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!

[Googlenurse, ASN, BSN, RN]

For everyone saying she went against P and P,I think everyone does that too at some point.

It is against Policy and Procedure to hang potassium with normal saline. But I did that last night because the patient was saying they were in pain. I ran both together on separate pumps but just used the y site for the NS. I ran the NS at 30ml/hour. It was safe to do so btw because the patient had no fluid overload or conditions associated with it. 

Also, my facility doesn't require us to measure the arm circumference of a patient with a Picc, but I do it anyway. It's not part of P and P but I do it to protect myself. 

[HiddenAngels]

0.9%NormalSarah said:

With this line of thinking, you might be okay with her screwing up someone's important insurance claim or work comp case etc. Just because a nurse isn't giving medications that could instantly kill someone doesn't mean that they can be trusted to do a good job. Those jobs are so important, too, and I think it might come across as insulting to the nurses that do those jobs. Oh yeah she's not allowed to give meds, she can just do the mindless work of claims....doesn't sound very nice that way. 

???

[Nurse Beth, MSN]

Googlenurse said:

For everyone saying she went against P and P,I think everyone does that too at some point.

It is against Policy and Procedure to hang potassium with normal saline. But I did that last night because the patient was saying they were in pain. I ran both together on separate pumps but just used the y site for the NS. I ran the NS at 30ml/hour. It was safe to do so btw because the patient had no fluid overload or conditions associated with it. 

Also, my facility doesn't require us to measure the arm circumference of a patient with a Picc, but I do it anyway. It's not part of P and P but I do it to protect myself. 

I always say you have to know the rules before you break them.

[Wuzzie]

Nurse Beth said:

I always say you have to know the rules before you break them.

Yes, but you have a responsibility to actually read them.

[Nurse Beth, MSN]

Wuzzie said:

Yes, but you have a responsibility to actually read them.

Right. Know, read.

[MaxAttack, BSN, RN]

Googlenurse said:

For everyone saying she went against P and P,I think everyone does that too at some point.

It is against Policy and Procedure to hang potassium with normal saline. But I did that last night because the patient was saying they were in pain. I ran both together on separate pumps but just used the y site for the NS. I ran the NS at 30ml/hour. It was safe to do so btw because the patient had no fluid overload or conditions associated with it. 

Also, my facility doesn't require us to measure the arm circumference of a patient with a Picc, but I do it anyway. It's not part of P and P but I do it to protect myself. 

Eh if it was just a little policy violation I don't think we'd be talking about it.

In this example it would be the difference between hanging potassium with saline and pushing potassium on a different patient in an entirely separate unmonitored unit with no order that you overrode and thought was a different drug altogether and slammed it in anyway and then left said patient to die.

Poh-tae-toh, poh-tah-toh

[MochaRN424, ASN]

When you give a medication you look to make sure what you're giving. If I was having an issue with the machine you ask someone especially when it seems as if she was a floater?It wasn't  your normal unit ask for help. God forbid if I made that type of error and I cost someone their life that would truly be it for me. I would not want to practice anymore. Lord please don't ever let me be in a hospital and she was working there. As my prayer from day one LORD NEVER LET ME CAUSE ANY HARM!

[MacNinni123]

Retired oncology nurse here. I do not believe there is enough information here to make a decision on RaDonda Vaught. Her med error certainly is egregious...the patient died. However, the nursing climate is...and has been...for quite some time, unhealthy for both patients and nurses. Perhaps, because of the stress of rushing from one assignment to the next as a "help-all" nurse, Vaught lost her way and her brain became muddled...allowing her to make such a horrible error. Nursing shortages have caused too many such errors. The hospital obviously needed a "help-all" and such nurses are often over-whelmed with varied duties. The hospital policy also did not include assuring the nurse would monitor after the injection of versed. The pyxis over-ride is certainly not a good thing either. That should be done only by a pharmacist. Had that been the case, the mistaken med surely would have been identified. Unfortunately, hospital nursing is, and has been, fraught with ability for mistakes to occur. It is not Covid that has brought to light all its frailties...they have been there for decades...Covid has simply exposed them all. Vaught's error will never leave her mind. The patient's family will never receive peace from her error. It is highly unlikely that she will ever have a med error again...unless there is more to this story than we know about her performance over the years. Laxity within hospital policies and care assist in the commission of these errors. Both Vaught and the hospital are accountable. But should she never be allowed to practice again?  I still am unsure because we do not have enough information here to make that decision.

