Nurse Charged With Homicide

[Nurse Beth]

Radonda Vaught, a 35 year old nurse who worked at the University of Vanderbilt University Medical Center, has been indicted on charges of reckless homicide. Read Nurse Gives Lethal Dose of Vecuronium

Radonda is the nurse who mistakenly gave Vecuronium (a paralytic) to a patient instead of Versed. The patient died.

[Nurse compassion]

V is good at throwing nurses under the bus. I worked there once and had an unfortunate episode. I ALMOST gave a patient wrong medication. I realized my mistake and did not administer the meds. It scared me so bad, I confessed my almost mistake to the charge nurse who reported it to administration. I did override the system to scan the meds but upon realizing my mistake I corrected the mistake, administered the medication correctly and nothing happened. I was fired and my license has permanently been reprimanded. I am forever followed by an almost mistake. I told my supervisors about other problems I was having such as: not being able to return narcotics in a timely manner and not understanding how to do it when the medicine is removed from the screen. They had just changed to Epic software and this confused me. I received no sympathy, and no further instructions. Just fired. My supervisors talked to me worse than anyone has ever talked to me. All they were concerned with was the override, that almost caused a mistake. I still haven’t found the courage to apply for another nursing position. The devastation to me that their actions caused is irreparable. To say that I have compassion for this woman is an understatement. I have the utmost respect for her. I would love to give her a hug and let her know I understand. Because I do. I didn’t have a patient to die but the situations are the same. Find out what was going on with her. V needs to understand, nurses are human too. There is such an environment of doing things quickly and being timely that the whole setup is designed to cause failure. My dream was always to work at V but after seeing how they treat their nurses I am surprised any nurse would want to work there. Their purpose is not to evaluate their process and improve it to help their nurses. Their mishandling of this situation is total proof of that. Administration needs to wake up. Nurses are humans too.

[Wuzzie]

21 minutes ago, missdebrafifi said:

We set a dangerous precedent being supportive of homicide charges for this case for all nurses. We make nurses the hospital scapegoat for a tragic incident. They wonder why most RNs get out of nursing the first five years? Things like this.

How exactly is she being made a scapegoat? She was the one who screwed up...egregiously. She bypassed three separate warnings, two on the Accudose and one on the vial itself. She didn’t look at the vial she pulled. She apparently, though as a previous ICU nurse I cannot fathom this, was unfamiliar with Versed. Versed does not need reconstituted...ever. She administered a drug she was unfamiliar with, or thought she did. She isn’t even sure how much she actually administered. She didn’t do the minimal monitoring for IV drug administration of any sort. She did not follow the 5 rights. The unit was clearly not understaffed as they had enough nurses to actually staff a resource nurse. So how exactly does the hospital bear the majority of the blame? This was an ICU RN with 2 years of experience and an advanced certification. She likely had leadership qualities because nurses who are dim bulbs rarely act as resource nurses. Too bad her persona masked her deficiencies.

I’ve been doing this a long time and haven’t seen nurses fleeing the profession in any great numbers. Do you have a source for your statement? I believe that nurses leave the bedside because it’s harder than most expect, the hours aren’t great when you’re new and the pay is acceptable but not what most expect for the type of work we do with limited recourse unless you want to work tons of overtime.

[Horseshoe, BSN, RN]

6 minutes ago, Wuzzie said:

I’ve been doing this a long time and haven’t seen nurses fleeing the profession in any great numbers. Do you have a source for your statement? I believe that nurses leave the bedside because it’s harder than most expect, the hours aren’t great when you’re new and the pay is acceptable but not what most expect for the type of work we do with limited recourse unless you want to work tons of overtime.

I hear this often, and would also like to know if it's true. I've been hearing that EXPERIENCED nurses are leaving the profession, and one of the most common reasons is that the nurse to patient ratio continues to increase. I really think this is the main reason nurses become burned out. I don't think it's about money or the hours or the benefits or anything along those lines. If the ratio was such that nurses felt they could do their best and didn't worry so much about making a mistake due to being hurried and overburdened, I think retention rates would improve dramatically. In ICU, it's easy to forget about the ratio problems other nurses are being saddled with, but I'm hearing that even ICU nurses are being tripled, and in some rare cases, quadrupled when management "can't find someone to come in."When I worked ICU, that 2:1 ratio was never EVER messed with. If they couldn't find anyone to come in, they got an agency nurse-absolutely without fail. To hear now that the suits no longer consider ICU acuity when staffing just tells me how bad it must be on the floors.

[Wuzzie]

14 minutes ago, Nurse compassion said:

V is good at throwing nurses under the bus. I worked there once and had an unfortunate episode. I ALMOST gave a patient wrong medication. I realized my mistake and did not administer the meds.

