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!

[londonflo]

Granuaile said:

I think *were* she to have her license reinstated, she should not be allowed to be responsible for providing care to patients (ie as staff nurse, charge nurse, or supervisor of other nurses, etc).

Why can't she just say..."I need a job but not in nursing" and go find one!

[Tenebrae, BSN, RN]

londonflo said:

Why can't she just say..."I need a job but not in nursing" and go find one!

Perhaps she geniuinely doesnt believe shes done anything wrong. 

Which makes it more important that the BON doesnt give her a licence

[TriciaJ, RN]

It's very sad when people can't distinguish an error from a pattern of egregiously negligent practice.  I don't know if this issue has been raised, but I find it very difficult to believe RV was a conscientious nurse and inexplicably, this incident was a one-off.  I suspect this was just the day her luck finally ran out and her recklessness caught up with her (well, her patient).

I wonder how many of her coworkers previously reported concerns and were blown off.  In my experience these types of events are not a huge surprise to the people who would have worked the most closely with her.

So do I think her license should be reinstated?  I still can't figure out how she got one in the first place.

[LibraSunCNM, BSN, MSN, CNM]

TriciaJ said:

It's very sad when people can't distinguish an error from a pattern of egregiously negligent practice.  I don't know if this issue has been raised, but I find it very difficult to believe RV was a conscientious nurse and inexplicably, this incident was a one-off.  I suspect this was just the day her luck finally ran out and her recklessness caught up with her (well, her patient).

I wonder how many of her coworkers previously reported concerns and were blown off.  In my experience these types of events are not a huge surprise to the people who would have worked the most closely with her.

So do I think her license should be reinstated?  I still can't figure out how she got one in the first place.

This is something I would be truly interested to hear--her former coworkers' thoughts and impressions of her as a nurse.  I also agree this was unlikely a one-off, but I wonder if she previously sort of skated by without doing anything life-threatening or or truly fireable, until this tragedy.

[Granuaile, ASN, RN]

LibraSunCNM said:

This is something I would be truly interested to hear--her former coworkers' thoughts and impressions of her as a nurse.  I also agree this was unlikely a one-off, but I wonder if she previously sort of skated by without doing anything life-threatening or or truly fireable, until this tragedy.

The Nurse Educator of Vanderbilt did testify as to the competency of RaDonda's nursing practice, though in general terms and she was one person, so based on what I have read so far, other opinions/evidence as to her competency are not known.

RV did skip over multiple precautionary steps that we are all taught to take when administering any medication, and she did not monitor the patient after giving her medication. We don't know if she had a pattern of unsafe practice or not. At least from what I have read, I don't yet know that. We do know that she immediately reported her error when she realized she had made it.

This is an aside, and does not absolve her of her complacency, but it is a little disturbing that none of this even came to light until an anonymous person notified state and federal authorities of the med error, 9 months after it had occurred, because the hospital covered it up by falsifying documentation to the Medical Examiner and simply not reporting it to state and federal authorities. As stated in an article by the ISMP (Institute of Safe Medication Practices), "This fatal error involved accidental administration of a neuromuscular blocker to an unventilated patient by a practitioner who thought she was administering a different drug—an all-too-common scenario with errors involving neuromuscular blockers,"  https://www.ismp.org/resources/safety-enhancements-every-hospital-must-consider-wake-another-tragic-neuromuscular which leads me to believe that errors involving this potentially life-threatening medication are a known issue. Additionally, midazolam is no longer available under the brand name Versed. So even if RV were to never be allowed to touch a patient again, are hospitals (and other healthcare settings) actually safer without her?

 

[Wuzzie]

Granuaile said:

We do know that she immediately reported her error when she realized she had made it.

Actually, another nurse discovered it and brought it to RV's attention. She had no choice but to admit to it. 

[klone, MSN, RN]

Granuaile said:

We do know that she immediately reported her error when she realized she had made it.

 

Not exactly accurate. Another nurse discovered her error, and it was reported, and then she was made aware of it. So it's not like it could have been covered up at that point.

Granuaile said:

So even if RV were to never be allowed to touch a patient again, are hospitals (and other healthcare settings) actually safer without her?

 

In a word, yes. They're certainly not LESS safe without her.

[MaxAttack, BSN, RN]

DoubleblessedRN said:

WHY does she want her license reinstated?  WHY does she want to work as a nurse again?  Is she hurting financially?  Does she want to right a wrong?  Does she really care about people, their quality of life and making a difference?  Hard to say with so many variables.  Last year in Michigan, a three year old ventilator dependent child died while under her the care of a private duty RN.  The parents were adequately trained to care for their child, but the purpose of a private duty nurse was to care for the child while the parents slept, as the child required 24 hour care. The vent had been disconnected when this happened; I believe the nurse was changing the trach dressing or performing some other type of procedure or care which required the vent being disconnected very briefly.  The nurse had been using meth for several nights in a row when she passed out.  One or both parents found the nurse semi conscious or unconscious and their child not breathing.  The child died, and the nurse was convicted of second degree murder.  Did the nurse deserve it?  Absolutely, positively without a doubt.  It's unclear as to how long she had a substance abuse problem; she had been licensed for about fifteen years and had never been disciplined by the board of nursing, nor had there ever been any formal complaints on this nurse.  But my point is, there are sooooo many nurses with substance abuse problems who are on probation with restricted licenses in which they cannot administer meds.  They jump through all the hoops and make it through.  And then there are some nurses who are on probation for the second and third time around, and the state continues to give them every chance in the world, knowing that the nurse is a potentially very serious risk to patient safety.

I see where you're trying to go but it's an incorrect generalization if you think all nurses with substance abuse issues are methed up and killing patients. Some things can be managed with decades of evidence guiding treatment and have strict multi-year protocols to continue practice. This particular nurse might not have even been in a position for that to happen had she been in a program. I'm not sure the same can be said of those that are just naturally terrible at what they do (I.e. RV). These issues are complex and controversial enough on their own without conflating them.

[MaxAttack, BSN, RN]

Granuaile said:

This is an aside, and does not absolve her of her complacency, but it is a little disturbing that none of this even came to light until an anonymous person notified state and federal authorities of the med error, 9 months after it had occurred, because the hospital covered it up by falsifying documentation to the Medical Examiner and simply not reporting it to state and federal authorities. 

Separate issue from RV's actions but 100% agree Vanderbilt made some questionable decisions and unsurprisingly escaped without any repercussions. 

Granuaile said:

Additionally, midazolam is no longer available under the brand name Versed. So even if RV were to never be allowed to touch a patient again, are hospitals (and other healthcare settings) actually safer without her?

100% safer without her. When you blow through so many warnings and chances to do the right thing it's only a matter of time before it catches up with you imo. I didn't even know it was discontinued because I don't think I've ever heard it called by the generic name in practice. At this point it's like saying Kleenex. Midazolam is Versed.

[Emergent, RN]

I think RaDonda skated by because she had an outgoing and likable personality. I've seen that happen a lot in nursing.

Like @TriciaJ said, her slap happy, careless practice caught up to her eventually.  It's just like someone who drove home from the bar dozens of time who finally killed someone in a drunk driving accident one day. You'd better believe that wasn't their first time drinking and driving... 

[Granuaile, ASN, RN]

MaxAttack said:

These issues are complex and controversial enough on their own without conflating them.

Thank you for saying this. Substance abuse and addiction are not only complex and controversial, but in my experience still poorly understood by many who work in healthcare.

[Granuaile, ASN, RN]

MaxAttack said:

100% safer without her. When you blow through so many warnings and chances to do the right thing it's only a matter of time before it catches up with you imo.

True.