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!

[Granuaile, ASN, RN]

klone said:

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.

Thank you for clarifying.

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

MaxAttack said:

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.

I wasn't generalizing; I just used this as an example because my employer hires nurses on probation or with a restricted license, and there was a particular RN whose scenario is very similar to that of the nurse on meth.  (She no longer works at my facility)  Anyhow, this particular nurse had been doing plasmapheresis on a patient and stole morphine from the pt's morphine drip or PCA and administered it to herself.  She was also found semiconscious at the bedside, with a cap to a line open and blood everywhere.  And this was her THIRD time on probation due to substance abuse.  Among some of the terms to probation included a length of five years, and no medication administration for at least the first three years.  That's pretty extensive.  Some very serious harm including death could have occurred when she was found semi conscious with that patient.  She's kinda set a track record that shows she is a very serious safety risk and liability, don't you think?  I think it's pretty surprising she still has a license.

[klone, MSN, RN]

I'm unclear what that has to do with RaDonda Vaught's situation.

[subee, MSN, CRNA]

DoubleblessedRN said:

I wasn't generalizing; I just used this as an example because my employer hires nurses on probation or with a restricted license, and there was a particular RN whose scenario is very similar to that of the nurse on meth.  (She no longer works at my facility)  Anyhow, this particular nurse had been doing plasmapheresis on a patient and stole morphine from the pt's morphine drip or PCA and administered it to herself.  She was also found semiconscious at the bedside, with a cap to a line open and blood everywhere.  And this was her THIRD time on probation due to substance abuse.  Among some of the terms to probation included a length of five years, and no medication administration for at least the first three years.  That's pretty extensive.  Some very serious harm including death could have occurred when she was found semi conscious with that patient.  She's kinda set a track record that shows she is a very serious safety risk and liability, don't you think?  I think it's pretty surprising she still has a license.

If she really was on probation, they weren't doing their due diligence.  It's difficult for me to imagine that a diversion program would EVER allow this person to be working anywhere on a 3rd try, much less be working in any area with access to narcotics.  

[MaxAttack, BSN, RN]

DoubleblessedRN said:

I wasn't generalizing; I just used this as an example because my employer hires nurses on probation or with a restricted license, and there was a particular RN whose scenario is very similar to that of the nurse on meth.  (She no longer works at my facility)  Anyhow, this particular nurse had been doing plasmapheresis on a patient and stole morphine from the pt's morphine drip or PCA and administered it to herself.  She was also found semiconscious at the bedside, with a cap to a line open and blood everywhere.  And this was her THIRD time on probation due to substance abuse.  Among some of the terms to probation included a length of five years, and no medication administration for at least the first three years.  That's pretty extensive.  Some very serious harm including death could have occurred when she was found semi conscious with that patient.  She's kinda set a track record that shows she is a very serious safety risk and liability, don't you think?  I think it's pretty surprising she still has a license.

Yep, I agree. If an action like that lead to death I also wouldn't be opposed to criminal charges there, either. I just don't think every patient safety issue can be rolled up into one equivalent package.

If the point is that they get second chances so why doesn't RV I would say the avoidable loss of life is probably a good place to start. Texting and driving is different than killing someone while texting and driving.

[Emergent, RN]

If Radonda isn't going to lose her nursing license, who is, only murderers and child molesters? ?

[DoubleblessedRN, ADN, RN, EMT-B, EMT-P]

klone said:

I'm unclear what that has to do with RaDonda Vaught's situation.

That RV is a very serious safety risk and liability,  The debate is whether her license should be reinstated when some states continue to license nurses who are just as risky and have a proven track record to support it. 

[subee, MSN, CRNA]

DoubleblessedRN said:

I wasn't generalizing; I just used this as an example because my employer hires nurses on probation or with a restricted license, and there was a particular RN whose scenario is very similar to that of the nurse on meth.  (She no longer works at my facility)  Anyhow, this particular nurse had been doing plasmapheresis on a patient and stole morphine from the pt's morphine drip or PCA and administered it to herself.  She was also found semiconscious at the bedside, with a cap to a line open and blood everywhere.  And this was her THIRD time on probation due to substance abuse.  Among some of the terms to probation included a length of five years, and no medication administration for at least the first three years.  That's pretty extensive.  Some very serious harm including death could have occurred when she was found semi conscious with that patient.  She's kinda set a track record that shows she is a very serious safety risk and liability, don't you think?  I think it's pretty surprising she still has a license.

Unless you can prove this allegation of patient harm you are making, I'm not going to believe it.  Nurses on probation are tested..a lot..and there are other nurse addicts on floors that are undetected and never tested.  I haven't decided which one I'd rather have:(

[Kaitey M]

The question, as graciously posed by Nurse Beth, was SHOULD RV have her nursing license reinstated? 

No. 

(Remember this is a complete sentence). 

? Maybe a poll? I wrote a signed letter to TBON when this was a whiff months ago.  While opinions will way, this outcome will never vary. That's enough.
 

Nursing is not a license to kill.  
 

To anyone that forgives and believes in "second chances" (and that is all of nursing), would we forgive our ilk if it was our loved one RV (or any other provider so recklessly) cared for in this manner. 
 

Not even addressing liability, criminality or the ability of a nurse to understand actual ENGLISH WORDS (Like WARNING ⛔️ PARALYZING AGENT), the currency of civil litigation is only money and criminal is, well, punishment. No gets a loved one back. Sorry.

Sometimes it's takes just 1. Methinks that was 1 of many, likely not a 1-off, but a play the way she practiced till she did the unthinkable. 

[subee, MSN, CRNA]

Kaitey M said:

The question, as graciously posed by Nurse Beth, was SHOULD RV have her nursing license reinstated? 

No. 

(Remember this is a complete sentence). 

? Maybe a poll? I wrote a signed letter to TBON when this was a whiff months ago.  While opinions will way, this outcome will never vary. That's enough.
 

Nursing is not a license to kill.  
 

To anyone that forgives and believes in "second chances" (and that is all of nursing), would we forgive our ilk if it was our loved one RV (or any other provider so recklessly) cared for in this manner. 
 

Not even addressing liability, criminality or the ability of a nurse to understand actual ENGLISH WORDS (Like WARNING ⛔️ PARALYZING AGENT), the currency of civil litigation is only money and criminal is, well, punishment. No gets a loved one back. Sorry.

Sometimes it's takes just 1. Methinks that was 1 of many, likely not a 1-off, but a play the way she practiced till she did the unthinkable. 

I was with you until the end.  What does your last paragraph mean?  Methinks it is negligent homicide.  She got off easy so far.  

[Wuzzie]

subee said:

I was with you until the end.  What does your last paragraph mean?  Methinks it is negligent homicide.  She got off easy so far.  

I think the poster was saying that this was one of likely many other lapses in nursing judgment committed by RV. This just happened to be THE one. 

[Wizard 1]

Reinstate her license after requiring some re-education, and a period of supervised probation/practice.  I have no way of knowing this for sure, but I bet getting charged and convicted for her mistake has resulted in re-assessing behavior and learning from her mistakes.  

She's already been pilloried and punished more than enough. 

What about the system for dispensing medications? Has anyone looked into that? 

Can we stop being so punitive and scapegoating, and really design a system/systems that can reduce the incidence of these by looking at root causes and fixing them, versus punishing the nurse? Can we start staffing properly and supporting nurses so they aren't in such a hurry all the time? 

This sets a dangerous precedent for nurses that is ridiculous and uncalled for.