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]

toomuchbaloney said:

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. 

Versed (midazolam) is a benzodiazapine and it's often used for procedural sedation but patients are typically closely monitored (may include Sp02, Co2, Aldrete score, EtC02, RR, pulse, B/P) every 5 minutes during the procedure and every 15 during recovery. A dedicated nurse must monitor the patient during a procedure. Emergency equipment must be available, plus a reversal agent.

It's hard to believe Vanderbilt did not have a policy as midazolam can cause respiratory depression. Apparently the nursing staff was unclear on the correct practice (happens when there's a lack of clear policies/practice). In my experience, a trained procedural RN based in Diagnostics or a similar specialty would have administered the drug.

[Nurse Beth, MSN]

Wuzzie said:

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.

I hear you, and nursing practice should be under Nursing and not Pharmacy. Pharmacy and Nursing policies sometimes cover both entities, but a Nursing policy would have been available in that case.

A provider may give a preference or opinion if asked, but it would not be evidence-based, and providers expect Nursing to regulate their practice (we should as a profession). 

If it's important enough to stay with the patient and 1:1 monitor her for 30 minutes, then there should be a policy. The policy should include differentiating monitoring requirements by dosage (if, in fact, there is evidence for that). AAORN would be a good start, and it should be researched for standardization.

I would bet by now, Vanderbilt has a robust, evidence-based nursing policy in place.

(I'm not debating checking the label)

[Wuzzie]

Nurse Beth said:

(I'm not debating checking the label)

What debate could there even be? And let's back this up since we're all about EBP. There is a standard of care, policy, procedure and EBP research to support following, at bare minimum, the 5 rights of medication administration which was not done and had it been we would not be having this discussion. The responsibility falls squarely on the shoulders of RV regardless of whatever shenanigans Vandy pulled after the fact. That is the crux of the issue and her lack of attention to this is indefensible.

Also wanted to add that given RV didn't read the label on the vial and  the spot on the gun permit asking about indictments before buying an automatic rifle (her excuse to the judge) why in the hell do you think she'd bother reading a policy?

[subee, MSN, CRNA]

No.  I think there's something wrong with a person who would even have enough self-confidence to even want to return to nursing after such a tragic lack of judgement.    She's been out of the game for awhile now and that should even make it more difficult to transition in.  This was an event that rightly severed her from his license and we have no evidence that she's had a personality transplant.

[toomuchbaloney]

Nurse Beth said:

Versed (midazolam) is a benzodiazapine and it's often used for procedural sedation but patients are typically closely monitored (may include Sp02, Co2, Aldrete score, EtC02, RR, pulse, B/P) every 5 minutes during the procedure and every 15 during recovery. A dedicated nurse must monitor the patient during a procedure. Emergency equipment must be available, plus a reversal agent.

It's hard to believe Vanderbilt did not have a policy as midazolam can cause respiratory depression. Apparently the nursing staff was unclear on the correct practice (happens when there's a lack of clear policies/practice). In my experience, a trained procedural RN based in Diagnostics or a similar specialty would have administered the drug.

It's a newer drug.  The manufacturer recommends observing the patient.  Vanderbilt's lack of policy doesn't excuse lack of professional judgment or criminally reckless behavior.

[Nurse Beth, MSN]

toomuchbaloney said:

It's a newer drug.  The manufacturer recommends observing the patient.  Vanderbilt's lack of policy doesn't excuse lack of professional judgment or criminally reckless behavior.

It's not new-I remember using Versed way back in the 1990's and before, when providers used to do bronchs at the bedside. But it was not safe, and soon moderate sedation was confined to diagnostic areas with trained nurses (thank goodness!).

I think RV had no idea about versed, its' side effects, reversal, or monitoring requirements and for that reason was an unsafe practitioner, and should not practice again.

But I'm puzzled that you think holding Vanderbilt accountable is excusing RV's actions.

