s all that relevant — an arguable point, I guess.)
What I am not hearing from the contras is any sustained discussion about what patient advocacy means in the context of a complex, conflicted health care environment, or what places nurses have in informing patients about treatment options, or how to effectively (and collectively) support nurses working in hostile environments, or what to do when hospital policy conflicts with basic nursing ethics, or what advocacy means for nurses in the age of social media.
What I am not hearing from the critics, to be precise, is why Trujillo was wrong to give her patient information on all treatment options, why Banner Health was right to fire Trujillo for what (at worst) could be construed as a minor practice issue, why nurse managers should always bow to angry physicians, why nurses advocating for patients is bad, why Banner Health reporting Trujillo to the state Board of Nursing — a one line complaint! — was necessary to protect the public from harm, why a group of us — including some blogging heavyweights like Emergiblog and Nurse Ratched — have utterly misplaced our passion in supporting Trujillo, and why, finally it is inappropriate to talk about this all over the Internet.
Instead all we get is a lot of fast talk, bloviation and (deliberate?) misinformation. I once hiked in the Guatemalan rainforest near the Mayan ruins at Tikal and a troop of howler monkeys followed us for a long time, flinging poo all the while. I’m having the same sensation now.
Nurses do to each other online exactly as we do to each other in real life. Fling poo. It’s sad, really, that for all our sophistication about social media and tech, things don’t really ever change.
I get that emotions are running high, on both sides. Even so, is it even possible have a serious conversation about Trujillo and what it means to be a nurse and advocate? Even me, secret Pollyanna I am, is beginning to doubt it.
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Note of Clarification: The Arizona Nurses Association issued this statement on their Facebook page, which I am glad to reproduce: “When AzNA first became aware of this case, Teri Wicker, AzNA President identified a conflict of interest (between AzNA and her employer [Banner Health]) and voluntarily recused herself related to any AzNA discussions or decisions.”