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!

[MaxAttack, BSN, RN]

RN_SummerSeas said:

But she didn't go to work intending to kill someone, she didn't plan with malice to cause harm. 

No one is accusing her of outright murder. Think of someone who hit and killed a pedestrian crossing the street because they were looking at their phone while driving. They didn't intend to kill anyone but that constitutes a criminally negligent act (I.e., involuntary manslaughter).

[0.9%NormalSarah, BSN, RN]

Tommy5677 said:

I get it and you're right. I'm just no longer interested in the post.

Because you don't want to be challenged on your line of thinking or statements? See below. My point was that someone who can't follow a simple routine we all do many times every shift, ON TOP OF making multiple bypasses of known safety features while believing themselves to be handling a high alert medication, which they claim they understood how to administer, they perhaps can't be trusted to handle something else life-changing like an insurance claim. And I stand by my opinion that you were insinuating she can do some other nursing work. No matter how you spin that, it belittles the other work. Wasn't trying to put words in your mouth, but perhaps say what I thought you were saying in a more crude manner to get my point across. I struck a nerve. 

 

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.

[beachbabe86]

If I had a nickel for every nurse who told me in interview about how they didn't follow policy, didn't know policy, didn't care about policy, or "I just do it my own way", I would have a pile of coins.  Sometimes, I would wonder what were they thinking or were they thinking at all.

Honestly, I would love to see state or federal mandated longer orientation programs for nurses or refresher courses for nurses where they REALLY had to show comprehension of patient care.  

[Tommy5677]

RN_SummerSeas said:

There are plenty of jobs she can do without patient interaction or treatment. QA, insurance calls, chart review for billing coding efficacy, IT, to name a few. I know plenty of nurses who don't do anything clinical.  Not saying she should but saying if she did get licensed she could fill a role without having to see/touch/treat patients.

Thank you for that. They could still do case management (believe it or not) and prior authorization. Things that require a RN. What about nursing informatics or something of that nature? Well, for that she would probably need a MSN. I think most of those commenting here are just unreasonable. I'm not trying to excuse her. Had she followed policy and protocol she would not have made such an egregious mistake. Maybe she could make lemonade from lemons: go on the lecture circuit teaching nurses what not to do, or whatever that might look like. Here's an example of a guy who got lucky after a med error. Wrong med, wrong patient: 

Michael Villeneuve knows this firsthand. After graduating from nursing school and working in a neurosurgical intensive care unit, Villeneuve gave the wrong medication to a patient. He administered a dose of potassium intended for one patient to another. Villeneuve realized the error immediately and called for help as the patient's heart went into distress. All he could think about was that his career was over, that he was going to lose his license, and that the patient was going to die.

Fortunately, the patient recovered. Villeneuve went on to head the Canadian Nurses Association, where he educated nurses on safety before his retirement in March 2022.

Anyway, it happens. This guy could have still been revoked even though the patient recovered but he and the patient got lucky.

Nurses wanting to be judge and jury is just tiresome.

 

[subee, MSN, CRNA]

Hoosier_RN said:

I agree with all said, except from her own admission, she wasn't running around like a headless chicken through the hospital. Her unit wasnt understaffed. She was a resource person for her unit. No patients. Just an orientee. I hope that the orientee learned a valuable lesson from this as well

Everything else, 100% right on!

I'm wondering if this in a generational thing.  We old timers came from times when educational standards were more stringet.  For people who didn't have the advantage of that type of education, maybe they think blame diversion is the appropriate thing to do.  After all, they've skated through with online classes and allowed to graduate on time despite the pandemic.  Don't flame me; I know PLENTY of good nurses are out there.  In fact, since patients aren't dying in numbers, I assume that most are possessed with the work ethic to be successful in this field.  But, I also believe that if I tried to pass blame for my mistake as a nursing student in the olden times, I would have received a metaphorical slap in the face.  My peers wouldn't back me up either.  

[subee, MSN, CRNA]

Tommy5677 said:

Thank you for that. They could still do case management (believe it or not) and prior authorization. Things that require a RN. What about nursing informatics or something of that nature? Well, for that she would probably need a MSN. I think most of those commenting here are just unreasonable. I'm not trying to excuse her. Had she followed policy and protocol she would not have made such an egregious mistake. Maybe she could make lemonade from lemons: go on the lecture circuit teaching nurses what not to do, or whatever that might look like. Here's an example of a guy who got lucky after a med error. Wrong med, wrong patient: 

Michael Villeneuve knows this firsthand. After graduating from nursing school and working in a neurosurgical intensive care unit, Villeneuve gave the wrong medication to a patient. He administered a dose of potassium intended for one patient to another. Villeneuve realized the error immediately and called for help as the patient's heart went into distress. All he could think about was that his career was over, that he was going to lose his license, and that the patient was going to die.

