The latest edition of the Best In Nurse Blogs-my bi-weekly focus on the best writing by, for, or about Nurses!
Best In Nurse Blogs:
The Nurse Blogosphere has exploded with articles, posts, diatribes, rants, about the pending case of Amanda Trujillo, MSN.
All for one?
The Incident as I understand it:
Ms Trujillo was fired and has been threatened with the loss of her nursing license. She reports she was acting as a patient advocate/educator. The patient in question was scheduled for a liver transplant.
Nurse Trujillo advised the patient that other options besides surgery were available. The patient apparently requested information about hospice care options before having the surgery-and the nurse ordered a hospice consult. This resulted in her firing and subsequent license review/hearing.
The details of her plight have been well documented elsewhere and I dedicate this version of The Best In Nurse Blogs to those writers.
Those Emergency Blues inital post, with an additional video montage from several nurse advocates.
Nurse Keith, the Nurse Coach at Digital Doorway
The Healthcare Team is broken
What I want to discuss today is not the details of this case as the eloquent nurse advocates listed above and many others are better able to do so.
What I want to discuss is the big picture. The big picture which has allowed this event to trigger the spark that has become a wildfire of indignation and resentment.
As sad as this case is, it is just a microcosm of a problem that exists in our current healthcare system.
Our current healthcare system is broken. And the fix (and I’m skeptical of the current misguided attempts) will be complicated and painful.
What can be done?
It will not be fixed until physicians, nurses, techs and hospital administrators get on the same team. Being teammates is not possible when we allow fellow physicians to bully, verbally abuse, berate, belittle, or ignore other members of the healthcare team.
How many times have we seen sports teams with great athletes lose in their chase for a championship? One or two “Stars” behave selfishly and refuse to be a true “teammate”-poisoning the efforts of all the other team members.
In healthcare, losing doesn’t mean losing a game or a championship, it may mean losing a life, needlessly.
Until we start taking the “team” approach seriously and not just give it lip service, we are doomed. The healthcare dollar is shrinking and as administrators struggle with keeping their facilities’ doors open, it is just too easy to appease the Docs who order the tests and admit the patients and drive the income.
Even when those same docs are abusive, egotistical boors.
- There has to be a consequence to those physicians who can’t be civil.
- There has to be a support system and non-judgmental investigative system in place to separate the whining, he said, she said, trivial issues from the truly malignant incidents that shouldn’t be allowed in a modern healthcare facility.
- There has to be a system that enforces accountability when a physician can’t control his temper, yells or screams, throws instruments and loses control. We can’t just (wink, wink) say, “He’s a pain in the ass, but he’s a good surgeon and accounts for 30% of the hospital revenue (wink wink…).
Every nurse, when reading the details surrounding the Trujillo case, concludes the nurse is being abused by the system. That her rights to assist her patient with information, because it was in conflict with the physician, were abrogated.
Nurses believe this happened in this case because they see it happen in their institution, day in and day out.
I’ve seen it at every level of my experience. As a high school student shadowing a physician, as a medical student, as a resident, and it continues even today after 26 years in practice. Doctors continue to abuse nurses and staff members. Sometimes it’s subtle, sometimes it crosses the line to behavior that would be illegal if it occurred elsewhere.
This has to stop.
Reader Questions:
What are your thoughts, not about this incident, but about the big picture? What can be done to improve and develop a collegial healthcare atmosphere? Please, let’s have a constructive dialogue.
{photo credit: dawnmanser c.c.}
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Tags: amanda trujillo case, the amanda trujillo issue and its healthcare implications, the details on the amanda trujillo case
Thanks for discussing this topic. I’ve had people accuse me of “not hearing both sides.” Every single nurse has seen “both sides” in their career.
So really, there are two major stories here. The nursing story, but even more frightening, the story of a patient who nearly underwent a major surgery without knowing what they were doing.
Nurses are tough, we can stand up as a group. Who stands up for the patient?
good points Kim.
Dr. Dean,
Thanks so much for highlighting the Amanda Trujillo case & the larger themes at play. We appreciate your support immensely. Great to meet a fellow HCP with his values so firmly planted in the team- & patient-centered approach to healthcare.
