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!

[MaxAttack, BSN, 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. 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. 

While I sort of get where you're trying to go with this I can't for the life of me see a relationship between routine medication administration for someone who's nervous about a scan and a situation where it's literally a possibility of my life or yours involving firearms. It's muddying the waters much more than it already is. 

It's hard to see a systemic issue regarding RV when she purposefully circumvented the system by overriding a medication in a non-urgent situation. It's hard to see this as a culture issue when every single one of us is taught to look at the medications we're pulling and pushing. There are some things that are so egregious that you have to stop and think maybe this person should take responsibility and accountability for their own actions.

The only person who had their "free will" taken away was the person who suffocated fully awake while paralyzed waiting for a scan.

[abbnurse]

Wuzzie said:

Typo, should have read "here" but I didn't see it until it was too late to edit.

Thank you Wuzzie ?

[JKL33]

toomuchbaloney said:

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. 

 

Yes, she was able to be charged and was subsequently convicted because she acted recklessly in her professional role and killed someone. However, I believe her prosecution came about for a few more/other reasons.  That's all. I realize people don't necessarily care since the end result was appropriate. It really makes me uncomfortable though.

[Been there,done that, ASN, 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. 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. 

We are all responsible for our own actions. Just because the Pyxis let her  override to obtain a drug... does not mean she shouldn't have followed the five rights that we all learned in nursing school. You want her to practice on you?

[nursebert, MSN]

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? 

Also she was an ICU nurse!

 

[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. 

"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? Kinda confirms to me that her superiors were not practicing well and she learned her practice from these people. This culture taught her poor nursing practice. And she paid the price. As a nurse that had only been practicing for 2 years, how would she know? Nursing school? Laughable if you ask me.

 

[Wuzzie]

KalipsoRed21 said:

So a manager in charge instructed her to hide her error? 

No, again the instructions were not for her to "hide her error". There was no med scanner in radiology. RV asked her what to do. She told her the med would be reflected in the MAR. It had nothing to do with hiding anything. That doesn't even make sense. 

[toomuchbaloney]

KalipsoRed21 said:

Yes, I read them. 

"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? Kinda confirms to me that her superiors were not practicing well and she learned her practice from these people. This culture taught her poor nursing practice. And she paid the price. As a nurse that had only been practicing for 2 years, how would she know? Nursing school? Laughable if you ask me.

 

Are you implying that nursing school does not teach nursing students how to safely administer intravenous medications or does not teach them that they should observe the patient for response to medication? Or are you saying that nursing school doesn't teach the student to read the medication label before they administer the drug? 

[MaxAttack, BSN, RN]

toomuchbaloney said:

Are you implying that nursing school does not teach nursing students how to safely administer intravenous medications or does not teach them that they should observe the patient for response to medication? Or are you saying that nursing school doesn't teach the student to read the medication label before they administer the drug? 

No, just that it doesn't count if it doesn't sound the way we want it to to excuse mistakes that result in death. I mean she was only two years in. Most nurses don't learn to read medications until at least five years.

[Hoosier_RN, MSN]

KalipsoRed21 said:

Yes, I read them. 

"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? Kinda confirms to me that her superiors were not practicing well and she learned her practice from these people. This culture taught her poor nursing practice. And she paid the price. As a nurse that had only been practicing for 2 years, how would she know? Nursing school? Laughable if you ask me.

 

You're total defense of RV, despite being shown so many reasons to question her safety and ethics as a nurse, makes me concerned. Nursing school teaches and preaches safety. At 2 years, working as a resource and having no patients, yet blowing by the 5 rights of medication administration as if they were only suggestions is concerning. I'm also concerned for the orientee that was with her. I hope that this orientee knows that ignoring safety protocols is not okay, and covering up bad outcomes is never okay, whether you've been a nurse 1 day, 2 years, or 30 years. PERIOD

2 years in nursing, she should have enough proficiency to know basic safety and med administration. If she didn't, she shouldn't be working around patients, nor should she ever have her license reinstated. 

