Should RaDonda Vaught Have Her Nursing License Reinstated?

[Nurse Beth]

RaDonda Vaught Seeking Reinstatement of Nursing License

TN state nursing board's 2021 decision to revoke her nursing license will be appealed in court on Tuesday, March 28. If the appeal is successful, she will face a retrial before the Tennessee Board of Nursing.

Nursing boards generally make decisions regarding the reinstatement of nursing licenses based on various factors, including the nature and severity of an offense, the rehabilitation efforts of the individual, and their ability to practice nursing safely and competently.

If RaDonda Vaught has completed the requirements (if any) and demonstrated that she could meet the standards of safe and competent nursing practice, then it may be possible for her to have her RN license reinstated. However, this decision ultimately rests with the state nursing board.

Background

Most of us recall the RaDonda Vaught case in 2017 because it involved a fatal medication error, and she was charged with reckless homicide for the mistake. The decision to prosecute her made history because it set a precedent for criminalizing medical errors.

On December 26, 2017,  RaDonda Vaught, a 35-year-old RN, worked as a "help-all" nurse at the Nashville, Tennessee-based Vanderbilt University Medical Center. She was sent to Radiology Services to administer VERSED (midazolam) to Charlene Murphey, a 75-year-old woman recovering from a brain injury and scheduled for a PET scan.

Charlene Murphey was experiencing anxiety, and her provider ordered Versed, a sedative,  to help her through the procedure. RaDonda entered the letters "ve" for Versed (the brand name) in the automated dispensing cabinet (ADC) search field.

No matches populated the screen under the patient's profile, so RaDonda used the ADC override function and again entered "ve," this time mistakenly selecting vecuronium.

Vecuronium is a neuromuscular blocking agent, and patients must be mechanically ventilated when administered vecuronium. RaDonda reconstituted the drug and administered what she thought was one mg of Versed.

Unaware of her mistake, RaDonda left the patient unmonitored and went on to her next help-all assignment in the ED to conduct a swallow test.

Charlene Murphey was discovered about 30 minutes later by a transporter who noticed she wasn't breathing. She had sustained an unwitnessed respiratory arrest and was pulseless. She was coded, intubated, and taken back to ICU but was brain-dead and died within twelve hours.

Charges and Convictions

Legal System

On February 4th, 2019, RaDonda was indicted and arrested on charges of reckless criminal homicide and impaired adult abuse.

On May 13, 2022, she was found guilty of criminally negligent homicide and gross neglect of an impaired adult, and sentenced to 3 years of supervised probation.

Board of Nursing

On September 27, 2019, the TN Department of Health (Nursing Board) reversed its previous decision not to pursue discipline against the nurse and charged RaDonda Vaught with:

• unprofessional conduct,
• abandoning or neglecting a patient, and
• failing to document the error.

On July 23, 2021, at the BON disciplinary trial, the Tennessee (TN) Board of Nursing revoked RaDonda Vaught's professional nursing license indefinitely, fined her $3,000, and stipulated that she pay up to $60,000 in prosecution costs. 

Controversial

Many opposed RaDonda Vaught being charged with a crime, including the American Association of Critical Care Nurses (AACN), the Institute of Safe Medicine Practice (ISMP), and the American Nurses Association (ANA).

If nurses fear reporting their errors for fear of criminal charges, it discourages ethical principles of honesty.

But should RaDonda be allowed to practice nursing again?

The (ISMP) felt strongly that revoking her license was a travesty and that the severity of the outcome wrongly influenced the decision. Contributing system errors were minimized, and RaDonda Vaught became the scapegoat, while Vanderbilt escaped full notoriety.

The ISMP said RaDonda displayed human error and at-risk behaviors but not reckless behavior. She did not act with evil intent and is a second victim of a fatal error. In a Just Culture, discipline is not meted out for human error.

Do you think RaDonda Vaught should be allowed to practice nursing again, and why or why not?

Thank you for your thoughts!

[Tweety, BSN, RN]

Nurse Beth said:

I do not absolve RaDonda Vaught by any means.

I also do not absolve Vanderbilt of their actions. 

People telling you that it's two separate issues doesn't make sense because clearly you understand that.   You brought it up because another poster brought it up talking about her being scapegoated.

I'm with most of the others that because she killed someone and was convicted, she should not practice nursing ever again.  

[Tenebrae, BSN, RN]

KalipsoRed21 said:

I think if we can let people with drug addiction problems back into care, then we can find some sort of work for a nurse who made a deadly drug error especially when she behaved ethically by reporting her error.

To be allowed back into practice nurses with substance abuse issues have to go through a long process of remediation including accepting responsibility for their actions and showing what they will do to not make the same mistake

RV has done nothing to show that she has learned from her mistake or what she would do to not make the same mistake again. 