[toomuchbaloney]

MacNinni123 said:

Retired oncology nurse here. I do not believe there is enough information here to make a decision on RaDonda Vaught. Her med error certainly is egregious...the patient died. However, the nursing climate is...and has been...for quite some time, unhealthy for both patients and nurses. Perhaps, because of the stress of rushing from one assignment to the next as a "help-all" nurse, Vaught lost her way and her brain became muddled...allowing her to make such a horrible error. Nursing shortages have caused too many such errors. The hospital obviously needed a "help-all" and such nurses are often over-whelmed with varied duties. The hospital policy also did not include assuring the nurse would monitor after the injection of versed. The pyxis over-ride is certainly not a good thing either. That should be done only by a pharmacist. Had that been the case, the mistaken med surely would have been identified. Unfortunately, hospital nursing is, and has been, fraught with ability for mistakes to occur. It is not Covid that has brought to light all its frailties...they have been there for decades...Covid has simply exposed them all. Vaught's error will never leave her mind. The patient's family will never receive peace from her error. It is highly unlikely that she will ever have a med error again...unless there is more to this story than we know about her performance over the years. Laxity within hospital policies and care assist in the commission of these errors. Both Vaught and the hospital are accountable. But should she never be allowed to practice again?  I still am unsure because we do not have enough information here to make that decision.

It sounds like you are making excuses for horrible professional judgment and practice that killed a patient in a horrifying way. The hospital is not responsible for the individual decisions of a health professional.  

[FallingSkies]

What people don't talk about is Vanderbilt doing an 'upgrade' that prevented nurses from pulling medications appropriately, forcing them to use override on almost all medications they pulled. Vanderbilt then tried to cover it, did not notify state or federal agencies as they are required, and lied to the coroner saying it was a natural cause of death. They did that because they knew they were largely at fault, which is why the term scapegoat is accurate.

[MacNinni123]

toomuchbaloney said:

It sounds like you are making excuses for horrible professional judgment and practice that killed a patient in a horrifying way. The hospital is not responsible for the individual decisions of a health professional.  

I am not surprised at your reply. I expected it from someone. However, I am not making any excuses for any body...nurse or hospital. You have been a nurse for a long time. You have seen what I expressed here. We do not know what Vaught's performance has been like up until this horrible event. IF there have not been other issues, or for any reason other issues would be expected, should a nurse's training and experience be wasted forever? Should any person ever be forgiven and allowed another opportunity if they make a mistake? I reiterate...there is not enough information here to make that decision. Never forget...any one of us can make a mistake. We are human. If Vaught's career has been sprinkled with poor decisions, then absolutely she should not be allowed to return.

[MacNinni123]

FallingSkies said:

What people don't talk about is Vanderbilt doing an 'upgrade' that prevented nurses from pulling medications appropriately, forcing them to use override on almost all medications they pulled. Vanderbilt then tried to cover it, did not notify state or federal agencies as they are required, and lied to the coroner saying it was a natural cause of death. They did that because they knew they were largely at fault, which is why the term scapegoat is accurate.

We do not have enough information to know if Vaught is a "scapegoat" or not. We do know she gave the wrong medication. We also know she used over-ride, which should not be accomplished by any one but the pharmacist. So, if the hospital, as you say allowed that, it in the least is an accomplice in an egregious death. The bottom line here is...we do not have enough information to make a decision on Vaught.