Arizona is Where Educating Patients is Bad, Bad, Bad: An Amanda Trujillo Update

Just a few words about Amanda Trujillo.  Jennifer Olin at RNCentral.com has detailed at the latest twists and turns of her case. I won’t repeat everything, but I want to comment instead on the Arizona State Board of Nursing’s latest action. The BoN has added a further charge that Trujillo has misrepresented herself as “an end of life” specialist because she counselled and educated patients about end of life care, using the materials provided by her employer, Banner Health.

This is pretty outrageous, and I think, an abuse of process. Let me elaborate from my point of view as an Emergency department nurse. In the course of any shift I may give advice and education on:

• wound care and dressing changes — but I am not a nurse specialist on wound care and dressings

• casts and splints — but I am not a specialist in orthopaedic nursing

• diet for cases of gastroenteritis — but I am not a dietitian

• prescriptions — but I am not a pharmacist

• preparation for diagnostic imaging — but I am not a radiography tech

• advise first time pregnancies on the benefits of breastfeeding — but I am not a lactation nurse

• head injury routine — but I am not a nurse specialist in neurology

• treatment of fever in children — but I am not a paeds nurse

Now according to the Arizona State Board of Nursing, I am representing myself as a specialist in all of these areas, and probably a few score more that I haven’t listed. By the considered, professional judgement of the nursing leadership inhabiting the halls of the Arizona State Board of Nursing, I should just shut up, because I am clearly qualified to do squat.

The Arizona State Board of Nursing evidently believes nurses educating patients on anything is beyond their scope of practice. And by extension, nurses educating patients puts patients in danger.

Ridiculous?

Absolutely. And this is why this latest charge is a trumped-up nonsense. Nursing as a profession would cease to exist in Arizona if nurses had to meet the stringent requirements the BoN now apparently requires, if nurses need some sort of official certification as “specialist” before providing education of any sort. The “position” now put forward by the Board of Nursing is contradicts widely accepted nursing practice. Providing health teaching is the standard of care around the world. This is what nurses do. In my jurisdiction, you can be disciplined for not providing appropriate education.

Jennifer Olin puts it this way:

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.

Exactly. This is what we know as nurses. We educate. To claim otherwise is to run against the experience and practice of millions of fully qualified and competent nurses. The Arizona Board of Nursing knows this too. They are nurses, after all. You can only conclude the Board is grasping at straws at this point, hoping to harass or intimidate Trujillo into submission.

The next step is an evidentiary hearing, for which the Board of Nursing has not yet set a date. As of next month it will be a year since this business started. The wheels of justice grind slowly, it’s said. Let’s just hope they grind as finely as advertised.

One more note: I spoke at length with Amanda yesterday, and she is very well and in good spirits. Her lawyer has asked her not to comment publicly further on her case, so I can’t relay what she told me. However, I will say the story grows more convoluted by the day and there is far more going on than can be publicly mentioned. So stay tuned!