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!

[Lunah, MSN, RN]

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. 

Have you still not read the TBI or CMS reports? If you did, you would see the many steps she took to perpetuate/compound the error that started with her pulling a drug without reading a label.

[klone, MSN, RN]

KalipsoRed21 said:

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. 

Yet, every single one of us here works in that same culture, and with those same systemic issues. And we all still have the time and common sense to LOOK at an unfamiliar vial of medication before reconstituting it, drawing it up, and pushing it into an IV.

[KalipsoRed21, BSN, RN]

Lunah said:

Have you still not read the TBI or CMS reports? If you did, you would see the many steps she took to perpetuate/compound the error that started with her pulling a drug without reading a label.

Yes, I read them. And yes, she missed the 5 rights of administration. I just don't see Vanderbilt's culture and her mistakes as separate as others may.

Per the TBI report:

"Misty Ashby, Unit Manager, advised her not to scan medication, the MAR would note it.”  

So a manager in charge instructed her to hide her error. What this confirms for me is what I suspected, a new grad who has been instructed in poor practice. I just can't see the two as separate. 

[Lunah, MSN, RN]

KalipsoRed21 said:

Yes, I read them. And yes, she missed the 5 rights of administration. I just don't see Vanderbilt's culture and her mistakes as separate as others may.

Per the TBI report:

"Misty Ashby, Unit Manager, advised her not to scan medication, the MAR would note it.”  

So a manager in charge instructed her to hide her error. What this confirms for me is what I suspected, a new grad who has been instructed in poor practice. I just can't see the two as separate. 

She wasn't a new grad. 

[Wuzzie]

KalipsoRed21 said:

Yes, I read them. And yes, she missed the 5 rights of administration. I just don't see Vanderbilt's culture and her mistakes as separate as others may.

Per the TBI report:

"Misty Ashby, Unit Manager, advised her not to scan medication, the MAR would note it.”  

So a manager in charge instructed her to hide her error. What this confirms for me is what I suspected, a new grad who has been instructed in poor practice. I just can't see the two as separate. 

No the manager did not tell her to hide her error!! There was no computer scanning in radiology at the time and she didn't know how to document the administration without it. Her manager told her to document it in the MAR. Also, she didn't just ignore the 5 rights. She also ignored 5 warnings on the Omnicell, pushed the drug too fast and walked away. She also was not a new grad. That's been made clear in all the documentation. 

[subee, MSN, CRNA]

KalipsoRed21 said:

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. 

I understand what you are saying.  Every case has it's own variables that contribute to the consequences for the guilty party.   I thought it was a bad precedent to criminally prosecute her but removing her license for life is, IMHO, commensurate with the severity of her incompetence.  You have to remember that she  also lied on her application for a gun while she was on trial.  See a pattern here?  She never had to serve a prison sentence.  Isn't that enough lenience?  There's no need to sully our profession by letting her back in.

[subee, MSN, CRNA]

subee said:

I understand what you are saying.  Every case has it's own variables that contribute to the consequences for the guilty party.   I thought it was a bad precedent to criminally prosecute her but removing her license for life is, IMHO, commensurate with the severity of her incompetence.  You have to remember that she  also lied on her application for a gun while she was on trial.  See a pattern here?  She never had to serve a prison sentence.  Isn't that enough lenience?  There's no need to sully our profession by letting her back in.

And I will add, what kind of restricted license to you have in mind, is she entitled to?  

[Hoosier_RN, MSN]

KalipsoRed21 said:

What this confirms for me is what I suspected, a new grad who has been instructed in poor practice. I just can't see the two as separate. 

She wasn't a new grad. She was 2 years in, orienting someone. This frankly scares me. The fact that you keep defending her actions as if she was new, and couldn't have possibly known better, shouldn't be held accountable for her actions, is concerning as well

[JKL33]

toomuchbaloney said:

Nah. The hospital's culpability is separate from her criminal negligence. 

I will admit (again) I do believe the order of and reason for events as described by Brandy. I have seen way too much to believe otherwise. 

Still think she should never have a license to practice nursing anywhere ever again.

The BON screwed up massively by not administering proper discipline.

But nothing will ever make me believe that the ultimate (later) series of disciplinary events came about because the universe demands that justice be administered and that things must be made whole. That sounds more like something people would like to believe rather than the way things actually roll. And in fact, if RV's conviction came about because the righteous nature of the universe refused to accept the BON's failure to discipline...if things worked that way--which they don't--then Vanderbilt itself (the hospital) would be nothing but a memory.

[toomuchbaloney]

JKL33 said:

I will admit (again) I do believe the order of and reason for events as described by Brandy. I have seen way too much to believe otherwise. 

Still think she should never have a license to practice nursing anywhere ever again.

The BON screwed up massively by not administering proper discipline.

But nothing will ever make me believe that the ultimate (later) series of disciplinary events came about because the universe demands that justice be administered and that things must be made whole. That sounds more like something people would like to believe rather than the way things actually roll. And in fact, if RV's conviction came about because the righteous nature of the universe refused to accept the BON's failure to discipline...if things worked that way--which they don't--then Vanderbilt itself (the hospital) would be nothing but a memory.

OK

She is the one who broke the rules and killed a patient... she didn't even blame it on being too busy or an unacceptable work load forced upon her.  She just decided to cut all of the corners and ignore the actual patient that she was obligated to observe for response to medication that she chose and gave.  

Sure, the hospital has culpability... it's separate from the actions of the professional.  She fooled the hospital into thinking that she was a skilled nursing professional when in reality she was not.  Does that hospital advance nurses based upon hours worked or quality of work?  

Where did she attend nursing school? Do any of their graduates know how to safely administer IV sedatives or monitor patients for desired effect? 

[JKL33]

toomuchbaloney said:

OK

She is the one who broke the rules and killed a patient... she didn't even blame it on being too busy or an unacceptable work load forced upon her.  She just decided to cut all of the corners and ignore the actual patient that she was obligated to observe for response to medication that she chose and gave.  

Sure, the hospital has culpability... it's separate from the actions of the professional.  She fooled the hospital into thinking that she was a skilled nursing professional when in reality she was not.  Does that hospital advance nurses based upon hours worked or quality of work?  

Where did she attend nursing school? Do any of their graduates know how to safely administer IV sedatives or monitor patients for desired effect? 

My response is solely regarding your dismissal of Brandy's comments regarding the prosecutorial events. I am stating my doubt that Mr. Prosecutor acted with a righteous desire to seek justice.

Although I have re-read Brandy's comment and your reply and now I'm not sure what part of her comment you were saying "nah" to.  My initial reading was that you were dismissing the idea that RV just might have actually been prosecuted to help take some of the heat off of the fact that Vanderbilt covered up Charlene Murphey's death.

[toomuchbaloney]

JKL33 said:

My response is solely regarding your dismissal of Brandy's comments regarding the prosecutorial events. I am stating my doubt that Mr. Prosecutor acted with a righteous desire to seek justice.

Although I have re-read Brandy's comment and your reply and now I'm not sure what part of her comment you were saying "nah" to.  My initial reading was that you were dismissing the idea that RV just might have actually been prosecuted to help take some of the heat off of the fact that Vanderbilt covered up Charlene Murphey's death.

Even if the employer DID throw her under the bus to save themselves...RV did what she did. She was charged, tried and convicted after her patient died directly because of HER professional decisions and actions.