Nurses are Like Howler Monkeys, Poo and All

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.

***         ***         ***          ***          ***

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.”

[Cross-posted at NurseUp.com]

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  1. #1 by midwest woman on Wednesday 15 February 2012 - 1320

    Beautifully and cleverly written post.
    Unfortunately, the only person who attempted an au contraire was a pompous lap band surgeon
    I have posted some of this discussion to my FB page and have always been surprised at zero comments from my nursing friends (although my Zumba follies posts are quite popular :) )
    It caused me to wonder if it is only a very small albeit noisy blogosphere phenomenon that most nurses either don’t care about or are not aware of. That what certain people think is a dangerous precedent is just a blip on the radar screen for most. Business as usual…move on.
    Or worse, people with a different opinions just view this as much ado about nothing and by presenting an alternate opinion would, god forbid, give the discussion some validity. In other words, if we ignore them, they will go away.
    The one thing I’m beginning to find most disturbing about all of this is after doing a lot of reading on scope of practice, etc. I find the language used to describe what it is or isn’t so non comprehensible that I am now more confused than ever. It’s a banana peel on a slippery slope after an ice storm. No wonder Amanda accidentally stumbled. It’s just non sensical gibberish.

  2. #2 by torontoemerg on Wednesday 15 February 2012 - 1346

    Thanks. But there has been quite a lot of negative commentary — everything I listed has been said on blogs or elsewhere, like on Twitter. I didn’t link it, but maybe I should have. :)

  3. #3 by sallie on Wednesday 15 February 2012 - 1422

    I entirely support each and every RNs responsibility to provide patient education and patient advocacy. I have posted on this blog and other blogs in support of AT and encouraging nursing organizations to reconfirm to the public the RNs duty to the patient including education and advocacy. I have written to the AZBoN and Banner Health in support of AT. I have signed a petition supporting AT. I think the AZBoN needs to stop lallygagging on ATs case and issue a final ruling. I hope everything works out in ATs favor. But and this is a big but, I do at times disagree with the tactics (not overall strategy) employed by AT and Team Amanda (including tweets and blog posts which I consider bullying, juvenile, ill-conceived), as I believe actions of that type weaken her position.

    • #4 by torontoemerg on Wednesday 15 February 2012 - 1554

      Thanks Sallie for this. I agree with you re personal attacks.That being said, there is also room for vigorous debate. I am much less sympathetic to the idea that institutions like Banner Health or the ANA or AzNA need to be treated with kid gloves, especially when their actions (or lack) raise serious questions. To put it another way, in the fight between Trujillo and Banner Health (revenue = $1 bn), Trujillo’s only weapon is publicity.

      Can you give examples of what you considered bullying or juvenile? Just curious — emotions, as I said, are high.

  4. #5 by sallie on Wednesday 15 February 2012 - 1622

    I certainly can give examples, but would prefer you email me to do so. I don’t think it is necessary to call specific attention to the exact (IMO) poor choices in an open forum as that gives ammunition to the anti-AT forces like the institutions you mention. You’ve gotten ANA, AZNA and AJN to respond and you’ve essentially shut down Banner Health’s social media efforts, and last I saw you’ve gotten someone on the AZNA team to say very wonderful things about AT, but again, IMO, Team Amanda needs to just keep hammering away with its talking points not engaging in over-the-top side battles with individuals.

  5. #6 by gregmercer601 on Wednesday 15 February 2012 - 1908

    I commend AZNA re the conflict of interest they noted and its response, but it seems perhaps moot. AZNA’s tacit policy, without intending so I’d assume, is to automatically side with Banner, by giving it a free pass to use the BON complaint system any way it chooses, as it seems. I fail to see how a single Banner-connected individual could shift the scales much further than that. To decline comment on a case in progress – that’s a defensible position, as we lack all the facts, although it shows little professional courtesy to refuse even general support for a colleague.
    But when it comes to the more pertinent COIs, ones that have the potential to unduly shape this and perhaps other Nurses’ fates – to decline comment reflects poorly on you. To show no interest in allegations of corporate abuse of the complaint system – none – reflects poorly, and degrades the very credibility Nurses need you for. Talk of “super heroes” on your staff, PR fluff, will not replace real involvement in public affairs.

  6. #7 by gregmercer601 on Wednesday 15 February 2012 - 1912

    Regarding personal attacks, such happen when passions run high, but we would all do well to take a breath and focus on issues. Whoever stops attacking first contributes the most the the good name and interests of Nurse everywhere.
    Personally, I encourage any and all complaints about anything I write anywhere – I have been wrong often enough before. You can’t help missing with you take so many shots, and mistakes offer far greater learning than successes.

  7. #8 by torontoemerg on Wednesday 15 February 2012 - 1925

    Thanks Greg. You’re exactly on point in both your first and second comment. And I echo the sentiment of the second — I am certainly not above criticism in that regard.

  8. #9 by Caryl J. Carver, RN, BSN on Friday 17 February 2012 - 1224

    Sincerely, I can not comprehend how there is any poo to fling. If there is any Howler Monkey nurse out there not wise enough to understand that the future of Nursing in the US rides on this case; they are the ones who are insane. It is past time Nurses started advocating for Nurses. GODSPEED, Amanda! GODSPEED Nurse Advocates!!

  9. #10 by Jenn Jilks on Tuesday 21 February 2012 - 1140

    Truth is important, progress = happiness, you grow or die. Many are dying, in jobs they don’t like, not working well with others.
    It is important to talk about workplace issues.
    I think, replace the word ‘nurse’ with women in the workforce – I have seen many of these same issues during my career in education.
    I’ve been yelled at in a hallway. I was not the only one – but the only one who spoke out about it.
    You must speak truth to power. I did, and made change. I suffered for it. But it was a price I paid to make things better. My health suffered, but I know that you are making a difference, as are all who speak out. It is the only way to learn and grow.
    Keep up your work!

  10. #11 by http://sterlingkmoe.wordpress.com/2014/06/15/useful-cosmetic-surgery-tips-you-may-not-have-heard on Thursday 03 July 2014 - 1118

    You could definitely see your skills within the article you write.

    The world hopes for more passionate writers such as you who aren’t afraid to mention how they believe.

    All the time go after your heart.

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