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!

[Wuzzie]

Aliceroye said:

the decision on whether to reinstate Vaught's nursing license should be made by the Tennessee Board of Nursing, taking into account all relevant factors and considerations.

This would be the same board that didn't take her license away and, in fact, did not discipline her at all???‍♀️

[subee, MSN, CRNA]

RN_SummerSeas said:

I think the point is just that it's up to the BON. They have plenty of considerations to take in-her actions, her inactions, etc. I'm pretty sure it was a very literal post saying that it really doesn't matter what anyone thinks but them, because they ultimately make the decision.

Obviously the poster has not read the thread.  They did nothing except possibly make a deal with the prosecutor that they would revoke her license in exchange for no prison time.

[RN_SummerSeas, MSN, APRN, NP]

subee said:

Obviously the poster has not read the thread.  They did nothing except possibly make a deal with the prosecutor that they would revoke her license in exchange for no prison time.

Or that is their opinion. People are allowed their thoughts whether others agree or not. Unless it's Charles Cullen type behavior I think criminal charges to people in health care destroys just culture and will lead to less disclosure and more problems. Mistakes, even stupid and/or careless ones happen, but that doesn't equal intent. That's just my opinion. I, personally, don't think she should practice and I'm surprised she'd want to, but again, not my call. 

[Wuzzie]

RN_SummerSeas said:

Unless it's Charles Cullen type behavior I think criminal charges to people in health care destroys just culture and will lead to less disclosure and more problems.

The ideal

"A just culture approach recognizes that even competent professionals make mistakes and acknowledges that they can develop shortcuts, workarounds, routine violations – yet declares intolerance for reckless behavior. The approach sometimes distinguishes between human error, at-risk behavior, and reckless action – three categories which involve increasing degrees of willfulness and disregard (Marx, 2001).”

"Just culture" never, ever, ever meant making excuses for reckless behavior. If all RV did was override the Accudose, see that she had pulled the wrong med, filed a "near miss" med error and she was subsequently disciplined for this I would be waving the American flag for her and shouting from the rooftops decrying her punishment but that. is. not. what. happened. She was reckless. Over and over and over and over and over and over and over and over and over and over and over and over again. Wanna know why I said "over" 12 times? Seems a little excessive doesn't it? That is exactly how many warnings and steps she missed when she killed Charlene Murphey. 

[RN_SummerSeas, MSN, APRN, NP]

Wuzzie said:

The ideal

"A just culture approach recognizes that even competent professionals make mistakes and acknowledges that they can develop shortcuts, workarounds, routine violations – yet declares intolerance for reckless behavior. The approach sometimes distinguishes between human error, at-risk behavior, and reckless action – three categories which involve increasing degrees of willfulness and disregard (Marx, 2001).”

"Just culture" never, ever, ever meant making excuses for reckless behavior. If all RV did was override the Accudose, see that she had pulled the wrong med, filed a "near miss" med error and she was subsequently disciplined for this I would be waving the American flag for her and shouting from the rooftops decrying her punishment but that. is. not. what. happened. She was reckless. Over and over and over and over and over and over and over and over and over and over and over and over again. Wanna know why I said "over" 12 times? Seems a little excessive doesn't it? That is exactly how many warnings and steps she missed when she killed Charlene Murphey. 

My point, as it seems missed, is that just because people don't share your exact view point doesn't make them wrong and you right or vice versa. You can feel how you do as others can feel how they do.  Expecting others to adopt the same view as you, because you feel it is the right one, is unrealistic.  People are entitled to their views. You have not walked in everyones shoes so you can't begin to imagine things people have encountered.  That is a little rule I keep to in my life, I can never know where someone else's path has taken them, what they have seen, where they are now.  I may not agree with others but it doesn't matter, we are allowed to disagree. 
Also, Just Culture, refers to a bigger view than the individual, it is a view of the whole.  I have seen people argue on this thread not to bring the hospital system into it, but just culture involves exactly that.  
"Any healthcare organization's top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they're a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just culture environment, organizations are accountable for systems they design and analysis of the incident—not the individual." 
Paradiso, Linda DNP, RN, NEA-BC, NPP; Sweeney, Nancy PhD, APRN-BC. Just culture: It's more than policy. Nursing Management (Springhouse) 50(6):p 38-45, June 2019. | DOI: 10.1097/01.NUMA.0000558482.07815.ae 

[Wuzzie]

RN_SummerSeas said:

My point, as It seems missed, is that just because people don't share your exact view point doesn't make them wrong and you right or vice versa.

