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.

[johsonmichelle]

25 minutes ago, TriciaJ said:

I have a hard time believing any circumstance could make "the most prudent nurse in the world" type in V-E and grab the first thing that came up. That is the part that I will never get my head around. We've all had experience with look-alike and sound-alike drugs. But a warning popped up on the Pyxis; there was a warning on the vial cap. It needed to be reconstituted. She used the wrong thing to reconstitute. And there was a second RN with her, because she was precepting.

I agree with the others; I want to hear the perspective of the orientee.

The nurse was considered to be prudent nurse by her facility since they made her a resource nurse and also a preceptor.I agree with you on the last part that we need to hear from the orientee because somethings does not seem right.

[JadedCPN, BSN, RN]

6 minutes ago, johsonmichelle said:

The nurse was considered to be prudent nurse by her facility since they made her a resource nurse and also a preceptor.I agree with you on the last part that we need to hear from the orientee because somethings does not seem right.

I can't completely agree with this logic. There are way too many facilities out there that are so focused on the money that you have brand new nurses with a year's experience getting placed in inappropriate roles like charge nurse, precepting, etc. Not saying she definitely wasn't a prudent nurse, simply saying that her being in the role of resource nurse does not automatically imply that she was.

[mtnNurse., BSN]

9 minutes ago, JadedCPN said:

There are way too many facilities out there that are so focused on the money that you have brand new nurses with a year's experience getting placed in inappropriate roles like charge nurse, precepting, etc. Not saying she definitely wasn't a prudent nurse, simply saying that her being in the role of resource nurse does not automatically imply that she was.

That is very true and I saw plenty of it where I worked. I suspect she was not experienced enough to be in that role (two years was likely not enough) and that she was striving to be a "good worker" more than a "good nurse" so went along with it and aimed to please administration. She may or might not have been a prudent nurse on every other day of her job up until that day, no matter how bad she erred that day -- we just don't know.

[Daisy4RN]

18 minutes ago, JadedCPN said:

I can't completely agree with this logic. There are way too many facilities out there that are so focused on the money that you have brand new nurses with a year's experience getting placed in inappropriate roles like charge nurse, precepting, etc. Not saying she definitely wasn't a prudent nurse, simply saying that her being in the role of resource nurse does not automatically imply that she was.

Yes, I have also seen this way too much. A nurse being placed in a position with little to no experience who then thinks that because they are in that position know what they are doing when in fact they do not.

[Sour Lemon]

1 hour ago, mtnNurse. said:

But the resource nurse was for several areas not just that unit, so it seems to me that clearly the unit was understaffed. And if the Neuro-ICU nurse had to double-up on patients so someone could take a lunch break, in my opinion that's never a good idea and means they should've had more staff to avoid that unsafe situation.

Regarding staffing ...I have no idea what their staffing ratios are, but I was assigned to be a "resource" nurse occasionally at my first job. I floated between med/surg (two units), tele (1 unit), and renal (1 unit). Staffing was 1:8 in med surg for an RN. The RN was also assigned an LVN to "cover" who had 8 patients of their own. Renal was 1:8, too. Tele was 1:7.
Most of my given help was in the way of admitting new patients and completing admission assessments/orders. The medications I gave were typically related to immediate comfort and getting the patient settled in so disruption to the nurse receiving the patient was lessened.
There was always a very long line for my services. Staffing was horrible.

[mtnNurse., BSN]

3 minutes ago, Sour Lemon said:

Staffing was 1:8 in med surg for an RN. The RN was also assigned an LVN to "cover" who had 8 patients of their own. Renal was 1:8, too. Tele was 1:7.

God help us. I don't know how a patient didn't die every day with those ratios unless there were a LOT of very experienced super-star nurses working there.

[Daisy4RN]

2 minutes ago, Sour Lemon said:

Regarding staffing ...I have no idea what their staffing ratios are, but I was assigned to be a "resource" nurse occasionally at my first job. I floated between med/surg (two units), tele (1 unit), and renal (1 unit). Staffing was 1:8 in med surg for an RN. The RN was also assigned an LVN to "cover" who had 8 patients of their own. Renal was 1:8, too. Tele was 1:7.
Most of my given help was in the way of admitting new patients and completing admission assessments/orders. The medications I gave were typically related to immediate comfort and getting the patient settled in so disruption to the nurse receiving the patient was lessened.
There was always a very long line for my services. Staffing was horrible.