[Nurse Beth, MSN]

Wuzzie said:

What debate could there even be? And let's back this up since we're all about EBP. There is a standard of care, policy, procedure and EBP research to support following, at bare minimum, the 5 rights of medication administration which was not done and had it been we would not be having this discussion. The responsibility falls squarely on the shoulders of RV regardless of whatever shenanigans Vandy pulled after the fact. That is the crux of the issue and her lack of attention to this is indefensible. 

Also wanted to add that given RV didn't read the label on the vial and  the spot on the gun permit asking about indictments before buying an automatic rifle (her excuse to the judge) why in the hell do you think she'd bother reading a policy?

Interesting, we mostly agree except that I do not see a conflict between holding Vanderbilt accountable and holding RV accountable. For me, it's not "either/or", I can hold both beliefs.

Wuzzie said:

Again, that had nothing to do with RV not actually reading the label on the vial of the medication she was given. 

Also, FTR neither did RV. How was that Vanderbilt's fault?

No one said it was.

[toomuchbaloney]

Nurse Beth said:

It's not new-I remember using Versed way back in the 1990's and before, when providers used to do bronchs at the bedside. But it was not safe, and soon moderate sedation was confined to diagnostic areas with trained nurses (thank goodness!).

I think RV had no idea about versed, its' side effects, reversal, or monitoring requirements and for that reason was an unsafe practitioner, and should not practice again.

But I'm puzzled that you think holding Vanderbilt accountable is excusing RV's actions.

I started practicing nursing in 1978. It was not a drug in the tool box at that time.  We were taught to remain at the bedside to observe the patient after administering an IV med... at least 10 minutes to observe for untoward response to rapid acting drugs. 

Did I say that holding Vanderbilt accountable is excusing RVs action actions?  No, I did not.  

I said that Vanderbilt's accountability is separate from RVs and is irrelevant to this thread and discussion.  Why do you keep mentioning it in a thread about the nurse's license?  How is Vanderbilt's bad policy related to her desire to have a nursing license? That's what is puzzling. 

Nurse Beth said:

Interesting, we mostly agree except that I do not see a conflict between holding Vanderbilt accountable and holding RV accountable. For me, it's not "either/or", I can hold both beliefs.

No one said it was.

The thread isn't about Vanderbilt. Insisting that we talk about Vanderbilt confuses that distinction.  Start another thread about Vanderbilt.  

[Wuzzie]

Nurse Beth said:

Interesting, we mostly agree except that I do not see a conflict between holding Vanderbilt accountable and holding RV accountable. For me, it's not "either/or", I can hold both beliefs.

My irritation comes when people appear to use what Vandy did as a smokescreen to cover up just how egregiously awful a nurse RV is. It's two different issues, marginally related but different. 

[Nurse Beth, MSN]

toomuchbaloney said:

I started practicing nursing in 1978. It was not a drug in the tool box at that time.  We were taught to remain at the bedside to observe the patient after administering an IV med... at least 10 minutes to observe for untoward response to rapid acting drugs. 

Did I say that holding Vanderbilt accountable is excusing RVs action actions?  No, I did not.  

I said that Vanderbilt's accountability is separate from RVs and is irrelevant to this thread and discussion.  Why do you keep mentioning it in a thread about the nurse's license?  How is Vanderbilt's bad policy related to her desire to have a nursing license? That's what is puzzling. 

The thread isn't about Vanderbilt. Insisting that we talk about Vanderbilt confuses that distinction.  Start another thread about Vanderbilt.  

I responded to others' posts on the topic if you'll look back. I often like to do that.

[toomuchbaloney]

Nurse Beth said:

I responded to others' posts on the topic if you'll look back. I often like to do that.

You also inserted it into a comment to me that quoted my remarks which DID NOT mention the hospital... because hospital policy would not have prevented RVs criminal lack of critical thought or professional judgment. I'm pretty sure policy assumes, first, that you actually read medication labels. 

[Nurse Beth, MSN]

toomuchbaloney said:

You also inserted it into a comment to me that word my remarks which DID NOT mention the hospital... because hospital policy would not have prevented RVs criminal lack of critical thought or professional judgment. I'm pretty sure policy assumes, first, that you actually read medication labels. 

You are so right.