I can't understand your total defense of someone who practiced so unsafely. If you would allow her to care for you or a loved one, you are much braver than I am. For anyone to nonchalantly blow by so many safety protocols, this was not her first time doing so. Sadly, it caught up with her 

[0.9%NormalSarah, BSN, RN]

KalipsoRed21 said:

Yes, I read them. 

"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? Kinda confirms to me that her superiors were not practicing well and she learned her practice from these people. This culture taught her poor nursing practice. And she paid the price. As a nurse that had only been practicing for 2 years, how would she know? Nursing school? Laughable if you ask me.

 

You keep saying "a nurse that has only been practicing for 2 years.” Well I worked in a procedural area at a little over 2 years where it was the same: no Med scanner, so we used a paper MAR. I still pulled correct meds, administered them appropriately and safely, and accurately recorded and carefully monitored the patients. It's a little insulting to suggest a nurse working for 2 years couldn't do that. And yes, I learned my rights of Med admin in nursing school. It's not a systems error. 

[KalipsoRed21, BSN, RN]

MaxAttack said:

While I sort of get where you're trying to go with this I can't for the life of me see a relationship between routine medication administration for someone who's nervous about a scan and a situation where it's literally a possibility of my life or yours involving firearms. It's muddying the waters much more than it already is. 

It's hard to see a systemic issue regarding RV when she purposefully circumvented the system by overriding a medication in a non-urgent situation. It's hard to see this as a culture issue when every single one of us is taught to look at the medications we're pulling and pushing. There are some things that are so egregious that you have to stop and think maybe this person should take responsibility and accountability for their own actions.

The only person who had their "free will" taken away was the person who suffocated fully awake while paralyzed waiting for a scan.

Look, your points and others do put this issue where it still is for me, on the fence. 
In my 15 year career I have made two medication errors. Fortunately no harm came to the patient, although one of them could have been really bad. So I guess I can just see how easy a lethal one could happen when other checks besides the 5 rights are not in place. 
Also, in my 15 year career I have seen plenty of unethical behavior taught to new graduates who really don't understand the name of the game. In my opinion a 2 year old nurse should just be leaving his/her first med surg job and has no effing business in the ICU and most certainly not a floater. I know some of you are going to vehemently disagree with that point of view. My loved experience says your opinions are wrong. 

I have seen a new grad of two weeks be assigned a team of her own with a patient on a heparin drip who didn't speak up because she was afraid to. The house supervisor told her it was a team she could handle and that she was sorry there was not enough staff for her to have a preceptor. I got involved, filled out a safe harbor form and everything and the house supervisor got mad at me saying that until I got involved the new graduate had not expressed any concern to her that the assignment was to much....I really just wanted to punch that person That supervisor wasn't an idiot or lazy, she was desperate. She knew she was wrong and did it anyway because she didn't have any other options.

They called in the director to "precept" the new grad. At 5pm the new grad came to me because she hadn't seen her preceptor in hours, and the heparin bag had run dry and she didn't know what to do. The poor kid didn't even know there was a protocol and had not checked their levels ALL DAY! 
My second year as a nurse my director threatened to report me to the board for insubordination because I refused to discharge a patient the doctor had not completed medication reconciliation appropriately on (He just checked off all his pervious meds prior to discharge. It was an open heart floor...he need the ACE, Beta Blocker , blood thinner etc meds he had been on in the hospital too.) Fortunately the guy coded before the end of my shift so I got an award for encouraging a patient to stay in the hospital when they didn't feel right. 

So please don't tell me that the accountability lies solely on the nurse. I didn't have a kid to support when I did those things, I'm not so sure I would speak up as much these days either depending on my finances. 

Nurses who divert medications for personal use or to sell on the side don't follow the 5 rights either. But we reinstate them with restricted licenses. RV paied her dues according to the law for what she did, she now needs to support her family and she is choosing to try to do it as a nurse. 

Medication errors and deaths are part of healthcare. Most of the people who commit them still get to work in healthcare. The CDC estimates 251,000 deaths a year due to medical error. I'm pretty sure we aren't revoking licenses on that many medical professionals every year. 

If you want patients to live and caregivers to be accountable, then everyone contributing to the conditions in the hospital have to be held accountable. Singling out one sheep for slaughter every few years isn't a sustainable option. It just makes our career look punitive and unappealing.