I was also in a "resource" position much like yours. However, at times they would float me to other areas as well with which I had zero experience. Once I was floated to peds ICU and they wanted me to take a list for 4hrs. Had I not refused who knows what could have happened. They "assured" me that these were easy pts but I still refused (I had no peds or ICU experience at that time). I did stay and just did Vitals etc, but it scared me then and still now about what the next nurse might do (or not do as in to refuse the assignment).

[Sour Lemon]

3 minutes ago, mtnNurse. said:

God help us. I don't know how a patient didn't die every day with those ratios unless there were a LOT of very experienced super-star nurses working there.

People did die, unfortunately ...usually in "failure to rescue" types of situations.

[Sour Lemon]

1 minute ago, Daisy4RN said:

I was also in a "resource" position much like yours. However, at times they would float me to other areas as well with which I had zero experience. Once I was floated to peds ICU and they wanted me to take a list for 4hrs. Had I not refused who knows what could have happened. They "assured" me that these were easy pts but I still refused (I had no peds or ICU experience at that time). I did stay and just did Vitals etc, but it scared me then and still now about what the next nurse might do (or not do as in to refuse the assignment).

I had an employer try to float me to ICU, too ...assuring me I'd be assigned "easy" patients. Refused that, outright.

[Wuzzie]

1 minute ago, Daisy4RN said:

I was also in a "resource" position much like yours. However, at times they would float me to other areas as well with which I had zero experience. Once I was floated to peds ICU and they wanted me to take a list for 4hrs. Had I not refused who knows what could have happened. They "assured" me that these were easy pts but I still refused (I had no peds or ICU experience at that time). I did stay and just did Vitals etc, but it scared me then and still now about what the next nurse might do (or not do as in to refuse the assignment).

I’ve been there too. When we had down time we were often expected to float to busy units to help. They wanted us to give meds. We didn’t want to because we were unfamiliar with most of them but instead of saying no we just looked up each and every one in painstaking detail before we gave it. It took us so long that the floor staff finally asked us to just do vitals and nebs. As licensed nurses we need to know our limitations.

[Corey Narry, MSN, RN, NP]

4 hours ago, Horseshoe said:

Juan, what do you mean by "the dosing instruction convinced me of that plan"? Which "plan" do you mean?

Also, can you clarify what you mean by a "true sedation" procedure, because many states specifically state that it is within the scope of an RN to provide "moderate" sedation. This is specifically distinguished between "deep sedation" and "general anesthesia."

In my state, it would be entirely within an RN's scope of practice to give Versed/fentanyl for a procdure like a colonsocopy, where the patient maintains his airway and can follow simple commands. 1mg Versed with another 1 mg Versed to follow in the event of continued anxiety would have been well within an RN's scope and would not have necessitated the presence of an anesthesia "provider."

I *think* we are saying the same thing; just wanted to clarify.

We are saying the same thing, I think.

Yes, I know RN's can administer moderate sedation during procedures in the ED, endoscopy suites, etc. Those are done with a physician present and ultimately that sedation protocol is the responsibility of the physician or the proceduralist. Like you said, Versed and fentanyl are used. There are more and more places that actually have a CRNA or provider trained in anesthesia in the procedure room because they could use propofol and monitor the patient without having to intubate.

In this case, like you stated, the physician wrote the order for Versed 1 mg x 1 to be followed by another exact same dose if the first one was not enough for anxiety. I think this certainly is within RN scope in a high acuity or monitored unit (ED, ICU, PACU). There usually is some sort of institutional policy and training module that allows RN's in certain units to do this. Typically Versed is restricted for use by RN's outside of those high acuity units.

[Daisy4RN]

2 minutes ago, Wuzzie said:

I’ve been there too. When we had down time we were often expected to float to busy units to help. They wanted us to give meds. We didn’t want to because we were unfamiliar with most of them but instead of saying no we just looked up each and every one in painstaking detail before we gave it. It took us so long that the floor staff finally asked us to just do vitals and nebs. As licensed nurses we need to know our limitations.

"As licensed nurses we need to know our limitations."

Absolutely, I also had an experience similar to this case. Working on the floor and my pt was going down for testing and MD ordered 2mg Ativan IV (small lady with no hx of taking drugs), I told Charge I would not give it without a resource nurse to monitor (since I could not go) and received a lot of flack from both Charge and MD, the situation went up to the NM who "assured" me it would be fine but I still refused and told NM and/or MD if it would be fine then they could give it. Imagine that, they then "found" a resource nurse.