I agree that healthcare in this country is broken, and that fixing it will require a whole new paradigm of how we view healthcare, of how healthcare providers view themselves, and an overhaul of the entire system, not just the payment system.
Working in healthcare for almost 15 years now, I’ve dealt with all sorts of MDs, and I’ve learned to stand up for myself to them. It makes me mad to see them bullying administrators and nurses, but when it comes to patients, I can’t believe it. Don’t they remember their oath? I believe it starts with “First, do no harm…”
Good points, unfortunately there are difficult people in every profession.
I should also mentioned that I have worked with some absolutely wonderful MDs.
You are right, there are difficult people in all professions. And there are great people in all professions.
Thank you Dr. Dean for not letting us forget there’s no “I” in team.
We can, we have, we must work together. We must sometimes carry a larger portion of the load (yes, nurses AND physicians often get to do this), but we still have to work together.
No doubt, that is my point. There will always be tension in every organization, but our personal pride has to come after the well being of the patient.
Since I am cancer survivor, in all of this scenario, I am a #patient. But I would not be here were it not for the nurses – or my great doctors for that matter- even the janitor, the committed person that kept my room clean of bacteria & germs.
I love nurses. I love my doctors.
My motto: A doctor is only as good as the person he/she is to begin with. In other words, if a person, no matter where, is greedy for money, power or position – their very soul is corrupt, and nothing good can come from it. A vulnerable patient will never be first in this person’s eyes. The value of life in their eyes is zero.
Great points, I agree completely.
don’t forget in this shrinking economy and even more shrinking healthcare dollar, money remains the root of all evil and dogs will fight to the death over the tiniset scrap of food….jmho
I don’t believe money is good or evil, it is just a tool. The people that lust for it over all things, may be evil.
And there are a lot of really great people out there, don’t let the media’s focus on the negative ruin your life. thanks for commenting
MONEY is not the root of all evil. The LOVE of money is the root of all evil (1Timothy 6:10). And I’m willing to bet that money was a large player in this game for both the physician and the hospital. I am an RN; and while it is true that there are many fine (and not-so-fine) physicians out there (as well as many fine and not-so-fine nurses) I think that clearly, this doctor and hospital are punishing this nurse for doing exactly what she is trained to do and what was well within her scope of practice. I hope that she receives a large enough settlement that the physician and the hospital will think twice before trying to silence good nursing judgment.
I don’t personally know any of the facts surrounding this issue, all I’ve read are the reports in the blogosphere. Many of which were written by people I respect greatly.
Your points regarding the lust of money are very valid, though sad.
I hope justice prevails. Thanks for commenting!.
Thank you so much for helping us highlight this issue.
You are a physician who values nurses and who makes me feel valued for what I do. I can honestly say that I am so grateful to have a the voice of an MD in the blogosphere that is doing such a fantastic job of acknowledging our contributions to healthcare.
Thank you so much for all you do to promote a positive image of nursing.
You have no idea how much this means coming from an MD.
Well said Nerdy Nurse…truly Dr Burke you are one of the good ones for being willing to acknowledge the atmosphere that exists in health care.
I honestly believe that most MDs start out with good intentions, truly it is the system that creates a huge conflict of interest. Procedures pay the bills at home. Patients and nurses who interfere with that can and do face violence and hostility from surgeons and other procedure based MDs who feel the money pressure.
I would bet every nurse with more than a year of experience has a story very similar to Ms Trujillos where they have been silenced for the sake of money. My most memorable experience occurred in Arizona 13 years ago but I was fortunate to work for a very highly regarded private system in the Phoenix area and I was supported 100% by wonderful nurse and physician leaders in the facility. The surgeon had to go to anger management classes and I experienced no adverse consequences.
Thank god for the good ones that are out there…we appreciate you
Thanks Kelly. I appreciate your comments.
Well, Dr. Dean, this post is much appreciated. Healthcare is truly a team effort, even down to the janitor, as a previous comment mentioned.
I’ve heard said that a doc is only as good as the people (nurses, techs, wound care, nutritionist, therapists, etc.) who carry out his orders. While I wouldn’t necessarily go that far in every case, I would mention that there is far too little appreciation from the top down for the people in the trenches that actually care enough to do their jobs well, for the good of the patient.