Fortunately, the patient recovered. Villeneuve went on to head the Canadian Nurses Association, where he educated nurses on safety before his retirement in March 2022.

Anyway, it happens. This guy could have still been revoked even though the patient recovered but he and the patient got lucky.

Nurses wanting to be judge and jury is just tiresome.

 

I don't believe one can earn an MSN without a nursing license.  Villeneuve had the correct drug in the syringe.  

[Hoosier_RN, MSN]

Tommy5677 said:

Nurses wanting to be judge and jury is just tiresome.

 

And other nurses wanting to excuse gross negligence is tiresome, and scary, as well

[toomuchbaloney]

Tommy5677 said:

Thank you for that. They could still do case management (believe it or not) and prior authorization. Things that require a RN. What about nursing informatics or something of that nature? Well, for that she would probably need a MSN. I think most of those commenting here are just unreasonable. I'm not trying to excuse her. Had she followed policy and protocol she would not have made such an egregious mistake. Maybe she could make lemonade from lemons: go on the lecture circuit teaching nurses what not to do, or whatever that might look like. Here's an example of a guy who got lucky after a med error. Wrong med, wrong patient: 

Michael Villeneuve knows this firsthand. After graduating from nursing school and working in a neurosurgical intensive care unit, Villeneuve gave the wrong medication to a patient. He administered a dose of potassium intended for one patient to another. Villeneuve realized the error immediately and called for help as the patient's heart went into distress. All he could think about was that his career was over, that he was going to lose his license, and that the patient was going to die.

Fortunately, the patient recovered. Villeneuve went on to head the Canadian Nurses Association, where he educated nurses on safety before his retirement in March 2022.

Anyway, it happens. This guy could have still been revoked even though the patient recovered but he and the patient got lucky.

Nurses wanting to be judge and jury is just tiresome.

 

Nurses willing to make excuses for criminally negligent behavior are more than tiresome, they are worrisome. 

[NurseTechNurse]

toomuchbaloney said:

Nurses willing to make excuses for criminally negligent behavior are more than tiresome, they are worrisome. 

At least on this forum, there are at least three general sides:
-She behaved inappropriately as a nurse. She should never be reinstated.
-She behaved inappropriately as a nurse but could we consider reinstating her? Could she be beneficial as a nurse again?
-She behaved inappropriately as a nurse but were there other factors (I.e. not the same as excuses) at play that day that were overlooked? (So far, I finding out that it may not have been the case for RV but it still happens for other nurses). 
 
This debate is an opportunity to view this case from different perspectives and perhaps help other nurses from making the same mistakes or contributing to these mistakes (I.e. like discouraging colleagues from asking for help - not sure if this was the case with RV but it has happened in others' cases). 

I would find it sad for this thread to turn to judging "x" type of nurses ,"y" type nurses, "z" type  of nurses, etc. 

[feelix, RN]

toomuchbaloney said:

Nurses willing to make excuses for criminally negligent behavior are more than tiresome, they are worrisome. 

Nurses lacking compassion are scarier than those with poor skills. Like someone said, there is more to Nursing than patient care. Let someone have a chance to make a living being a HEDIS nurse or Health Coach or whatever life throws at them. Nobody is going to hire RV in the ICU any way.

[toomuchbaloney]

feelix said:

Nurses lacking compassion are scarier than those with poor skills. Like someone said, there is more to Nursing than patient care. Let someone have a chance to make a living being a HEDIS nurse or Health Coach or whatever life throws at them. Nobody is going to hire RV in the ICU any way.

This has nothing to do with compassion.  I don't agree that some professional nursing positions don't require critical thought or ability to follow training and policy.  I believe that they all do and that no one should want RVs unique lack of critical thought or sound judgement anywhere near health care decisions or duties.  

RV displayed a lack of professional conduct that would make her unsafe or unreliable in any setting.  Would you trust her to follow rules? 

[londonflo]

MaxAttack said:

they were looking at their phone while driving. They didn't intend to kill anyone but that constitutes a criminally negligent act (I.e., involuntary manslaughter).

 

The law is clear on this. You cannot be in an active activity while driving (nor waiting at traffic light) when you hit someone. If you think I am wrong, develop a relationship with a criminal defense attorney NOW, You will then have their telephone number at your fingertips when you  hit/maim/kill someone.

MaxAttack said:

Think of someone who hit and killed a pedestrian crossing the street because they were looking at their phone while driving. They didn't intend to kill anyone but that constitutes a criminally negligent act (I.e., involuntary manslaughter).

Actions speak better than words.