She gave a paralytic medication and walked away without without monitoring, leaving the patient fully conscious and dying and unable to  alert anyone. 

[brandy1017, ASN, RN]

toomuchbaloney said:

I started practicing nursing in 1978. It was not a drug in the tool box at that time.  We were taught to remain at the bedside to observe the patient after administering an IV med... at least 10 minutes to observe for untoward response to rapid acting drugs. 

Did I say that holding Vanderbilt accountable is excusing RVs action actions?  No, I did not.  

I said that Vanderbilt's accountability is separatefrom RVs and is irrelevant to this thread and discussion.  Why do you keep mentioning it in a thread about the nurse's license?  How is Vanderbilt's bad policy related to her desire to have a nursing license? That's what is puzzling. 

The thread isn't about Vanderbilt. Insisting that we talk about Vanderbilt confuses that distinction.  Start another thread about Vanderbilt.  

My irritation comes when people appear to use what Vandy did as a smokescreen to cover up just how egregiously awful a nurse RV is. It's two different issues, marginally related but different. 

The reality is it wasn't until Vanderbilt's omission to CMS and outright lies to the medical examiner were brought to light that Radonda Vought lost her license and then was criminally prosecuted so I think they are entwined!  Radonda did admit what she did from the start and yes, what she did was wrong and would have been avoided if she had looked at the med closely and if she had observed the patient.  But Vanderbilt did not have a up to date computerized pixus that recognized both generic and brand name meds. nor did it have the computer scanning med process that most of the younger, newer nurses have been accustomed to.  Vanderbilt was switching to Epic and there were problems that were causing lots of med overrides and also they were taking their sweet time in having med scanning in the radiology department and didn't even have a policy for Versed monitoring.  All these things are safety features that could have and most likely would have prevented this deadly accident!  
 

As an experienced nurse of almost thirty years I would not have relied on med scanning and of course would have looked at the vial and monitored the patient, most nurses will say the same, but I think newer nurses have become accustomed to relying on the med scanning technology and may not realize the need to monitor a patient if they weren't taught and I believe she had only been a nurse for two years.

I honestly believe if Vanderbilt had been up front in the beginning, she wouldn't have lost her license nor been criminally prosecuted.  But this was done in retaliation after Vanderbilt was exposed for their own criminal, yes I said criminal misconduct!  They are the ones that covered it up purposely and knowingly lying to the medical examiner and paying off the family with an NDA so they couldn't speak up and purposely failing to report this to CMS!  When the truth was exposed and Vanderbilt was threatened with losing Medicare/Medicaid funding Radonda, then in a knee jerk reaction and probably at Vanderbilt's request behind the scenes, had her license pulled and was prosecuted.  Also, the prosecutor worked for Vanderbilt at the same time and even her own attorney gave a donation to the same prosecutor for his reelection!  

I imagine her attempt to get her license reinstated probably is to help pay off all the attorney fees and the prosecution fines did I not read over $60,000!  If she does get her license back, I'm sure it will be with many stipulations just as nurses who have had drug/alcohol or mental health issues face and it will be hard to even find a job.  If she does get her license back I hope and imagine she would look for a non bedside job where she wouldn't have to deal with life and death decisions and giving drugs.  She is probably just looking for a way to pay off all the fines and lawyer fees she is saddled with.

[Susie2310]

Nurse Beth said:

Here's where I stand-

 I believe medication errors should not be prosecuted. Healthcare professionals will then fail to self-report.

I signed in to reply to this.  You keep insisting and promoting that failure to provide the standard of care and failure to practice as a normally prudent nurse, resulting in grossly negligent practice that results in the death/harm of a patient, is an error.

If I fail to follow the 5 Rights of Medication Administration that have been drummed in to me since my first days of nursing school, when I know this is the procedure I am required to follow, I have made a choice, not an error.

I have given this example before; if a plane is preparing for take-off, a time of high risk, just as administering medications is, the person/s in charge of flying the plane safely engage in pre take-off safety checks to ensure the plane may safely take off and fly.  Failure to perform these essential safety checks, especially when death/harm results to people on board the plane due to this failure, would appropriately result in severe consequences for those whose responsibility it was to fly the plane safely.  Whether their failure to perform the safety checks was due to forgetting to do the safety checks, not bothering to do them, or being distracted, negligent behavior has taken place as a very large level of responsibility and accountability is involved in operating a place safely.  It is the same in nursing/medicine/health care.

If healthcare professionals will fail to self-report errors that can/will harm patients in order to avoid the personal consequences for themselves of being prosecuted, then new methods need to be instituted in order to hold health care professionals accountable.  I don't think this would be too difficult to do.