When people who care are bullied, maligned, put down, and treated as insignificant (or fired and the ability to earn a living put in danger, like Amanda)…they start to ask themselves if the caring is really worth it.
Not only do the patients lose out when this happens, but also the whole healthcare TEAM loses out. Caring is contagious…so is fear.
The question is…what ramifications are falling like dominoes in a row now because of what has happened to Amanda? Whether or not she was in the right or in the wrong due to details we are not yet aware of, the FEAR is there…I see it across the blogosphere…even down to the opposing side, like another doc in the blogosphere calling Amanda an “angel of death.”
And this fear is not just from nurses as nurses, but from the nurses as PATIENTS. The ability of a patient to truly determine his/her own care these days is slowly shrinking here in the USA. From the pending legislation in some states to make certain vaccinations mandatory (e.g. flu vax for HCW, HPV vax/Gardasil for teens) to the ongoing marginalization of alternative healthcare choices by mainstream docs and media (not to mention some of the points of the new healthcare bill)…we as a whole are being herded into choices that we may not want, but the process to opt out of them becomes so onerous and stigmatized that people who are not well-read/educated about available treatments just give up and do whatever their healthcare team tells them to do. BAD idea, even if the prescribed treatment is legit…
And now we come to the case in point…liver transplant candidate who apparently did not understand the current course of action, nor seemed aware of alternative choices. How many times have we, as nurses, been asked by a patient or patient’s family to explain in layman’s terms what the heck is going on? In my own experience, 9 out of 10 patients I’ve cared for in the past 13 years have received detailed education from me…answers to questions that only come out because of the trust and repoire that forms from 12-hour shifts of contact between nurse and patient/family.
We nurses have become used to doctors not providing adequate education to their patients/families, and have attempted to fill the gap time and time again. A lot of docs build walls around themselves, always busy, always impatient, making it difficult for even nurses to approach them with questions, much less call them back to the bedside because the patient has more unanswered questions. We just fill the gap and move on, trying to avoid facing the irritation of a doc (especially a SURGEON…whose title may bring a grimace to the face of any nurse) by suggesting that he/she hasn’t fully educated the patient.
The big picture I see is this: We as a whole in healthcare need to get off our own individual and group “high-horses” and realize that what we see as “best treatments” or best outcomes for our patients may NOT be what that patient sees as their best outcome. We get so used to saving lives and feeling like heroes from that, that we fail to realize that some people may want to die in peace on their own terms, REGARDLESS of the high success rate of treatments, surgeries, or other interventions that may be readily available. Everyone, regardless of educational level, has the right to know all the options…and to receive support from the healthcare team for his/her choice without feeling like they will be written off by the team for not following the “best” options as viewed by the team.
Docs continue to have their sway in this nation…not because of trust, but because of fear. When we cave to fear, we will only continue to see upper level eschelons of healthcare act as gods. When we fight fear, even by proxy through those like Amanda, we are fighting for our own rights as healthcare professionals and people.
Thanks,
Jessica
Thanks for your comments. We can all do a better job of educating patients. And working together as team players will accomplish this much better than either side being on their own or at odds. We just have to keep up a dialogue and support positive change to the system.
“In healthcare, losing doesn’t mean losing a game or a championship, it may mean losing a life, needlessly.”
Agree. Healthcare is not just about the best doctor or the best nurse working, this is all about team effort and teamwork. Without this, the healthcare will come to an end in due time as well as patient’s trust will fail too. Too bad many physicians out there don’t know this.
Thanks for sharing,
Peny@Nurse Up for Nurse Amanda!
[...] is also heartwarming to see support from Dr Dean, the only one I have come across so far. And, the condescending and overbearing tone of another [...]
[...] Network response to post by Dr. Dean’s blog here titled “The Best in Nurse Blogs: Amanda Trujillo Edition!” He asks at the end of his [...]