Not knowing, and not asking, for details I won’t comment on what happened to you other than to say that you acted as a prudent nurse because you did your checks and discovered your mistake. I think near misses are the most important errors to report and when reported should have the fewest repercussions. Had this nurse overrode and pulled the medication, looked at the vial, realized her mistake and had a “holy crap I could have killed a patient” moment our discussion would be very, very different. I’d wager a guess we would all be supportive of the nurse. I know I would be.

I’m so very sorry you are going through this. I’m sure it’s been awful. Hopefully you are getting the help you need to heal and are surrounded by people who love you. ?

[Wuzzie]

6 minutes ago, Horseshoe said:

I hear this often, and would also like to know if it's true. I've been hearing that EXPERIENCED nurses are leaving the profession, and one of the most common reasons is that the nurse to patient ratio continues to increase. I really think this is the main reason nurses become burned out. I don't think it's about money or the hours or the benefits or anything along those lines. If the ratio was such that nurses felt they could do their best and didn't worry so much about making a mistake due to being hurried and overburdened, I think retention rates would improve dramatically. In ICU, it's easy to forget about the ratio problems other nurses are being saddled with, but I'm hearing that even ICU nurses are being tripled, and in some rare cases, quadrupled when management "can't find someone to come in."When I worked ICU, that 2:1 ratio was never EVER messed with. If they couldn't find anyone to come in, they got an agency nurse-absolutely without fail. To hear now that the suits no longer consider ICU acuity when staffing just tells me how bad it must be on the floors.

I guess I should have been more specific because I agree that ridiculous patient loads are part of it being hard. I don’t agree that nurses are fleeing because of med errors and fear of retribution. I think the situation we are discussing is an outlier. Certainly there are hundreds if not more med errors being made yearly but I would have to believe that most don’t rise to the level that this one does.

[DVB, BSN, RN]

How we set a dangerous precedent is saying if a RN has a medication error it is homicide. Would it then be hard to say "If an RN didn't check on the patient every 20 minutes and they expired, it's homicide". This is what I am talking about. It sets a criminal precedent for allowing the RN to be charged for a homicide for a medication error. Yes she did bypass the override, it is wrong to do such. However; why does the hospital allow an override? This makes the hospital liable also. My current hospital does not allow an RN to access Vec. Why is there an override available for an RN to access a paralytic? I am not allowed to access paralytics. So how is the hospital not responsible for this portion? Yes the nurse was negligent in pharmacology and apparently stupid to not understand what she was giving and doing it anyway, was her intention to kill the patient? The very definition of homicide is the deliberate and unlawful killing of one person by another. She has to prove that she didn’t mean to kill the person? This is why it makes it dangerous for us if she is charged and found guilty, anything can be considered homicide.

22 minutes ago, Wuzzie said:

I’ve been doing this a long time and haven’t seen nurses fleeing the profession in any great numbers. Do you have a source for your statement? I believe that nurses leave the bedside because it’s harder than most expect, the hours aren’t great when you’re new and the pay is acceptable but not what most expect for the type of work we do with limited recourse unless you want to work tons of overtime.

First, I do believe this to be true, as I preceptor as part of my duty. I also agree with your reasons why nurses leave the bedside. I do know the RN's are scared, older RNs are scared to practice and younger RN's. At every turn joint commission, board of nursing and administration is chipping away at autonomy to practice. How many travelers do you have? How many people graduate in your area and work? Yes I agree some are the fact that it isn't what school portrayed, but I have been questioning nurses for the past 20 years. I also have questioned why they stay. I love what I do and try to help others love what they do, but administration and joint commission taking away our abilities to practice is definitely a problem. I don't work with limited resources, I work for an organization that is staffed rather well currently, however; we have RN's leave all the time. If we add homicide to a medication error, how long will we keep them?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762080/

https://nurse.org/articles/reasons-nurses-leave-profession/

https://www.registerednursing.org/why-new-nurses-leaving-profession/

[Workitinurfava, BSN, RN]

10 minutes ago, missdebrafifi said:

How we set a dangerous precedent is saying if a RN has a medication error it is homicide. Would it then be hard to say "If an RN didn't check on the patient every 20 minutes and they expired, it's homicide". This is what I am talking about. It sets a criminal precedent for allowing the RN to be charged for a homicide for a medication error. Yes she did bypass the override, it is wrong to do such. However; why does the hospital allow an override? This makes the hospital liable also. My current hospital does not allow an RN to access Vec. Why is there an override available for an RN to access a paralytic? I am not allowed to access paralytics. So how is the hospital not responsible for this portion? Yes the nurse was negligent in pharmacology and apparently stupid to not understand what she was giving and doing it anyway, was her intention to kill the patient? The very definition of homicide is the deliberate and unlawful killing of one person by another. She has to prove that she didn’t mean to kill the person? This is why it makes it dangerous for us if she is charged and found guilty, anything can be considered homicide.

