As Ms. Trujillo was assessing a patient she found that the patient didn't seem to fully understand what she had consented to when (pt) agreed to go forward with an intensive transplant evaluation scheduled to begin at (facility) the following day.
Based on this knowledge, Ms. Trujillo gathered patient education materials and spoke with the patient regarding the transplant evaluation, the waiting period and the commitment needed in following a lifelong self-care regimen. After their discussion, the patient expressed a desire to learn more about hospice care because (pt) was uncertain she was willing to take the necessary steps to maintain a successful organ transplant. Thus, the patient inquired into whether (pt) could speak with a hospice representative.
Ms. Trujillo then placed an “order” for a case management consult with a hospice representative. As a result of the additional information given by Ms. Trujillo, the patient determined (pt) did not want to go through with the liver transplant evaluation or resulting transplant procedure.
When the doctor treating the patient found out about the patient’s wishes to forgo the evaluation he was unhappy that the patient had changed (pts) mind and determined that the education given by Ms. Trujillo was the underlying cause of the patient’s change of heart. He accused her of going beyond her scope of practice by entering a physician order without permission (writing the referral for the case management consultation). As a result of the accusation, Ms. Trujillo was placed on administrative leave by her nursing director, and was eventually terminated by (facility). Ms. Trujillo was then reported to the Arizona State Board of Nursing and her license was placed in a “under investigation” status.
The fact is, when a patient requests more information from a nurse, that nurse is bound to give them that information. When this brings about a request by the patient to receive further counseling, the patient is not required to seek permission from a physician, via a nurse requesting a physicians order. This is a basic patient right and Ms. Trujillo was well within her scope of practice. However, as a result of the physician's demands Ms. Trujillo has been terminated from her employment and her licensed status has been placed “under investigation” by the Arizona State Board of Nursing rendering her unemployable as a nurse.
This case not only threatens a nurses' responsibility to educate and advocate for his/her patients, but also threatens a patient's right to know and right to self-determination. While the actual reasons for Ms. Trujillo's persecution by first the physician involved, her employer and then the Arizona State Board of Nursing are elusive, we ask that the investigation be dropped on the basis of their having no merit. This ordeal has caused the unjust hardship and treatment of Ms. Trujillo and her family, and again, sets a dangerous precedent regarding patient rights. Please clear the “under investigation” status on Ms. Trujillo's license allowing this professional to return to her work, caring and advocating for patients.
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