I have worked in ORs at every nursing level for over 30 years. I applaud Dr. Deans remarks about the pervasiveness of the abuse of nurses by physicians, all too true in my experience. The history of teh relationships between hospitals, nurses and physicians contributes greatly to the present situation. My capsule history of nursing follows:
In the beginning there was the Pennsylvania Hospital in Philadelphia. As with so many other institutions in that city, Benjamin Franklin was one of the founders. There were no trained nurses in those days, just women from the almshouse who worked in return for room and board. The hospital was in effect a family, and these women were the self sacrificing caretakers of that family, doing the housekeeping, laundry, cooking, bathing, etc. The Doctors were of course the head of the hospital family, and enjoyed all the perks and privileges. Remember too, that in those days bathing was believed to not be a healthy thing to do on a regular basis. Medicine itself was full of dangerous treatments such as bleeding and purging and even the use of animal dung and herbs as poultices for wounds. Hospitals were for the “Deserving Poor”, meaning the employed working class. Indigents need not apply. Wealthy people were cared for in the home.
All this began to change with the Crimean war in Europe with Florence Nightingale, and the Civil war in the US with Clara Barton. The need for hygienic conditions became apparent, medicine began to be practiced on a scientific basis, and the need for a more trained workforce was recognized. The nurses now were those women of the working class who had to provide for themselves, and did not qualify as governesses or maids, the other legal occupations open to independent women. They were still seen as the caretakers of the hospital family, and got a meager wage, if any, as well as room and board. All respect and obedience was due to the heads of the family, the Doctors. As medicine advanced, this evolved into an apprenticeship model to train nurses, and the hospital school of nursing became the norm. Every hospital had one. At the same time, Doctors began to look at the practice of medicine as a business, and the hospital as their enterprise. Labor costs need be contained of course, so there was a great incentive to use the apprentices as an unpaid or lowly paid work force, so there was little need to employ the graduates of these programs. They were only there for the good of the family anyway. A few graduates were employed as supervisors. Other graduates worked for the wealthy in their homes on an as-needed basis.
World War Two brought the next significant changes to nursing. Practically overnight, the need for a highly trained workforce of nurses materialized. The military establishment saw the need to regularize this workforce, to give them advanced training, and pay them accordingly, which led to commissioning them as officers. Before this they were just volunteers, with minimal sort of training. However, with the war over, the need shrank, and most of this cohort married and entered civilian life. Hospitals still needed this workforce so the apprentice system expanded and the employment prospects for graduates grew. Graduates staffed the days, apprentices the night shifts and weekends. Nurses were still the caretakers of the hospital, and expected to be totally self sacrificing. Nurses were explicitly excluded from basic labor laws such as Taft-Hartley, minimum wage, overtime, etc. Pay was not good. As recently as the late seventies nurses did not make as much as grocery checkout clerks.
The next significant change was the explosion of technology in medicine. More people were in hospitals for more and more complicated procedures and treatments. Suddenly there was a large shortage of nurses. To further complicate the picture, the organization that accredited nursing schools banned the use of students to staff hospitals. Hospital schools of nursing began to close everywhere. There was no incentive for a hospital to have a school if it was not a source of cheap labor. The nursing shortage grew; wages climbed, and into this milieu entered Anne. (A character in my fiction blog).
How to overcome this history? Hospitals give lip service to “Nurses as Professionals” but the reality is that nurses are a labor force that must be contained and controlled. I have seen hospitals spend millions of dollars fighting a union campaign over issues they could have addressed for a few thousands of dollars. Why? Not the $ but the loss of control and loss of face.
There are some hospitals out there that are doing more than just give lip service to a true team/collaborative approach. I believe that their example will become more prevalent when they become more economically successful than their non collaborative competitors.
Thanks for the thoughtful post, with historical references. I do hope the team approach becomes the norm and becomes successful. I see it beginning to take root. Hopefully we will see it flourish soon. Thanks for stopping by.
[...] Best in Nurse Blogs: Amanda Trujillo Edition [...]
[...] Best in Nurse Blogs: Amanda Trujillo Edition [...]
Hi Dean, remember me? I worked with you on a project with Pratt Bennet. Excellent post. I agree with all that you said. In fact, I published an article on my website in February called, “Nurses and Doctors Work Together to Provide the Best Care.” Many people do not understand what different members of the health care team do. If we all do what we each do best and work together, then we will reach our mutual goal: the highest quality care for our patients.
Thanks for dropping by! Keep in touch!