Nurse Charged With Homicide

allnurses Guide · Feb 17, 2019

9 minutes ago, Susie2310 said:
I posted the comment below yesterday on the "Nurses Call The Governor Of Tennessee" thread in reply to another poster:
"You keep making the point that nurses brains are subject to failure because we are humans. By your logic all workers in all types of occupations should never be charged with any crime due to their negligence unless they deliberately intended to cause harm to the public.
Following your logic airline pilots brains are subject to failure at any moment during an 11 hour flight, and the plane could crash if the pilot gets overwhelmed or distracted. Think of all the many, many flights that take place all over the world, just in the course of one day, yet planes aren't crashing all over the place every day. Should we conclude that airline pilots brains function better than nurses brains? Or do airline pilots practice to higher professional standards? Nursing isn't the only profession with a lot of stressors, distractions, and responsibility/accountability.
I just had a licensed electrician work perform some work for me. Should I assume that he/she may be under extraordinary stressors and be unable to perform safely? I never thought that he/she might actually have been incompetent is his/her practice or might make a mistake that would lead to him/her ignoring basic electrical safety procedures. That perhaps he/she might be negligent to the point that I will get electrocuted. Oh, well, I guess I will just put it down to brain failure on his/her part. In which case, what is the point of professional licensure? If a licensed electrician can't perform their job safely why should I bother using his/her services?
Why bother to have any professional standards for any professions at all? Why bother with licensure? If the public can't trust that a licensed professional will be able to perform to industry standards of safety, why should they bother using the services of a licensed professional? Then we don't have professions, because everyone does the job equally incompetently/unsafely.
If you believe that nursing is a unique profession with extraordinary stressors such that nurses are unable to concentrate on their licensed activities to the point that they are unable to perform safely and must excuse themselves due to brain failure when they inadvertently harm or kill patients due to not being able to perform safely, why should anyone have any confidence in nurses ability to perform safe care? Why should the public go to hospitals?
You are saying something quite terrible, that perhaps you don't realize you are saying, and that is that the public shouldn't expect to rely on licensed professionals to meet industry safety standards. You are saying that licensed professionals shouldn't be held criminally liable for failing to meet industry safety standards; that as long as they did not deliberately intend harm they should not face criminal charges and that their lapse of judgement/unsafe performance however caused should not result in criminal charges.
I ask you a question in return, why should the public have confidence in licensed professionals? Why should I receive nursing care from you? Do you see where this goes? If the general public loses confidence that they will receive safe nursing care, do you think you can take for granted that they will continue to come to the facility you work at for their care? Do you think you might lose your job?
Licensed professions rely on the confidence of the general public. The reason licensed professionals get paid is that the general public trust in the standards of the professions and place their trust in the licensed professionals. If you can't provide safe nursing care why should I come to the facility you work at for my care? If a licensed airline pilot can't fly a plane safely, meeting industry safety standards, why should I fly with that airline? If the problem is endemic to the airline industry, why should I fly at all?"

I too had trouble following the logic that nurses suffer inordinately from some kind of brain fatigue/fog that makes them more susceptible to this kind of mistake. If that were true these type of fatal errors would be happening all the time. Nurses are human and make errors just like any other human - it is when that error is egregious and goes unreported in an effort to shield the nurse or the facility from the consequences that it rises to criminal activity. In the years I have been a nurse I have worked with some fantastic, professional rock-star nurses and I have worked with some that I hope would never be my nurse should I get ill and need care.

Many errors not just one took place here. The hospital colluded with the nurse to hide the mistake and later threw that nurse under the bus. Still the nurse by-passed several safety protocols anyone of which could have prevented this tragedy. It was not like she was forced to act quickly in an emergent situation and so the by-pass was necessary. It was simply that she did not care to take the time to make sure she was pulling the right med. If she had even done the three checks of the medication label this patient would likely still be alive today.

Hppy

LilPeanut, MSN, RN, NP · Feb 17, 2019

9 hours ago, Anonymous865 said:
The board didn't meet in Dec. or Jan. The first time they would have met since the DA charged her would have been Feb 13 & 14.