[toomuchbaloney]

brandy1017 said:

The reality is it wasn't until Vanderbilt's omission to CMS and outright lies to the medical examiner were brought to light that Radonda Vought lost her license and then was criminally prosecuted so I think they are entwined!  Radonda did admit what she did from the start and yes, what she did was wrong and would have been avoided if she had looked at the med closely and if she had observed the patient.  But Vanderbilt did not have a up to date computerized pixus that recognized both generic and brand name meds. nor did it have the computer scanning med process that most of the younger, newer nurses have been accustomed to.  Vanderbilt was switching to Epic and there were problems that were causing lots of med overrides and also they were taking their sweet time in having med scanning in the radiology department and didn't even have a policy for Versed monitoring.  All these things are safety features that could have and most likely would have prevented this deadly accident!  

As an experienced nurse of almost thirty years I would not have relied on med scanning and of course would have looked at the vial and monitored the patient, most nurses will say the same, but I think newer nurses have become accustomed to relying on the med scanning technology and may not realize the need to monitor a patient if they weren't taught and I believe she had only been a nurse for two years.

I honestly believe if Vanderbilt had been up front in the beginning, she wouldn't have lost her license nor been criminally prosecuted.  But this was done in retaliation after Vanderbilt was exposed for their own criminal, yes I said criminal misconduct!  They are the ones that covered it up purposely and knowingly lying to the medical examiner and paying off the family with an NDA so they couldn't speak up and purposely failing to report this to CMS!  When the truth was exposed and Vanderbilt was threatened with losing Medicare/Medicaid funding Radonda, then in a knee jerk reaction and probably at Vanderbilt's request behind the scenes, had her license pulled and was prosecuted.  Also, the prosecutor worked for Vanderbilt at the same time and even her own attorney gave a donation to the same prosecutor for his reelection!  

I imagine her attempt to get her license reinstated probably is to help pay off all the attorney fees and the prosecution fines did I not read over $60,000!  If she does get her license back, I'm sure it will be with many stipulations just as nurses who have had drug/alcohol or mental health issues face and it will be hard to even find a job.  If she does get her license back I hope and imagine she would look for a non bedside job where she wouldn't have to deal with life and death decisions and giving drugs.  She is probably just looking for a way to pay off all the fines and lawyer fees she is saddled with.

Nah. The hospital's culpability is separate from her criminal negligence.  This should be a wake up call for new nurses who call themselves professionals.  Even if the new nurse's employer has some responsibility to play in the death, they will not step into the fire to save the new nurse from prosecution. Professionals are responsible for their actions, their conduct and their their decision-making. Healthcare is serious business.  

You hope and imagine that she would magically have good judgement about nursing related issues after she saddled herself with these legal expenses? 

[MaxAttack, BSN, RN]

NRSKarenRN said:

Versed is in liquid form in vial; vecuronium is powder, needs to be reconstituted, has RED CAP  with "paralyzing agent" warning statement embossed on it.  RN reconstituted med in Neuro ICU, bagged up supplies then proceeded to PET scan unit to administer drug.  Pulling med out of bag in PET SCAN should have SECOND look at vial seeing paralyzing agent on it and NEED TO ASSESS BREATHING!

Violating so many parts of medication administration, no vote to regain license.  However, legal charge inappropriate as Hospital also at fault for policy issues --ICU pharmacist didn't observe vecuronium override for patient (thought they monitored for such).

All of those reasons are why I'm not up in arms about legal charges. If you're not paying attention while driving and kill someone walking across the street you'll likely get hit with involuntary manslaughter. What she did was easily more negligent than that.

Regarding the override - at the hospitals I've worked at an override is done because pharmacy hasn't verified the medication. Either it's because it's an emergency or because it's a new order and they haven't gotten to it. As much as I like the blame pharmacy for everything I can't blame the them for this one.

[traumaRUs, MSN, APRN]

What has she done to remediate her lack of awareness when administering high risk meds? Has she kept up with current practice?

[brandy1017, ASN, RN]

toomuchbaloney said:

Nah. The hospital's culpability is separate from her criminal negligence.  This should be a wake up call for new nurses who call themselves professionals.  Even if the new nurse's employer has some responsibility to play in the death, they will not step into the fire to save the new nurse from prosecution. Professionals are responsible for their actions, their conduct and their their decision-making. Healthcare is serious business.  

You hope and imagine that she would magically have good judgement about nursing related issues after she saddled herself with these legal expenses? 

Yet the hospital got away with a slap on the wrist, other than a black eye PR wise.  But yes all nurses should know that the hospital will never protect them so they need to carry Liability Insurance, but that doesn't protect you if you are criminally charged.  Also be very cautious, thoughtful in your actions as a nurse, do not rush, do not skip safety measures.

