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]

JKL33 said:

For clarification—I didn't say those were the circumstances; sorry if that's the way it came across. I was referring to the idea that people are imagining the circumstances of this case based on what we know we personally routinely experience, which for almost anyone in the hospital regularly involves some degree of understaffing and associated pressures. Those assumptions are easy enough to make; I did the same upon first hearing of the case years ago. But one by one additional facts showed those were not the circumstances. 

What I am additionally saying is that despite those frequent circumstances that we personally experience at work, almost none of us find ourselves behaving the way RV did. So even under significant stress we *still* don't practice nursing that way. Because it is simply an unacceptable way to practice. 

Gotcha! Sorry I misunderstood. You're 100% right!

[feelix, RN]

She deserves her day in court and a decision based on evidence. We know too little to pronounce a verdict in favor or against.

I think, Vanderbilt's case needs to be reopened too. It should be investigated, how the big guy gets away while the small guy loses their life after being responsible for killing someone.

[toomuchbaloney]

feelix said:

She deserves her day in court and a decision based on evidence. We know too little to pronounce a verdict in favor or against.

I think, Vanderbilt's case needs to be reopened too. It should be investigated, how the big guy gets away while the small guy loses their life after being responsible for killing someone.

We know enough and she already had her day in court.  Our justice system is designed and funded to keep the working classes in check... the majority... not the few.  It's the same with the revenue system... it's funded and staffed to focus on the masses who have some money not upon the few who have most of the money.  

Voting matters. 

 

[MaxAttack, BSN, RN]

feelix said:

She deserves her day in court and a decision based on evidence. 

She had her day and she was found guilty of criminally negligent homicide and gross neglect of an impaired adult. 

The question is do we give a nurse that was convicted of criminally negligent homicide involving a patient her license back? There's no real debate in my book.

[Tommy5677]

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. 

With your line of thinking no nurse would ever have a chance against the BON. I'm certainly glad you're not sitting on one. I would be OK with her screwing up a claim or a work comp case? Are you serious? Because she was grossly negligent with reference to the med error, you automatically assume she would be incapable of doing anything competently when you have no idea the working conditions she was under. I'm not excusing her. She failed miserably at her job but no one ever said that nonclinical work was mindless so stop putting words in my mouth.

[mrphil79]

Tommy5677 said:

Because she was grossly negligent with reference to the med error, you automatically assume she would be incapable of doing anything competently when you have no idea the working conditions she was under. I'm not excusing her. She failed miserably at her job 

We do know the exact conditions she was under - from her own words and statements. 
She herself said she was an extra set of hands. She herself said she was not in a position where she was overworked. She herself said she did not feel burned out and was not being unduly rushed. 
 

Based on her own words - she had what very many of us would consider to be a dream job. 
 

Her own words are very damning. 

[klone, MSN, RN]

MacNinni123 said:

Talked about? Completed? How? Are over-rides still being allowed, encouraged? Over-rides should only be done by the pharmacist.

Why do you keep saying that? Overrides of emergency medications absolutely SHOULD be available to nursing staff. 

[klone, MSN, RN]

MacNinni123 said:

The fact that she didn't read the label is another piece of info missing from the All Nurses query I see.

Wrong. It's been discussed as nauseum

[klone, MSN, RN]

klone said:

Wrong. It's been discussed as nauseum

And now that I've read through the whole thread, I see "ad nauseum" has been used as nauseum

And what happened to MacNinni?? They poof, disappeared!

[Hoosier_RN, MSN]

Tommy5677 said:

With your line of thinking no nurse would ever have a chance against the BON. I'm certainly glad you're not sitting on one. I would be OK with her screwing up a claim or a work comp case? Are you serious? Because she was grossly negligent with reference to the med error, you automatically assume she would be incapable of doing anything competently when you have no idea the working conditions she was under. I'm not excusing her. She failed miserably at her job but no one ever said that nonclinical work was mindless so stop putting words in my mouth.

Many nurses get a 2nd chance everyday. See the Recovery threads. In her own words her working conditions were excellent that day, she chose to be negligent. No one put words in your mouth. The attitude of your post was exactly as stated, if not giving meds, RV could do this other work and not be a danger. Those jobs require a level of critical thinking as well

I'm going to put out here that RV has posted her various doings and life since this tragedy. She is very nonchalant about killing someone, albeit a negligent accident. If most of us did that, we'd hide and work on rebuilding our life in a positive direction instead of crying out "poor me, I was wronged" much of the time. She has been a bit remorseful as of late, as I believe she's finally seen the writing on the wall, not out of any innate sense of responsibility, or she would have been more accepting of her role in the death of Ms Murphy from the beginning

[NurseTechNurse]

I am glad this case is being debated. I was under the impression that she was like others nurses who would be burnout and rushed from patient A to patient B to etc. 

At some hospitals, it is policy to scan the patient's bracelet and then scan the medication prior to giving the medication. This comes in handy, especially when the provider changes their orders without notifying the nurse ?

My understanding is that RV was able to override the pyxis to get the wrong medication.

At the time of the incident, did Vanderbilt not have nurses identify the patient, scan patient's bracelet, and then scan the medications prior to giving medications?
 

[mrphil79]

klone said:

Why do you keep saying that? Overrides of emergency medications absolutely SHOULD be available to nursing staff. 

Oof yeah if you think we should never be able to override, you need to hope nobody you love ever develops an allergy to shrimp and needs an emergency epi shot in the ER at 1 AM. 
Between the time it takes the doc to get to the computer to enter the order and the off-site pharmacist to verify the order, we'd have already had to intubate because it takes FOREVER especially when someone is about to asphyxiate.