I need to be snarky: well, good thing there are never dangerous nurses in Dec or Jan. That reminds me of that homebirth doc in CA - in the 3-4 months between the start of proceedings and to where his license was given a black mark, another baby died in his care. When they contracted with him, he had an unencumbered license, and it was right before the disciplinary marks and probation were about to start (like days or a week I think) and he did this one last solo delivery and baby died.

Bringing criminal charges though stops her from practicing pretty immediately.

mtnNurse., BSN · Feb 17, 2019

19 hours ago, Wuzzie said:
22 hours ago, mtnNurse. said:
I agree, and I also think that licensed health professionals have a right to be protected from criminal charges when a facility fails to provide safe working environments, safe workloads, and safe work expectations. If the facility had provided all these things that would promote good nursing care, would this nurse have been in helper-nurse role or was she too inexperienced for that? Would there have been a med scanner in radiology (yes, we will never know if she would have chosen to use that scanner had there been one...but just maybe)? Would the dead patient never have been subject to the careless nurse because the patient's primary nurse would not have been overloaded to the extent that she couldn't attend to the patient while in radiology? We could think of lots more of such questions.
So you feel the hospital should test every staff person to make sure they understand basic nursing concepts? Like the 5 rights. Like monitoring patients for adverse reactions when giving IV push meds? Any nursing student knows these things. What if she paid lip-service to them and did her own thing when nobody was watching. There are lots of people who put on a good front but are very different behind closed doors. Perhaps this is just the first time she got caught. Given the sheer number of horrible decisions she made in this single situation it’s a good bet she’s been playing it fast and loose for a long time. Is the hospital supposed to be psychic?

I don't think she purposely skipped the five rights and chose to risk the patient's life by not monitoring, as I've gone over many times. I think the problem is the working environment and unsafe work expectations that are not conducive to keeping the nurse's most important tool (brain) sharpened. I think if her brain had been sharp in those moments, she would not have accidentally killed a patient. I think the facilities actively seek to squeeze as much work as they possibly can out of staff, knowing full well it's not safe for the patients, but doing so anyway to maximize profits. I mean, that seems obvious to me. If they really prioritized patient safety, then the primary nurse of the dead patient wouldn't have had to double up on patients so another nurse could take a lunch break. If they really prioritized patient safety, primary nurse could have cared for her own patient because there wouldn't even be a helper/resource-nurse position because no nurse would be given so many patients to require helper-nurse. I can think of LOTS of scenarios that led the charged nurse to become so mindless (just use your imagination). Again, not an excuse for failing nursing standards of practice, but a reason to not be criminalized. If it takes psychic abilities for the facility to provide safe working environments, safe workloads, and safe work expectations, then sure.

Wuzzie · Feb 17, 2019

9 minutes ago, mtnNurse. said:
I don't think she purposely skipped the five rights and chose to risk the patient's life by not monitoring, as I've gone over many times. I think the problem is the working environment and unsafe work expectations that are not conducive to keeping the nurse's most important tool (brain) sharpened. I think if her brain had been sharp in those moments, she would not have accidentally killed a patient. I think the facilities actively seek to squeeze as much work as they possibly can out of staff, knowing full well it's not safe for the patients, but doing so anyway to maximize profits. I mean, that seems obvious to me. If they really prioritized patient safety, then the primary nurse of the dead patient wouldn't have had to double up on patients so another nurse could take a lunch break. If they really prioritized patient safety, primary nurse could have cared for her own patient because there wouldn't even be a helper/resource-nurse position because no nurse would be given so many patients to require helper-nurse. I can think of LOTS of scenarios that led the charged nurse to become so mindless (just use your imagination). Again, not an excuse for failing nursing standards of practice, but a reason to not be criminalized. If it takes psychic abilities for the facility to provide safe working environments, safe workloads, and safe work expectations, then sure.

