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!

[mtmkjr, BSN]

NurseTechNurse said:

Mind pointing out which posts you are referring to? For this thread, was there a post deflecting blame from RV?

Why not look at what could have done better from the hospital's angle? To your credit, whatever the hospital could have done better may not have affected RV's actions that day, though, in my opinion, it is worth looking at the hospital's actions, too, more so to learn from what they did wrong (if anything) and what could have been done differently.

I'm sorry I ended up with two posts, was not able to delete the one that didn't attach the quote. 

Multiple people in this thread and in general chatter relating to the case keep pointing to Vanderbilt's system failures. I don't excuse Vanderbilt but I see it as needing to be addressed separately. I don't find them at fault in this patient's death. 

[MacNinni123]

To Klone and any others who wondered what happene-rid to me. I'm still here...but gave up trying to explain myself once I realized no one was paying attention to what I said. Once more...I read ONLY the email from All Nurses giving the background to the story...which did NOT include all the rest of the stuff ad nauseum (as it was described). And, yes ad nauseum has been overused, too. I simply said that the error was egregious...someone died. However, from what I read which is ONLY what All Nurses included in my email...there wasn't enough info to make a decision. As far as the over-ride issue...yes they may be done but ONLY in sync with the pharmacy. The impression I have from recent comments is that is not the case. I don't KNOW whether she should get her license back from what info I have read. I am way up here in Maine...nowhere near where all this occurred. I have not seen the reams of info spoken of here. That is all folks!

[Tenebrae, BSN, RN]

Tommy5677 said:

I seem to be the only one here willing to cut her some slack. Even with putting limitations on her practice everyone here seems to have a need to crucify her. Maybe this isn't the right forum to ask such a question.

She made an egregious medication error. 

She failed to follow the five rights of medication administration. she made so many errors and failed in basic nursing care. 

She pushed an IV med that paralysed the patient leaving them fully conscious and aware and suffocating as they died. 

I have no interest in crucifying RV. I don't want her looking after patients 

 

[Tenebrae, BSN, RN]

toomuchbaloney said:

At the time of the incident did standard nursing practice require the professional to read the medication label before injecting the drug, regardless of how they accessed the drug? 

My students think I'm mean because I made them double check the medication after they take it out of the box. eg Just incase the 150mg venlafaxine was put back in the 75mg box

[Tenebrae, BSN, RN]

Tommy5677 said:

TMichael 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.

And thats the difference. RV slammed the medication and walked away and left the patient unmonitored. 

[beachbabe86]

Tenebrae said:

My students think I'm mean because I made them double check the medication after they take it out of the box. eg Just incase the 150mg venlafaxine was put back in the 75mg box

You are teaching them well!  They will remember and thank you some day.  Funnily enough, I check my own personal medications twice before I take them and even what I am giving my dog.

[Hoosier_RN, MSN]

MacNinni123 said:

I don't KNOW whether she should get her license back from what info I have read. I am way up here in Maine...nowhere near where all this occurred. I have not seen the reams of info spoken of here. That is all folks!

It doesn't matter where you are, you have internet, AEB commenting on this thread. Instead of continuously stating " there's just not enough info" look up RVs, case as has been suggested, and investigations via TBI and CMS, all available online. There's plenty of info. If you actually review it instead of skimming over it, it's very damning. Have a great day!

[Hoosier_RN, MSN]

There are a few that keep going back to Vanderbilt's culpability. The issue I have with them was the cover up. This thread isn't about Vandy, it's about RV and her license. Vandy didn't, in any way, cause RV to follow the course of action that she did. Some want to blame the technology, or lack thereof. It makes me wonder how these folks think nurses have administered medications for all of the years that we have without computerized charting and electronic dispensaries (Pyxis, Omnicell, etc), and the vast majority of us never once had anything like this happen. This scares me for our future. If nurses strictly rely on technology and don't double check their actions, ee are in deep trouble. Technology is only as good as the person propagating it

[Rose_Queen, BSN, MSN, RN]

Hoosier_RN said:

Some want to blame the technology, or lack thereof. It makes me wonder how these folks think nurses have administered medications for all of the years that we have without computerized charting and electronic dispensaries (Pyxis, Omnicell, etc), and the vast majority of us never once had anything like this happen. This scares me for our future. If nurses strictly rely on technology and don't double check their actions, ee are in deep trouble. Technology is only as good as the person propagating it

Exactly! And what about the nurses in New Orleans following hurricane Katrina who didn't have functioning IV pumps and had to calculate rates in drops per minute? Nearly 20 years later, how many have become so reliant on technology that they can't calculate a drip rate?

Technology is not the end all be all that so many seem to make it out to be. It was never meant to be the only tool that removed the need for basic nursing practice and critical thinking. 

[phoebe2020, BSN, RN]

First of all, I would have questioned the fact that I am giving Versed to an unmonitored patient. I would have honestly asked the physician for something less potent! Midazolam is more likely to have respiratory side effects than say, a low dose Lorazepam.

The whole thing is just one massive dumpster fire. I feel terrible for RaDonda. I feel terrible for the patient's family. I cannot stand Vanderbilt for trying to cover it all up. She should not have been charged, but I agree with Beth that she needs to find another career. If I was her, I don't think I could trust myself to take care of another patient again!

[Wuzzie]

phoebe2020 said:

The whole thing is just one massive dumpster fire. I feel terrible for RaDonda. I feel terrible for the patient's family. I cannot stand Vanderbilt for trying to cover it all up. She should not have been charged, but I agree with Beth that she needs to find another career. If I was her, I don't think I could trust myself to take care of another patient again!

Although I completely agree with the criminal charges I  think many of us would have more sympathy for RV if it wasn't for her behavior after the incident. 

[toomuchbaloney]

It's difficult for me to have sympathy for blatant disregard of fundamental safety steps in completing an intravenous injection.  

Imagine if she had completed the injection and then, before leaving, had looked at the patient and asked her if she was feeling better. I'm certain that the patient was looking at RV, with growing panic in her eyes, as the nurse walked away and the patient couldn't move, call for help and with rapid progression couldn't even breathe anymore.  

Yeah... I'm having trouble finding sympathy for that.  There's a reason that we sedate conscious patients before paralyzing them.