I am allowed to voice my viewpoint as many times as I want whether you want to hear it or not. This is a discussion board after all. It matters not to me if a stranger on the internet disagrees.  I will also correct misstatements, misrepresentations and outright lies based on the facts of the case represented in the reports filed by the TBI and CMS. If you are tired of hearing from me and unable to tolerate my take on this issue (which I find enormously ironic) there are tools on this site to make that happen. If you need assistance in finding them I or one of the moderators would be happy to point you in the right direction. 

[subee, MSN, CRNA]

RN_SummerSeas said:

My point, as it seems missed, is that just because people don't share your exact view point doesn't make them wrong and you right or vice versa. You can feel how you do as others can feel how they do.  Expecting others to adopt the same view as you, because you feel it is the right one, is unrealistic.  People are entitled to their views. You have not walked in everyones shoes so you can't begin to imagine things people have encountered.  That is a little rule I keep to in my life, I can never know where someone else's path has taken them, what they have seen, where they are now.  I may not agree with others but it doesn't matter, we are allowed to disagree. 
Also, Just Culture, refers to a bigger view than the individual, it is a view of the whole.  I have seen people argue on this thread not to bring the hospital system into it, but just culture involves exactly that.  
"Any healthcare organization's top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they're a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just culture environment, organizations are accountable for systems they design and analysis of the incident—not the individual." 
Paradiso, Linda DNP, RN, NEA-BC, NPP; Sweeney, Nancy PhD, APRN-BC. Just culture: It's more than policy. Nursing Management (Springhouse) 50(6):p 38-45, June 2019. | DOI: 10.1097/01.NUMA.0000558482.07815.ae 

What point of view should the BON of Tennessee adopt?  

[klone, MSN, RN]

RN_SummerSeas said:

I think the point is just that it's up to the BON. They have plenty of considerations to take in-her actions, her inactions, etc. I'm pretty sure it was a very literal post saying that it really doesn't matter what anyone thinks but them, because they ultimately make the decision.

Really? Gosh, and here I thought we were going to do a survey monkey poll at the end of this discussion and the result would decide whether or not she gets her license reinstated.

I mean, not to be rude, but...duh. I don't think any one of us was under any illusions that anyone besides the TN BON had the power. That wasn't the point of this thread.

[JKL33]

RN_SummerSeas said:

Also, Just Culture, refers to a bigger view than the individual, it is a view of the whole.  I have seen people argue on this thread not to bring the hospital system into it, but just culture involves exactly that.  
"Any healthcare organization's top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. [...]

Neither here nor there, but that little tidbit is far from scientific fact. And the authors/paper using that extrapolated allegation are/is not the original source, whom it seems they did not cite in text.

Medical errors and just culture important topics even without the exaggerations.

Misapplication of "third leading cause of death" BS and just culture talk is never going to stop someone who fails to utilize extremely basic practices; in fact there isn't much that is going to stop that sort of thing while still having a functioning hospital. It's like a driver who thinks it is a bit odd that the light has turned red, but what the hell might as well step on the gas and blow through the intersection.

[toomuchbaloney]

RN_SummerSeas said:

I have seen people argue on this thread not to bring the hospital system into it, but just culture involves exactly that.  
"Any healthcare organization's top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they're a sequence of events with multiple opportunities for correction.

The culpability of the hospital is separate from the negligent malpractice of the health professional. The flawed hospital processes did not cause or precipitate the death.  

Yes... there were multiple points at which the deadly actions could have been corrected, but they all required that the RN or her orientee actually read the label of the drug before injecting it and walking away without bothering to assess for desired outcome. 

I certainly blame the the hospital for elevating sloppy and dangerous nursing practice and trying to conceal the cause of death after that elevated nurse nonchalantly killed a patient. 

[JohnHood, BSN]

She made some very serious errors. Had she properly identified the medication and done the 5 rights, this would not have happened. Had she stayed with the patient and properly monitored, she would have recognized the patient was in distress. I really do not think she should have her license back. Actions have consequences, especially actions that directly cause a patient's death.

[ppfd, BSN, EMT-P]

45 pages LOL

No OT to pick up??