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!

[subee, MSN, CRNA]

aynRN513 said:

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

To whom are you speaking?  

[chare]

subee said:

aynRN513 said:

... Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

To whom are you speaking?

I believe he or she is referring to this:

Susie2310 said:

[...]

I find it immature and self-serving that some people think nurses and other health care workers should practice in a kind of fantasy world where they are only ever held accountable for their negligent actions that cause harm to patients through informal internal processes and state BON action ...

I'm obviously unaware of @Susie2310's intent, but see how this could be taken as belittling or condescending. 

[Tenebrae, BSN, RN]

aynRN513 said:

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

She did go before the BON, they did nothing which is why it went to criminal charges

[Susie2310]

aynRN513 said:

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

This is your comment that I replied to:

   aynRN513 said: 

" I do NOT believe healthcare workers should be prosecuted for med errors, but I believe we should be held accountable for our actions by our licensing & governing boards."

I said:

"I find this to be an oversimplification.  We are talking about professional nursing care provided by any licensed nurse that qualifies as gross/criminal negligence.  In my view, prosecution that is brought with merit, after careful consideration of the evidence, has the effect of:  1) Removing the individual from their practice with the public and thus protecting the public; 2) Providing a measure of justice to the injured parties; 3) Putting the particular industry involved on notice; 4) Determining whether criminal conduct has taken place and determining what consequences the person charged should face.  It is a formal procedure that has long lasting consequences for the person charged.

I find it immature and self-serving that some people think nurses and other health care workers should practice in a kind of fantasy world where they are only ever held accountable for their negligent actions that cause harm to patients through informal internal processes and state BON action, when the BON in my state, to the best of my knowledge, doesn't discipline a nurse's license for negligence resulting in harm to patients although the injured party still has the right to bring a civil lawsuit.  My understanding is that in my state, the level of injury/harm has to amount to gross negligence or more before the BON takes action against a nurse's license.  As far as I know, every other licensed professional, from the catering industry to the airline industry, to electricians, surveyors, building contractors, ad infinitum, is held accountable legally when their actions breach the standards of their profession with harm resulting to the public.  In my view, it doesn't engender public confidence to protect healthcare workers from the legal consequences of their actions."

The word "immature" means not mature, and the word "self-serving" means to be primarily concerned with one's own interests.  That is what I expressed above.  No offence was intended.

NB:  This discussion is not about benign errors in nursing care.

[Hoosier_RN, MSN]

chare said:

I believe he or she is referring to this:

I'm obviously unaware of @Susie2310's intent, but see how this could be taken as belittling or condescending. 

It may seem belittling or condescending, but at least it is honest. Many healthcare workers, many newer-but definitely not limited to those younger generations, have a sense of operating without responsibility for their actions. I have run into more than a few that feel like they deserve a free pass just when they make a mistake because they have some letters behind their name. Then some proceed to make the same mistake over and over...

[klone, MSN, RN]

aynRN513 said:

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

Let's use an analogy. Say there is a taxi driver. He has a taxi driver's permit/certification. In the course of doing his job, he is playing candy crush on his cell phone while driving 40 mph down a city street. In the course of playing candy crush, he doesn't once look at the street in front of him while hurtling down the street, and he kills a pregnant woman, crossing the road, who was crossing with a green light. So the cab driver, so engrossed in his game, didn't even realize he just killed this woman, but proceeded to pick up a fare, and it wasn't until the fare saw blood dripping down the grill and called 911 themselves, that the cabbie even realized he just killed someone. 
 

Do you think he should be charged with reckless vehicular homicide, or do you think it's sufficient that he just has his cabbie's permit taken away? What if you learned that, unless he was charged criminally, he would just get a "hey, be careful!” and could still go on to drive a taxi? Would that change your mind about whether he should be charged criminally?

[Nurse Beth, MSN]

aynRN513 said:

I stand by my statement that I do not believe nurses should be prosecuted for making medication errors. If an error is not made with malice and forethought, but a true error, then let the governing/licensing boards discipline the offender. Here is my issue with your response, you felt the need to offend and belittle by stating those who believe differently than you are "immature and self-serving". 

I wonder what it would be like to have a debate without sarcasm or a lack of respect for each other. 

I am certainly not blameless, so please don't jump on me!

It would be refreshing and challenge us all to improve our communication skills. Anyone want to accept the challenge?

 

[Susie2310]

Nurse Beth said:

I wonder what it would be like to have a debate without sarcasm or a lack of respect for each other. 

I am certainly not blameless, so please don't jump on me!

It would be refreshing and challenge us all to improve our communication skills. Anyone want to accept the challenge?

 

You quoted a selected portion of my post above, so I will reply:  1) No sarcasm or disrespect was intended.  2) As nurses we are the Patient's Advocate, not the Nurse's Advocate.  In my state, Nursing licensure requires of nurses that they act as The Patient's Advocate to obtain care for the patient that meets the Standard of Care.  In my state, nurses are required to intervene if they see an unsafe patient situation, regardless of whether that patient is assigned to them.  For me, in this discussion, Patient Safety is the first thing that is on my mind.  

With Patient Safety foremost in mind, I do not believe it is reasonable or possible to expect all views expressed to be politely uncritical of all beliefs held by other nurses or politely uncritical of all attitudes that prevail in the health care industry in general.  Respectfully, you started this discussion.  I do not believe it is possible to treat every view expressed as being of equal merit, or to expect harmonious agreement, nor do I think this is even desirable.

I don't have a problem with other posters disagreeing with my views, which I usually substantiate and which I am willing to explain and defend.  While you selected a small part of my entire post to serve as an example of being disrespectful, thus taking it out of context, I clearly explained in the entirety of my post why I hold the view that I do.  

[Wuzzie]

Nurse Beth said:

I wonder what it would be like to have a debate without sarcasm or a lack of respect for each other. 

If someone views another's passionate defense of their position as a lack of respect perhaps they should not participate in discussions such as these. Why would anybody waste the energy on getting their knickers in a twist over an anonymous poster's opinion on the internet? Frankly, the idea that people are misbehaving on this particular thread, which I honestly have not seen, just means some posters are viewing it through their own filter and making a lot of assumptions about intent. It's the internet people. Just because someone disagrees does not mean they are being rude.

[RN_SummerSeas, MSN, APRN, NP]

The fact that people on here can't even agree that civil discussion should ensue is sad.  People can absolutely disagree and discuss/debate without being uncivil. If people have to attack others to get their point across, well that speaks more of the person then their point.  

[Wuzzie]

RN_SummerSeas said:

The fact that people on here can't even agree that civil discussion should ensue is sad.  People can absolutely disagree and discuss/debate without being uncivil. If people have to attack others to get their point across, well that speaks more of the person then their point.  

Before I respond are you referring to my post? 

[Tweety, BSN, RN]

Wuzzie said:

If someone views another's passionate defense of their position as a lack of respect perhaps they should not participate in discussions such as these. Why would anybody waste the energy on getting their knickers in a twist over an anonymous poster's opinion on the internet? Frankly, the idea that people are misbehaving on this particular thread, which I honestly have not seen, just means some posters are viewing it through their own filter and making a lot of assumptions about intent. It's the internet people. Just because someone disagrees does not mean they are being rude.

I agree, pretty much most of this thread has been respectful.  Full of strong opinions for sure but pretty decent.  This thread has over 500 responses and sure there might be some that are not appropriate but no need brand an entire thread or group of posters.  Kind of like that one rude nurse and then it's the entire profession "eating their young".  LOL