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!

[klone, MSN, RN]

Wuzzie said:

But that is an entirely different issue and has nothing to do with RV getting her license back. It just muddies the waters. 

I think she was addressing Medic Mike's statement that the only thing the hospital was guilty of was allowing Vec to be pulled through override (which I disagree with, because it is needed for RSI). They were guilty of a lot more than that. 

[LovingLife123]

I hope she never gets her license back.  She violated every safety measure that is in place to prevent this.  Then left a patient after administering what she thought was a benzo IV.  She didn't bother to read a label.  She didn't bother to even try and figure out how much to draw up.  She somehow reconstituted a med and then just drew up whatever she wanted and administered it.  Who does that?

I work in a pacu.  I give Ativan daily.  I give fentanyl daily.  I still look at my vial every single time I draw up a dose from those vials and do the med math in my brain to ensure I am giving correct dosing.  I've given Ativan to patients at bedside going into an mri.  I still observe those patients.

She blatantly disregarded everything we are taught as nurses for medication administration.  She killed a patient.  While I don't think she should have been criminally prosecuted, she should never work as a nurse again.

I despise Tik Tok and every nurse that is on it.  So if those supposed "nurse influencers" saying she was treated poorly and get her license back, I give those people zero credit.  Their credit is crap by simply being on tik tok.

[Hoosier_RN, MSN]

LovingLife123 said:

So if those supposed "nurse influencers" saying she was treated poorly and get her license back, I give those people zero credit.  Their credit is crap by simply being on tik tok.

I hope that if they're ever hospitalized, she's their nurse ?

[Nurse Beth, MSN]

LovingLife123 said:

 She didn't bother to read a label.  She didn't bother to even try and figure out how much to draw up.  She somehow reconstituted a med and then just drew up whatever she wanted and administered it.  Who does that?

Whenever I see a new grad with no intellectual curiosity or sense of urgency, it is chilling. You can't teach that.

[0.9%NormalSarah, BSN, RN]

LovingLife123 said:

I despise Tik Tok and every nurse that is on it.  So if those supposed "nurse influencers" saying she was treated poorly and get her license back, I give those people zero credit.  Their credit is crap by simply being on tik tok.

Yes the social media "influencer" thing is so annoying! I got totally off social media this past year just because it was so bad for my mental health to see all these people suddenly become medical experts and the politicization of our career. I was never on Tik Tok, but on IG the nurse influencers are also there and it's all over my feed because I said I'm a nurse in my own bio. And the amount of those horrible videos posted where the nurse stages a crying moment or some emotional breakdown in front of the camera because they lost a patient: ? I'm betting those are the same ones that are backing up RV so much. No awareness.

[beachbabe86]

This info will hit hot buttons.  While I personally do not agree, a nurse in the state of Tennessee has a "property right" to their nursing license.  I predict that she will be granted her license.  We shall see.

[KalipsoRed21, BSN, RN]

Wuzzie said:

But that is an entirely different issue and has nothing to do with RV getting her license back. It just muddies the waters. 

Honestly I feel it is naïve to say that poor hospital policy has nothing to do with RN accountability. That is like saying that gun laws have no effect on elementary school children being murdered. Of course it does! 

The fact of the matter is that nurses have no where to turn for support. I have no idea what world you live in where you think that people have millions of choices in jobs? Families and other responsibilities in life trap them in certain areas where job prospects are limited. I only have two hospitals to work at in the town I currently live in (moved here to take care of my mom). The first one I tried was deathly terrible. I passed going to JACHO and wrote the state. The response I got from state (Texas) is that they don't take punitive action and will inform JACHO of my concerns. That was 2 years ago....they are still open and JACHO hasn't fined them or anything. When I say terrible, I mean this hospital didn't even have a policy to keep a pediatric code cart in L&D. Their only pediatric code cart, aside from the one in the ER, was in the ADULT med-surg floor. This hospital's only pediatric areas were the ER and L&D. L&D had it's own building which was not in the same building as the med-surg unit or the ER. This was one of the things I reported. So does the nurse who maybe draws up the wrong amount trying to calculate from an adult cart need to have her license removed because she should have waited 20 minutes for a team member to go get the pediatric cart? Puh-leeze. 

If State isn't going to do anything about our complaints for safety BEFORE an event, and JACHO does their ***ing *** and just fines the hospital (which is in part how JACHO makes money hello?!?), and only the person who makes the mistake is held to account; I don't see how nursing is nothing but a scapegoat for money hungry assholes. We currently have no power to change things before nurses are put in positions that increase the likelihood of mistakes, and the only risk to organizations is to have some big wig "retire early" or "resign" (so they can happily take a job and *** up another organization), but somehow the only person accountable is the one overworked nurse who ***ED up. That is like saying a pilot who was pushed to fly more than the recommended hours without recovery is the only one accountable for the plane crashing. I can't even get close to seeing that as reasonable.