I’m beginning to think you don’t really understand how staffing works in critical care units or what the role of a helper nurse is. Having a helper nurse is not indiciative of poor staffing. In fact to be able to have a helper nurse means they had enough staffing to have an extra nurse. Often times things will come up and an ICU nurse needs an extra hand. For instance, she might have two relatively stable patients but one needs to go off the floor. She can’t leave her other patient unattended so the helper nurse might do it for her, which is the case in the event being discussed. It doesn’t matter that she was watching two assignments (which BTW is SOP in most ICU’s unless a patient is super unstable) because she still would have sent her even if she was only watching hers because she couldn’t leave. Or one of her patients takes a turn requiring her attention at the moment so the helper nurse might step in with the other patient to complete some tasks that need done. These are the kind of things the helper nurse does. It in no way means staffing was bad, assignments were overwhelming or that RV was stressed. I’ve been in this role too numerous times to count and while you might have several things to do you triage them and do them one at a time with the care that each task requires. There are thousands of prudent nurses, myself included, who have skipped a step in the medication process and I guarantee you all of us will say we had no reason to, we just didn’t do it and most of us don’t know why. Most of us will also say we have no excuse. But the level of sloppiness in this case rises well above situational blindness, busyness or any other environmental excuse you can put forth. It just does. There were too many missteps, too many lapses of good judgment and too many violations of the standards we have in place in ONE scenario for this to be anything but a nurse accustomed to taking short cuts and being over-confident until it finally caught up to her.

Anonymous865 · Feb 17, 2019

3 hours ago, LilPeanut said:
I need to be snarky: well, good thing there are never dangerous nurses in Dec or Jan. That reminds me of that homebirth doc in CA - in the 3-4 months between the start of proceedings and to where his license was given a black mark, another baby died in his care. When they contracted with him, he had an unencumbered license, and it was right before the disciplinary marks and probation were about to start (like days or a week I think) and he did this one last solo delivery and baby died.
Bringing criminal charges though stops her from practicing pretty immediately.

I am not sure how to feel about the BON.

The law directs the BON to meet quarterly, so meeting in Nov and then in Feb follows the law.

On the other hand the law permits the BON to meet in special sessions if something requires their immediate attention, so they could have met earlier.

The board has an obligation to protect the public.

The board also has an obligation to properly investigate a charge and allow a nurse to present her case before deciding to sanction, suspend, or revoke a license.

The question is was this nurse so great a threat to the public that the board should have suspended her license pending an investigation?

What I find particularly disturbing is that they didn't immediately suspend her license when criminal charges were brought.

JKL33 · Feb 17, 2019

I get why the speed of BON action might be cause for concern, but realistically in this case 11 months were lost due to the cover-up which was under way.

mtnNurse., BSN · Feb 17, 2019

2 hours ago, Wuzzie said:
I’m beginning to think you don’t really understand how staffing works in critical care units or what the role of a helper nurse is. Having a helper nurse is not indiciative of poor staffing. In fact to be able to have a helper nurse means they had enough staffing to have an extra nurse.

I thought she wasn't exclusively helping on ICU floor since she was headed to ED after. So I thought she was a hospital-wide resource-nurse like we had where I worked rather than just for ICU. That's great if there can be a helper-nurse in addition to each nurse not being given more than a safe number of patients; you're right, I just haven't seen a place like that. I'm happy that such a place exists, but from what I've read it doesn't sound like the way others have described that particular hospital.

2 hours ago, Wuzzie said:
It doesn’t matter that she was watching two assignments (which BTW is SOP in most ICU’s unless a patient is super unstable) because she still would have sent her even if she was only watching hers because she couldn’t leave.

I think it does matter. Even if she couldn't go herself to administer the med, she would have had more time and more unused brain to devote to the whole delegated med task and what would become of the patient after the task. We don't know what all miscommunication might have occurred regarding monitoring. Yes, helper-nurse should have monitored despite communication. And yet, we don't know what all failed behind the scenes to lead her to behave the way she did.

2 hours ago, Wuzzie said:
There are thousands of prudent nurses, myself included, who have skipped a step in the medication process and I guarantee you all of us will say we had no reason to, we just didn’t do it and most of us don’t know why. Most of us will also say we have no excuse. But the level of sloppiness in this case rises well above situational blindness, busyness or any other environmental excuse you can put forth. It just does. There were too many missteps, too many lapses of good judgment and too many violations of the standards we have in place in ONE scenario for this to be anything but a nurse accustomed to taking short cuts and being over-confident until it finally caught up to her.