I can't imagine being personally responsible for a patient's death.  I wouldn't be able to go back to nursing due to the fear and guilt.  I can't believe that Radonda hasn't learned, grown and matured after coming to terms with being the cause of her patient's death and being prosecuted and found guilty.  I think only a sociopath would not have guilt, remorse and make amends.

[toomuchbaloney]

brandy1017 said:

Yet the hospital got away with a slap on the wrist, other than a black eye PR wise.  But yes all nurses should know that the hospital will never protect them so they need to carry liability insurance, but that doesn't protect you if you are criminally charged.  Also be very cautious, thoughtful in your actions as a nurse, do not rush, do not skip safety measures.

I can't imagine being personally responsible for a patient's death.  I wouldn't be able to go back to nursing due to the fear and guilt.  I can't believe that Radonda hasn't learned, grown and matured after coming to terms with being the cause of her patient's death and being prosecuted and found guilty.  I think only a sociopath would not have guilt, remorse and make amends.  

What the hospital got away with is irrelevant to the nurse's criminal accountability.  

There is no evidence that she's learned or grown or matured, is there?  Sociopaths aren't that uncommon...3% of the general population. 

[Susie2310]

Susie2310 said:

If healthcare professionals will fail to self-report errors that can/will harm patients in order to avoid the personal consequences for themselves of being prosecuted, then new methods need to be instituted in order to hold health care professionals accountable.  I don't think this would be too difficult to do.

I want to clarify that I am not saying that I believe healthcare professionals shouldn't face prosecution for their gross or criminal negligence that results in harm/death to patients.  I'm saying that if the expectation or apparent reality is that healthcare professionals, in order to avoid the possibility of prosecution, will choose not to self-report their errors/poor choices in providing care that result in patients receiving the wrong care/care that is below the standard of care, then I believe the health care industry/health care facilities should utilize other methods to track errors/poor choices made by healthcare professionals, for the purpose of patient safety. I don't think this would be too difficult to do, and I can even think of some suggestions.

[KalipsoRed21, BSN, RN]

Accountability and culture....really that is what makes this difficult. Because some of you see RV actions as her's alone and some of us see her error as a byproduct of the systemic issues in healthcare. Issues that ultimately fall on the neck of licensed caregivers, the people who have the most accountability but the smallest say in how their work is preformed. And you may want to sit there and say we all have free will yadda yadda yadda, but when your livelihood and that of your family's is dependent on the paycheck provided; well "free will" is a myth. 

Deadly medical error and deadly police shootings share this complicated accountability issue. 
 

So with policing I think we can all safely say that a cop like the one who murdered George Floyd is obviously malicious and unethical. That cop showed a blatant disregard for George Floyd's life, his responsibility to protect it, chose to use his power to force his will and tried to use his position as a cover up to do what he wanted. I guess I just feel in George Floyd's case the onus of murder was clearly on the officer who killed him.

Other cases, like Tamir Rice or Breonna Taylor, I feel those officers were wrong in what they did but as a byproduct of a broken system. And instead of massive sweeping practice, policy, and training reforms to ensure that these incidences NEVER happen again, we get pulled into debate about personal accountability.  In these incidences, from what I've read, these officers have shown poor judgment, but were supported in their poor judgment by a broken system. It is like who was first the Chicken or the Egg. And when that sort of situation presents its self to me I tend to hold the system at greater fault than the person. Who needs to be held accountable? The people with the most power, privilege, and profit...and that is rarely the middle class worker. 
And because I don't see RV's error as her's alone, I am more inclined to say she should be able to practice on a restricted license. 

[Hoosier_RN, MSN]

KalipsoRed21 said:

And because I don't see RV's error as her's alone, I am more inclined to say she should be able to practice on a restricted license. 

Her actions, and the hospital's actions are 2 separate issues. By her own admission, she blew right by the 5 rights, the 5 rights that are basic nursing. I wouldn't want her caring for my worst enemy, much less a beloved family member, on any level of license. Her blatant disregard killed someone. When her mistake was at first pointed out, she basically shrugged it off (her own admission), and only reported it because her charge nurse was going to, and others knew as well (again, her own admission). In her statement and testimony, she was well rested, had no patient group-only an orientee, and was a resource nurse for her unit. Very concerning,  because it means she had those extra moments to review the label, etc, she wasn't running back to continue a med pass or provide patient care. 

The hospital is another story, they deserve well more than what they got. But at no time did they force her to choose the incorrect medication, or administer it, or walk away from someone incompacitated, or be nonchalant about the med administration, or any subsequent actions thereafter (lying on a gun application). As a professional adult, that's all on her. Her wanting her nursing license back is really a slap in the face to those who do the right thing everyday, and to those who actually understand the consequences they face when they don't do the right thing