The (Very Public) Case of Amanda Trujillo

State Seal of Arizona.
State Seal of Arizona. (Photo credit: Wikipedia)

The Truth About Nursing had a post yesterday, “Amanda Trujillo: Fired for Educating A Patient?” Briefly, it is reported that in April 2011 the hospital administration where Ms. Trujillo was employed filed a complaint against her with the Arizona Board of Nursing (BON) and also fired her. The firing and BON complaint were allegedly for Ms. Trujillo referring her patient with end-stage liver disease to have a hospice consult—when the patient’s surgeon had already scheduled the patient for a liver transplant. As stated in the Truth About Nursing post, the Arizona BON was scheduled to decide on the case at its meeting at the end of March, but there are no public reports of their decision.

What I find most interesting about this case is the level of social media presence about the issue, and much of it directly from Ms. Trujillo. Unless there is someone posing as her, she appears to weigh in with details about her case on high profile forums such as KevinMD (see guest post by a semi-anonymous ‘J. Doe’, RN. “Why Physicians Should Care About Amanda Trujillo” date unstated). Ms. Trujillo set up an online legal defense fund to help defray the costs of retaining a personal lawyer to assist with her case with the Arizona BON.  A psychiatric nurse who goes by the name Mother Jones and blogs under Nurse Ratched’s Place, has a link to the NurseUp! nursing advocacy website that reports having raised $1,700 in additional support for Amanda Trujillo. Mother Jones speculates in April 25th blog post that the case is headed to the court system, and that this is why there is no public information on the Arizona BON decision. There have been numerous letter-writing campaigns to the Arizona BON and the Arizona Nurses Association, as well as to various state officials and even to the ANA. There were allegations of close ties between the Arizona BON and the hospital which filed a complaint against Ms. Trujillo. There have even been calls to boycott the Arizona tourism industry in protest of the Arizona BON in the their handling of the case of Amanda Trujillo. Maybe boycotting Arizona’s hospitals would have made more sense?

I continue to be dismayed by the lack of understanding by nurses (and the general public) of just how corrupt and inefficient our state-level health professions regulatory system is. It will be interesting to see if higher profile cases such as Amanda Trujillo help bring much needed reform to this system. (see my previous post “Not Just Culture” 11-19-11 for more information on the health professions regulatory system and its relation to nursing and public health.).

More than a few good men needed in nursing

Walt Whitman and his male nurse Fritzenger
Image via Wikipedia

“Bearing the bandages, water and sponge, Straight and swift to my wounded I go…” Walt Whitman “The Wound Dresser” The Civil War Poems

Walt Whitman was a nurse. My students, and especially the male students, always seem surprised by this fact. Whitman stumbled into volunteer nursing during the Civil War as he went looking for his brother wounded in the war. It is difficult to find reliable statistics on such things, but it is likely that male nurses involved in the war were not unusual.

We need more men in nursing. They don’t have to be poets as well, but we need more men. Whenever we discuss the need to increase diversity in nursing, it needs to include gender diversity. This fact is addressed in the IOM Future of Nursing Report. They point out that all other health care professions have achieved approximately equal gender parity. Even among the traditionally male dominated physicians: 50% of MD graduates are women.  And looking outside of health care to another (at least more recently) ‘female dominated profession’—teachers in public schools, 25% of the teachers are male.

What’s wrong with us? Current HRSA statistics are that only 7% of our RN workforce is male, and our schools of nursing only admit 13% male students. A quick and highly unscientific analysis of the undergraduate students I have personally taught in the past 12 months (close to 300), are that only 8% are/have been male. The current “Master Plan for Nursing” in Washington State where I reside and teach, completely leaves out gender under discussion of the need to improve diversity within nursing. Apart from all of the societal issues of gender stereotypes related to nursing, I do think that the ‘old girl’s network’ of leaders in nursing education is hindering an improvement in gender equity. I think that many of the nursing leaders have an unacknowledged bias against men in nursing. I have seen this played out and even stated in classroom settings, in meetings, in reports, and ‘in private/behind closed doors.’ What are they afraid of? I don’t think that it is a coincidence that there does seem to be a strong age correlation, and the older cohort of nursing leaders tend to have a stronger anti-male nurse bias. But given the ‘advanced age’ of our nursing educator workforce throughout the US, this translates to a big problem for making nursing education more gender-neutral.

The American Academy of Men in Nursing (aamn.org) takes on these and related issues—and they are open to women members as well as men. Their 2010 winners of the “Best Nursing Schools for Men” include Duke, Louisiana State, and University of Pennsylvania. I plan to check out what they are doing right.

Truth-tellers and nursing leadership

Truth
Image via Wikipedia

“Tell all the truth but tell it slant–” (Emily Dickenson) I have been re-reading Dickenson’s poem as well as Foucalt’s “Fearless Speech” series of lectures while thinking about the state of truth-telling in nursing leadership. Truth-telling  to me connotes honesty, integrity and courage, which are all essential ingredients of good leadership. Truth-telling in the classical sense involves self-reflection and truth-telling to oneself. There is an art to good truth-telling. I believe that the current nursing leadership in our country has a lot to learn in all of these areas of truth-telling.

First though, just who are nurse leaders? My working definition of “nurse leader” is anyone who is a nurse of some sort who has the power and position, or the power of position to be able to effect change on systems–whether the system is a hospital unit, an entire hospital, some other health-related agency public or private, a public health program, a unit of or an entire school of nursing. Perhaps they are the nurses chosen (by other nurse leaders) to be part of the RWJ Nurse Executive Nurse Fellows Program, or chosen (by other nurse leader/fellows) to be a Fellow of the American Academy of Nursing (FAAN). Do you notice a pattern here at all? The inner circle, the “old girls’ network of nurse leaders chooses who to let into the inner circle. This, of course, is human nature, and nursing is no different in many ways from say, medicine. Except that it is significantly different from medicine in terms of power and prestige–not essential ingredients to truth-telling, but they help in being heard and not being killed in the process.

The Dean of my school of nursing, Marla Salmon, ScD, RN, FAAN recently said that the focus in nurse leadership should not be about increasing the status of nursing as a goal, but rather to have nursing be partners in leading improvements in health care: It’s not just about nursing getting in the door, but it’s what happens when they’re at the table. I like this, but I like thinking about this table not as a sandbox with people (and nurses especially) “playing nice” and not throwing sand in Jimmy’s face–but rather thinking of the table as the Ancient Greek marketplace where truth-telling, open debate and reflection were encouraged.

We do not practice or encourage truth-telling in our profession of nursing. As nurse educators we actively discourage our students from voicing different viewpoints from our own, or from the accepted Cannon of Sacred Nursing. I recently read a document on revising the BSN essentials (e.g.: the most important things we want BSN-prepared RNs to be ‘taught’) and it stated that we should not teach/practice critical thinking “because it is too critical.” And in the practice of nursing it is obvious that nurse leaders shoot the messenger when line staff RNs “speak the truth” about patient safety issues.How is any of this going to change if the existing nurse leaders don’t start modeling more truth-telling in all of it’s ancient connotations?