I think if we can let people with drug addiction problems back into care, then we can find some sort of work for a nurse who made a deadly drug error especially when she behaved ethically by reporting her error.

[KalipsoRed21, BSN, RN]

FiremedicMike said:

I don't need a policy to tell me to monitor a patient after giving what I thought was a sedative. 

Them covering it up is their own problem, Vaught didn't get disciplined or charged for their cover up, she got in trouble for her own role in this.

You don't need a policy because you are a 2 year old nurse? Sorry, we all need lots of freaking policies until we know what we are doing. A 2 year old nurse doesn't know a lot.

[KalipsoRed21, BSN, RN]

RaDonda Vaunght should have a path to getting back her license. As far as I have read about this case she made an error, which she was prosecuted for. But she also reported her own medication error to her organization, she did not hide it. She then relied on her institution for guidance on how to handle the error with their legal team,(her organization was shady as ***, hid the error and the reason RV was persecuted at ALL was because CMS couldn't find any other way to punish the hospital for their fraud) and she only had been a nurse 2 years at the time of the incident.

To me, she didn't demonstrate complete negligence, she had the ethical wherewithal to report her error to help her patient. That is really all I needed to know to say that she should have her license back and be able to practice in some capacity. Probably a modified license like a person in drug recovery whee she can't work in certain sectors until proven safe, but yeah she should be able to have her license back.

I have seen several deadly errors by doctors and they still get to practice, why shouldn't we?

[0.9%NormalSarah, BSN, RN]

KalipsoRed21 said:

You don't need a policy because you are a 2 year old nurse? Sorry, we all need lots of freaking policies until we know what we are doing. A 2 year old nurse doesn't know a lot.

 What? A 2 year nurse should definitely be able to practice safety with medication admin. In fact I'm pretty sure we had to be able to do that before getting out of nursing school. Like others have said, a policy wouldn't have helped if there were one. You just can't teach the type of awareness that should come with certain nursing skills like giving IV meds. You either are on high alert and understand the consequences of making a mistake, or you're not and the other shoe will drop some day. Unfortunately for her, it killed a patient. It's sad and all of us will make mistakes, but there are checks that should mitigate such a tragedy and she just didn't follow prudent nursing procedure. 

[klone, MSN, RN]

KalipsoRed21 said:

RaDonda Vaunght should have a path to getting back her license. As far as I have read about this case she made an error, which she was prosecuted for. But she also reported her own medication error to her organization, she did not hide it. She then relied on her institution for guidance on how to handle the error with their legal team,(her organization was shady as ***, hid the error and the reason RV was persecuted at ALL was because CMS couldn't find any other way to punish the hospital for their fraud) and she only had been a nurse 2 years at the time of the incident.

To me, she didn't demonstrate complete negligence, she had the ethical wherewithal to report her error to help her patient. That is really all I needed to know to say that she should have her license back and be able to practice in some capacity. Probably a modified license like a person in drug recovery whee she can't work in certain sectors until proven safe, but yeah she should be able to have her license back.

I have seen several deadly errors by doctors and they still get to practice, why shouldn't we?

Um, no. She didn't demonstrate complete negligence? She reconstituted a medication IN THE BOTTLE, without first looking at the label. She bypassed MULTIPLE warning messages and safety mechanisms that are taught as basic nursing 101. And no, she did not "report her error to help her patient." Her patient was already dead long before she even realized she had killed her.

She demonstrated the very definition of negligence, which is defined as: A failure to behave with the level of care that someone of ordinary prudence would have exercised under the same circumstances. 

The fact that she bypassed half a dozen warnings, and failed to do her 5 rights at multiple points, when that is BASIC NURSING CARE, is in fact, the definition of negligence.

[Wuzzie]

KalipsoRed21 said:

Honestly I feel it is naïve to say that poor hospital policy has nothing to do with RN accountability.

I literally never said that! What I said is that in this case conflating the two issues is a thinly veiled attempt at obfuscating what really happened which is a nurse did not follow the protocol for safe medication administration that is so simple it is taught to nursing students in their first year. 

KalipsoRed21 said:

I think if we can let people with drug addiction problems back into care, then we can find some sort of work for a nurse who made a deadly drug error especially when she behaved ethically by reporting her error.

She didn't "behave ethically". The evidence of her poor nursing judgment (the bag with the vial and syringes) was found by another nurse. She had no choice but to admit it.