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!

[Nurse Beth, MSN]

Rose_Queen said:

If you look at all of the pictures included in the TBI report, it is logical to assume this vial, the syringe of saline used, the alcohol swab, and the bag with Versed written on it in marker were collected from Vanderbilt and the picture above is the actual vial of medication administered to Charlene Murphy. 

Interesting, I wonder who saved the evidence. The hospital did not report the error. CMS did not investigate for months. 

[chare]

Wuzzie said:

Nurse Beth said:

That would make a difference....is there a source for monitoring differences based on dosage?

Do you really need a "source" to understand basic IV administration

I think she's referring to patient monitoring post medication administration; if there would be requirements based on nintent (I.e., anxiolysis vs. procedural sedation).

Considering the discussion I think that is a fair question.

[Wuzzie]

chare said:

I think she's referring to patient monitoring post medication administration; if there would be requirements based on nintent (I.e., anxiolysis vs. procedural sedation).

Considering the discussion I think that is a fair question.

No, I get it but I feel like she's trying to trap me into saying that there should have been a procedure for this thereby placing the blame on the institution. I've never worked in a place that called IV anxiolytics "procedural sedation" therefore requiring a policy. But there is good medication practice that calls for "monitoring for effect" that is appropriate for this situation. In fact any time we give an IV push medication we should monitor for effect as any adverse reactions are likely to occur within the first 5 minutes of the medication being given. Heck, when I start an antibiotic IVPB, especially if it's the first time a patient has received it, I monitor for 5-10 minutes to watch for an allergic reaction. There is no policy for this, it's just good practice. I would like to know if anyone has seen a medication policy that allows for slamming a medication and walking away. 

Nurse Beth said:

Interesting, I wonder who saved the evidence. The hospital did not report the error. CMS did not investigate for months. 

Sooo, are you implying that there was some kind of nefarious plot now? You've jumped the shark Beth. 

[JKL33]

chare said:

I think she's referring to patient monitoring post medication administration; if there would be requirements based on nintent (I.e., anxiolysis vs. procedural sedation).

Considering the discussion I think that is a fair question.

Answer is yes.

This should be clear, or at least be able to be deduced, by the fact that places have policies defining what constitutes procedural sedation, the specifics that differentiate the escalating levels of planned sedation, etc., and one could be expected to know that this scenario was not that. [Although it is clear this nurse doesn't possess basic levels of knowledge].

I am sure you know this chare, but others may not: Just because Versed is a medication that may be used for procedural sedation doesn't mean that every time it is given a procedural sedation is underway. Same with Ativan, and Wuzzie already explained why Ativan was likely not used. Ativan can be used in procedural sedation as well, but we also push it all the time when we are not performing a procedural sedation.

In any case, procedural sedation has nothing to do with this scenario and what should have happened is the bare bones due diligence that is required and expected when administering any IV medication. 

[JKL33]

Wuzzie said:

No, I get it but I feel like she's trying to trap me into saying that there should have been a procedure for this thereby placing the blame on the institution. I've never worked in a place that called IV anxiolytics "procedural sedation" therefore requiring a policy. But there is good medication practice that calls for "monitoring for effect" that is appropriate for this situation. In fact any time we give an IV push medication we should monitor for effect as any adverse reactions are likely to occur within the first 5 minutes of the medication being given. Heck, when I start an antibiotic IVPB, especially if it's the first time a patient has received it, I monitor for 5-10 minutes to watch for an allergic reaction. There is no policy for this, it's just good practice. I would like to know if anyone has seen a medication policy that allows for slamming a medication and walking away. 

Sooo, are you implying that there was some kind of nefarious plot now? You've jumped the shark Beth. 

Nah!! Now that is a fair question. Why the heck keep that around for MONTHS. And do nothing with it. That's bizarro. I mean, they certainly could've turned it in when they reported the death.

But....I guess if you don't report the death you just throw it on top of file cabinet somewhere.

I don't think it was a nefarious plot against RV, per se, but hell yes it was a nefarious plot to not report the death.

[Wuzzie]

JKL33 said:

I don't think it was a nefarious plot against RV, per se, but hell yes it was a nefarious plot to not report the death.