I still think it is a possibility that this nurse was prudent and the unthinkable happened to her that day. I don't think her grab-wrong-med-administer-and-fail-to-monitor mindless rush rises above the level of unintentional blindness (for people who didn't read that article someone posted about that, it's worth a read!). I'm giving the nurse the benefit of the doubt and I can imagine all types of unfortunate circumstances leading up to her failings which led up to an accidental death. As I said before, maybe I can more easily imagine a prudent nurse making the mistakes she did because it's more recent in my mind how overwhelming the first couple years can be in an understaffed hospital. To be clear about what I mean by 'understaffed', I believe any hospital is understaffed if an ICU nurse has to take on more than 1-2 patients (even just to cover for another nurse's lunch break); more than 2-3 patients on step-down; more than 3-4 patients on medsurg. I firmly believe beyond that is risking patients' lives every single day. I can understand if a very experienced nurse claims to safely handle more patients. But if so, I ask those very experienced nurses to also understand that those of us less superhuman (I mean that in a flattering way) and less experienced might be putting patients and ourselves in danger by taking on more than that.

I'll admit I'm surprised and dismayed that you can conclude from all facts known about this case that this must be "a nurse accustomed to taking short cuts and being over-confident until it finally caught up to her." I can't conclude that and hope the courts won't. But we won't convince each other without more facts known.

Editorial Team / Admin · Feb 17, 2019

8 minutes ago, mtnNurse. said:
But we won't convince each other without more facts known.

Which is exactly what a trial will find. We can all sit here and debate whether or not she should be charged; the fact is that the DA has decided there's enough to take that measure.

JKL33 · Feb 17, 2019

11 minutes ago, mtnNurse. said:
I thought she wasn't exclusively helping on ICU floor since she was headed to ED after. So I thought she was a hospital-wide resource-nurse like we had where I worked rather than just for ICU.

Obviously I can't say for certain but it would make sense if the ED patient was going to be admitted up to their unit and they were just getting the swallow eval done ahead of time or if that unit's nurses are the ones who do swallow evals in the ED.

Wuzzie · Feb 17, 2019

41 minutes ago, mtnNurse. said:
I still think it is a possibility that this nurse was prudent and the unthinkable happened to her that day. I don't think her grab-wrong-med-administer-and-fail-to-monitor mindless rush rises above the level of unintentional blindness (for people who didn't read that article someone posted about that, it's worth a read!).

I appreciate your passion, I really do but let’s line up the sequence of events

RV took a verbal order from another nurse-illegal
Did not look at the MAR
Did not know the generic for Versed
Ignored override warning
Overrode using too few letters
Selected first med that came up-either didn’t look or didn’t know the difference
Disregarded bright orange “paralytic” sticker on cubie
Didn’t look at name on vial or didn’t know the difference
Disregarded the warning on the cap
Reconstituted with the wrong solution
Did not label syringes
Did not waste excess
Gave wrong dose-was supposed to be 1mg repeated x1 as needed but she didn’t look at the MAR
Did not assess patient appropriately
Admits she does not know how much she really gave (could be 8mg because syringes weren’t labeled.)

These are not the actions of a normally prudent nurse. There are simply too many missteps for it to be one of those “crap” moments we all have had.

mtnNurse., BSN · Feb 17, 2019

1 hour ago, Rose_Queen said:
1 hour ago, mtnNurse. said:
But we won't convince each other without more facts known.
Which is exactly what a trial will find. We can all sit here and debate whether or not she should be charged; the fact is that the DA has decided there's enough to take that measure.

What a trial will find and decide does not guarantee justice served, as history makes obvious. There could be many purposes for debating: to learn from what happened, to imagine a better world where it couldn't happen, to let the public know how you feel about this nurse being criminalized. So I agree that when we reach a dead-end, e.g. "I think she wasn't aware and thus shouldn't be charged" and "You think she was aware and should be charged", then maybe there's no way to move forward with a conversation that's worth anything. Yes, the DA charged her regardless of how we feel about it. DAs are part of a democracy and as such influenced by public opinion. That also makes debating about whether she should be criminalized worthwhile.

Wuzzie · Feb 17, 2019

I think if even one nurse looks at the things she did wrong, identifies a similarity in their practice and changes it then all this debate is totally worthwhile.

Nurse Charged With Homicide

Should Radonda Vaught, the nurse who gave a lethal dose of Vecuronium to patient at Vanderbilt University Medical Center, be charged with reckless homicide?