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!

[KalipsoRed21, BSN, RN]

Hoosier_RN said:

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 

It isn't "total defense". I am on the fence. I paid a lot of money to go to nursing school. I passed like 5 oral meds the entire program. I didn't administer any IV meds the whole program.

 

I feel our whole system of care delivery is broken and that instead of fixing it we single out those who made a mistake and say we fixed it by cutting those people off. Nothing was fixed just punitive action taken against the lowest paid staff that they can sacrifice. 
 

According to the CDC 251,000 deadly medical errors happen a year. We aren't pulling licenses from that many people....and I'm fairly certain at least a few of those errors were gaps in the 5 rights. So because RV's was on the news and she has a giant 60K to pay she should be cut from her career? We let people who divert drugs have their license back.....that is a blatant disregard of the 5 rights too. "But they didn't kill anyone”….that you know of. She paid her dues to society via her sentencing, she took herself out of bedside care AFTER her deadly medication error (she practiced for 3 years before the case was brought to CMS). I said I think she deserves a second chance…….no, not deserves.....I can see it reasonable for the board to decide to let her practice on a restricted license. I never said let by gones be by gones. 

[0.9%NormalSarah, BSN, RN]

KalipsoRed21 said:

I passed like 5 oral meds the entire program. I didn't administer any IV meds the whole program.

I'm seeing where your opinion of new grad nurses is coming from. Not all of us went to programs that so poorly prepared us. I'm sure there was plenty lacking in my program, but medication administration was very heavy because they had to know we would be safe on one of the skills nurses perform many times every shift. I think it's possible that your experience is clouding your judgement in this case. 

[Hoosier_RN, MSN]

KalipsoRed21 said:

It isn't "total defense". I am on the fence. I paid a lot of money to go to nursing school. I passed like 5 oral meds the entire program. I didn't administer any IV meds the whole program.

All of us paid a lot to go to nursing school. All of us learned safety and the 5 rights of med admin. Had she simply observed those 5 rights, this would never have happened, along with Pyxis warnings that she overrode for her own convenience (stated via her testimony). This leaves no fence to sit on, I'm not sure why you think there is one.

In almost 30 years,  I've made 3 med errors, none due to foregoing the five rights. All 3 were orders that were entered incorrectly DAYS before, and timing or route not caught. Not my med error alone, and glad that no one died. Sorry, her blatant disregard, and that's what it is, makes me unable to come to another conclusion. The only thing it seems that I do agree with you is that she has/had no place in ICU. But med surg or any other area is going to be just as dangerous for someone who doesn't follow basic safety measures

She didn't remove herself from bedside care out of any noble gesture, she was fired-twice! Kinda like the self reporting. She did that because she knew her behind was in a sling. These are things said by her. She lied on a gun application, so she's not really learned a lesson. There are other jobs out there, nursing isn't the only thing she relegated to doing, and being forced to not do. Geez, I'm just done discussing this, as it just makes me sick

ETA: this young lady's lack of self awareness during the incident,  during the investigation and hearings, and after the closure of the hearings is what has turned so many sour. If you remain on the fence, that is definitely your choice, but seeing red flags and choosing to ignore them tears the fence down...

[MaxAttack, BSN, RN]

KalipsoRed21 said:

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. 

I started in the ICU as a new grad. Either way this patient was already downgraded and wasn't an ICU patient. The rest of it is all a distraction.  There are medication errors and unsafe conditions and then there's this. Some sheep need to go out for slaughter. I get she has a family but what about the family of the patient who died as a direct result of her actions? There are plenty of career options where such a blatant disregard for things you're taught don't result in death. We won't ever agree on this and that's OK.

[HiddenAngels]

KalipsoRed21 said:

RaDonda Vaunght should have a path to getting back her license. As far as I have read about this case she made an error, which she was prosecuted for. But she also reported her own medication error to her organization, she did not hide it. She then relied on her institution for guidance on how to handle the error with their legal team,(her organization was shady as ***, hid the error and the reason RV was persecuted at ALL was because CMS couldn't find any other way to punish the hospital for their fraud) and she only had been a nurse 2 years at the time of the incident.

To me, she didn't demonstrate complete negligence, she had the ethical wherewithal to report her error to help her patient. That is really all I needed to know to say that she should have her license back and be able to practice in some capacity. Probably a modified license like a person in drug recovery whee she can't work in certain sectors until proven safe, but yeah she should be able to have her license back.

 

I have seen several deadly errors by doctors and they still get to practice, why shouldn't we?

So basically from an end of argument stance, you are saying that you are okay with Vaught being your nurse, or your mother's nurse or if you have children, your children's nurse in a critical emergency situation?

[HiddenAngels]

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'm gonna stop you.  Deadly medical errors and Deadly Police shootings are not the same.  

[Wuzzie]

KalipsoRed21 said:

She paid her dues to society via her sentencing, she took herself out of bedside care AFTER her deadly medication error (she practiced for 3 years before the case was brought to CMS). 

She hasn't even finished her probationary period. How has she paid her "dues"? Also SHE didn't take herself from bedside. She continued working until she was fired, went to another hospital and got herself hired and then they fired her once they found out what happened. 

 

 

[HiddenAngels]

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. 

This post is a bunch of fluff.  This is NOT a chicken and egg situation.  These are individuals who think they are ABOVE THE LAW. what is wrong with you!!

 

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. 

And with the end of this post, goes the end of my responses to you. WOW

[Wuzzie]

KalipsoRed21 said:

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. 

Many of us started in the ICU (I started in NICU) and managed to not kill anyone. It depends on the individual. Also, she wasn't "floating" she was a resource person working in her own unit. I have more than twice your experience and have worked at the highest level of my license for many of those years. My opinion is not wrong. 

[HiddenAngels]

Hoosier_RN said:

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

???

[Wuzzie]

HiddenAngels said:

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.

Please tell us how Vandy stopped RV from reading the damn label?

[Hoosier_RN, MSN]

Wuzzie said:

Please tell us how Vandy stopped RV from reading the damn label?

? 

I started in the ICU as well, and always checked labels-pharmacy can mistakenly put wrong med in wrong place in Pyxis 

I'm still of the frame of mind that this lady's lack of selfawareness and accountability are frightening, she should not be allowed to practice with any of level of license

My mom, who's been retired from nursing for a few years and hasn't really followed this, says RV is a definitely not what we need representing our profession. This stuff would've never flown back in the day