Ya know, I'm not entirely convinced that the docs were soley trying to cover their butts. Part of me wonders if they were trying to protect RV as well. They knew she screwed up royally. Now before you light me up I've seen it happen more than once. A nurse makes a med error and a doctor covers it up as a favor. It happened to me. I gave 0.5mg Ativan PO to the wrong LOL on a hall cart in an ED. The carts had been switched when 2 LOLs had gone to radiology at the same time. Totally my fault for not checking the ID bands even though having patients in hall beds was asking for trouble. The doc on that night was just going to write for Ativan for the patient I accidentally gave it to to negate the mistake. Of course I refused and took my lumps instead. BTW-the patient was fine, it didn't even make her sleepy. I wasn't though. 

[Nurse Beth, MSN]

JKL33 said:

Answer is yes.

This should be clear, or at least be able to be deduced, by the fact that places have policies defining what constitutes procedural sedation, the specifics that differentiate the escalating levels of planned sedation, etc., and one could be expected to know that this scenario was not that. [Although it is clear this nurse doesn't possess basic levels of knowledge].

I am sure you know this chare, but others may not: Just because Versed is a medication that may be used for procedural sedation doesn't mean that every time it is given a procedural sedation is underway. Same with Ativan, and Wuzzie already explained why Ativan was likely not used. Ativan can be used in procedural sedation as well, but we also push it all the time when we are not performing a procedural sedation.

In any case, procedural sedation has nothing to do with this scenario and what should have happened is the bare bones due diligence that is required and expected when administering any IV medication. 

Versed causes respiratory depression and is a moderate sedation agent that requires standardized monitoring.

Monitoring is not based on the intent but on the physical agent administered, and the two should not be conflated. 

[Wuzzie]

Nurse Beth said:

Monitoring is not based on the intent but on the physical agent administered, and the two should not be conflated. 

Monitoring is based on the dose and the dose is based on the intent. 

[Nurse Beth, MSN]

Wuzzie said:

Monitoring is based on the dose and the dose is based on the intent. 

What is your monitoring nursing practice for Versed 1-2 mg? 

 

[Wuzzie]

Nurse Beth said:

What is your monitoring nursing practice for Versed 1-2 mg? 

When I used it as an anxioytic it was a baseline set of vitals, monitor for effect and recheck vitals in 15 minutes or sooner if my nursing assessment judged it necessary. This was not a policy but my personal practice and also the practice of every nurse I worked with and with every medication that had the potential to drop BP, decrease respirations or had a risk of allergic reaction. This meant staying at the bedside until we were comfortable with how the patient was handling the medication. Patients who were not narcotic naive still were watched for at least 5 minutes and had their vitals rechecked. We NEVER slammed a med with the potential side effects like versed and then walked away. Would you?

[Nurse Beth, MSN]

Wuzzie said:

When I used it as an anxioytic it was a baseline set of vitals, monitor for effect and recheck vitals in 15 minutes or sooner if my nursing assessment judged it necessary. This was not a policy but my personal practice and also the practice of every nurse I worked with and with every medication that had the potential to drop BP, decrease respirations or had a risk of allergic reaction. This meant staying at the bedside until we were comfortable with how the patient was handling the medication. Patients who were not narcotic naive still were watched for at least 5 minutes and had their vitals rechecked. We NEVER slammed a med with the potential side effects like versed and then walked away. Would you?

I would not have given it in that setting.

At a minimum, she should have been on continuous pulse ox and a heart monitor, with resuscitative equipment, and a reversal agent at hand.

Giving Versed in neuro ICU is one thing.

Giving Versed in a diagnostic area with no plan for close monitoring is another.

It's unconscionable what she did; I say that repeatedly. It was horrifying and tragic.

But there was no concern from anyone about ordering, administering, or delegating the administration, of Versed in Imaging. No plan for monitoring this patient. No standard of care. 

 

 

[Wuzzie]

Nurse Beth said:

No standard of care. 

But there is a standard of care. You don't slam any medication and walk away. You don't need a policy for that. Or maybe you do. I prefer to think independently and with the goal of providing good, safe patient care.