First, I do believe this to be true, as I preceptor as part of my duty. I also agree with your reasons why nurses leave the bedside. I do know the RN's are scared, older RNs are scared to practice and younger RN's. At every turn joint commission, board of nursing and administration is chipping away at autonomy to practice. How many travelers do you have? How many people graduate in your area and work? Yes I agree some are the fact that it isn't what school portrayed, but I have been questioning nurses for the past 20 years. I also have questioned why they stay. I love what I do and try to help others love what they do, but administration and joint commission taking away our abilities to practice is definitely a problem. I don't work with limited resources, I work for an organization that is staffed rather well currently, however; we have RN's leave all the time. If we add homicide to a medication error, how long will we keep them?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762080/

https://nurse.org/articles/reasons-nurses-leave-profession/

https://www.registerednursing.org/why-new-nurses-leaving-profession/

This........

[Wuzzie]

10 minutes ago, missdebrafifi said:

How we set a dangerous precedent is saying if a RN has a medication error it is homicide. Would it then be hard to say "If an RN didn't check on the patient every 20 minutes and they expired, it's homicide". This is what I am talking about. It sets a criminal precedent for allowing the RN to be charged for a homicide for a medication error. Yes she did bypass the override, it is wrong to do such. However; why does the hospital allow an override? This makes the hospital liable also. My current hospital does not allow an RN to access Vec. Why is there an override available for an RN to access a paralytic? I am not allowed to access paralytics. So how is the hospital not responsible for this portion? Yes the nurse was negligent in pharmacology and apparently stupid to not understand what she was giving and doing it anyway, was her intention to kill the patient? The very definition of homicide is the deliberate and unlawful killing of one person by another. She has to prove that she didn’t mean to kill the person? This is why it makes it dangerous for us if she is charged and found guilty, anything can be considered homicide.

She isn’t being charged with murder. Reckless homicide or negligent homicide takes out the “intent” aspect of it. Certainly she did not go to work that day intending to kill someone but by her actions or inaction she did, in fact, cause a death. She had standards by which she was bound and she violated those standards repeatedly. Those standards are in place so things like this don’t happen. We all know why we do the 5 rights. We do it so as not to harm the patient. No one has a moment where they forget why we do them. They just choose not to do them. If they know why but opt not to do them then it is not unreasonable to say that they knew there was a risk involved. That is the very essence of recklessness. This is so much more than a med error and I believe that is why she was indicted. I’ve asked before. Where do we draw the line? How many principles do we have to violate before someone admits that perhaps it really is the fault of the nurse.

As to your second point. Immediate access to paralytics is necessary because they are often used in emergency situations. Having to wait for an order to be entered, then verified and then recognized by whatever machine a facility uses could be the difference in outcome for the patient. For example, there is a 3-5 minute time lag from verification to availability in my enormous, university based facility. Paralytics can be safely administered by nurses who are educated in the drug (it’s usage, it’s risks, required monitoring) have the ability to critically think at an expert level and are excruciatingly aware that each time they administer it the patient’s life is literally in their hands. Every time I have administered a paralytic has been a “butt-pucker” moment for me. Not because of fear but because of the realization of the enormous responsibility I bear.

[TriciaJ, RN]

1 hour ago, Nurse compassion said:

All they were concerned with was the override, that almost caused a mistake.

I don't think anyone is letting Vanderbilt off the hook. You say they used Epic. Sounds like you worked there AFTER the vecuronium incident. Can you see now why they are completely wigged out about overrides?

Hospital admins being what they are, they're not going to cop to their own culpability. They pick one thing to focus on. For Vanderbilt, it's overrides.

[PhyllisMSN, MSN, RN]

4 minutes ago, TriciaJ said:

I don't think anyone is letting Vanderbilt off the hook. You say they used Epic. Sounds like you worked there AFTER the vecuronium incident. Can you see now why they are completely wigged out about overrides?

Hospital admins being what they are, they're not going to cop to their own culpability. They pick one thing to focus on. For Vanderbilt, it's overrides.

CMS came in and did an audit and found that Vanderbilt had many deficiencies and they came them a chance to correct them. The nurse never got that second chance.

[TriciaJ, RN]

1 minute ago, hyllisR said:

CMS came in and did an audit and found that Vanderbilt had many deficiencies and they came them a chance to correct them. The nurse never got that second chance.

I'm not saying they treated the nurse fairly. I certainly don't have a high opinion of Vanderbilt after reading the 57 page report. I'm just saying that for the foreseeable, the word "override" will likely get their knickers in a knot.

[Wuzzie]

You said knickers. ?

Sorry, for some reason I’m getting slap-happy and that made me giggle.