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!

[Hoosier_RN, MSN]

There are some social media influencers crying about horribly she's been treated, nursesshould band together and demand that she get her license back. Nurse Erica comes to mind first. It made me sick for Ms Murphy's family

[Nurse Beth, MSN]

Hoosier_RN said:

There are some social media influencers crying about horribly she's been treated, nursesshould band together and demand that she get her license back. Nurse Erica comes to mind first. It made me sick for Ms Murphy's family

If I did something like that, I would not ask to get my license back.

[LibraSunCNM, BSN, MSN, CNM]

Hoosier_RN said:

There are some social media influencers crying about horribly she's been treated, nursesshould band together and demand that she get her license back. Nurse Erica comes to mind first. It made me sick for Ms Murphy's family

Gluttons for attention are gonna glutton for attention, unfortunately.  People are sick.

[Nurse Beth, MSN]

FiremedicMike said:

I don't need a policy to tell me to monitor a patient after giving what I thought was a sedative. 

Them covering it up is their own problem, Vaught didn't get disciplined or charged for their cover up, she got in trouble for her own role in this.

Not having a policy to monitor patients is serious.

@FiremedicMike, you would monitor the patient after giving Versed, but how frequently, for how long (what outcome), using what metrics, and what source of reference?

How can that be evidence-based practice when your understanding of monitoring is surely different than others? Policies are important and protect nurses and patients.

[Wuzzie]

Nurse Beth said:

How can that be evidence-based practice when your understanding of monitoring is surely different than others? Policies are important and protect nurses and patients.

Would you have pushed Versed and then walked away immediately, without looking at the patient and then leaving them alone in a holding area if your hospital did not have a policy? 

[toomuchbaloney]

Nurse Beth said:

RaDonda's errors were grievous, and she was sanctioned by the BON as well as criminally prosecuted.

Vanderbilt did not have a policy about monitoring patients after administering Versed (midazolam), and they covered up the incident.

Vanderbilt's involvement is irrelevant to the question of whether the nurse should regain her license and therefore irrelevant to this discussion.  It is a separate topic.

No, she shouldn't get her license back.  She demonstrated criminal level poor judgment and professional practice but no remediation of the thinking, knowledge base or attitudes that resulted in indefensible nursing care and a death. 

Hell to the no.

[toomuchbaloney]

Hoosier_RN said:

There are some social media influencers crying about horribly she's been treated, nursesshould band together and demand that she get her license back. Nurse Erica comes to mind first. It made me sick for Ms Murphy's family

Social media is good at getting people riled up over questionable causes. 

[Nurse Beth, MSN]

Wuzzie said:

Would you have pushed Versed and then walked away immediately, without looking at the patient and then leaving them alone in a holding area if your hospital did not have a policy? 

No, and I'm sure you wouldn't either, Wuzzie.

But if you had an orientee with you, what would you have instructed them as far as monitoring frequency, how long, to what measurable outcome, and what exact metrics?

[toomuchbaloney]

Nurse Beth said:

Not having a policy to monitor patients is serious.

@FiremedicMike, you would monitor the patient after giving Versed, but how frequently, for how long (what outcome), using what metrics, and what source of reference?

How can that be evidence-based practice when your understanding of monitoring is surely different than others? Policies are important and protect nurses and patients.

Versed takes a couple minutes to achieve affect...IV response is slower that benzos. She thought she was providing sedation with versed (her previous reckless and unprofessionalbehavior had already put the wrong drug in her hand), she should have assessed the response to her IV sedation.  This is basic professional nursing, IMV. 

[vintagegal, BSN, DNP, RN, NP]

To be empathetic, if this was me I think I would pursue other interests besides nursing. I would work every day to rectify what I had done. And I would make every effort to show people how sorry I was for what happened.

[toomuchbaloney]

Nurse Beth said:

No, and I'm sure you wouldn't either, Wuzzie.

But if you had an orientee with you, what would you have instructed them as far as monitoring frequency, how long, to what measurable outcome, and what exact metrics?

I'm going to jump in.  I've given IV sedatives to someone else's patient while having a student or orientee with me. I would assess the patient for appropriateness of sedation orders,  administer the IV med according to manufacturer guidelines, observe patient response, and chart. Many years ago I was taught that, outside of a patient with a secured airway, the ordered dose is administered in divided doses waiting for observed patient response. Versed came around after I was out of school when I was in the PICU. We used it lots. The manufacturer recommends speed and observation guidelines for IV administration.

[Wuzzie]

Nurse Beth said:

But if you had an orientee with you, what would you have instructed them as far as monitoring frequency, how long, to what measurable outcome, and what exact metrics?

As a prudent nurse if I was unsure I would consult a pharmacist and clarify with the ordering physician what monitoring the patient required.  Remember she was given the anxiolytic dose not the sedating dose. Exact metrics would be based on the patient but at minimum, knowing that an adverse reaction is most likely in the first 30 minutes, I would have checked a set of vitals first then stayed with the patient and rechecked vital signs within that time frame. This does not require a research project. Had RV stayed even 2 minutes and reassessed the patient the issue would have been obvious and the patient would be alive. 

But before all of that I would have read. the. damn. label.