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]

Just to be clear. Firemedic Mike was not the poster quoted in the above post. It was ValarieRN08 who so compassionately stated that killing someone with incompetency is okay if the person is old or otherwise infirm. I prefer my compassion without a side of sociopathy. 

[MaxAttack, BSN, RN]

Wuzzie said:

Just to be clear. Firemedic Mike was not the poster quoted in the above post. It was ValarieRN08 who so compassionately stated that killing someone with incompetency is okay if the person is old or otherwise infirm. I prefer my compassion without a side of sociopathy. 

Thanks, didn't see that. Corrected!

[mtmkjr, BSN]

ValarieRN08 said:

He who has no sin cast the first stone. If your human, you have made mistakes. Some nurses have lost their compassion not me! Blessings

No, this is a misuse of that scripture. We are not judging her for any sin, we are holding to standards of safe nursing practice.

Also, your compassion is misplaced. I am full of compassion for the patient who suffered a terrible death and for the family who lost a loved one.

I even had compassion for Radonda initially. That was before she started victimizing herself and thinking she could just pick up where she left off. 

 

[floydnightingale]

I didn't know that she was working in an ED. I assumed that maybe a med-surg nurse wasn't familiar with Versed or vecuronium, both of which are very common in emergency settings. In my experience vec was almost always pushed by a pharmacist who attended all resuscitations and codes. My own orientation was shorter than the typical 5 months because I came from another level one but some experienced nurses didn't make it even after the full 5 months. While I think she needs to consider a new career, Vanderbilt shares culpability for letting her loose on patients without supervision.

[MaxAttack, BSN, RN]

floydnightingale said:

I didn't know that she was working in an ED. I assumed that maybe a med-surg nurse wasn't familiar with Versed or vecuronium, both of which are very common in emergency settings. In my experience vec was almost always pushed by a pharmacist who attended all resuscitations and codes. My own orientation was shorter than the typical 5 months because I came from another level one but some experienced nurses didn't make it even after the full 5 months. While I think she needs to consider a new career, Vanderbilt shares culpability for letting her loose on patients without supervision.

She was an ICU nurse - either way she would know these meds - but can you clarify what you meant by letting her loose without supervision?

[klone, MSN, RN]

She had been an ICU nurse for 4 (?) years. How long do you suggest she should be supervised?

[floydnightingale]

klone said:

She had been an ICU nurse for 4 (?) years. How long do you suggest she should be supervised?

I'm unaware of her history, ICU or whatever, but if she exhibited incompetence she should have been watched until they realized she wasn't safe and let her go.

Interesting, reading a lot comments and people are saying she didn't follow protocol for monitoring after Versed, but it wasn't Versed that she gave. I've administered plenty of Versed either as a part of procedural sedation or to snow agitated patients as a stronger alternative to Ativan and never witnessed an adverse reaction. The only proper follow-up to vec is a BVM or a vent.

 

[Wuzzie]

@Floyd Nightingale appreciate your input but you really need to read what actually happened. She was supposed to push Versed but she pulled Vec and pushed that without even looking at the vial. We are well aware of how to manage a patient on a neuromuscular blockade. The reason we are talking about monitoring post-Versed is because even if she had given the right medication she did not use any nursing judgment at all when she slammed it and walked away. 

[MaxAttack, BSN, RN]

floydnightingale said:

I'm unaware of her history, ICU or whatever, but if she exhibited incompetence she should have been watched until they realized she wasn't safe and let her go.

Interesting, reading a lot comments and people are saying she didn't follow protocol for monitoring after Versed, but it wasn't Versed that she gave. I've administered plenty of Versed either as a part of procedural sedation or to snow agitated patients as a stronger alternative to Ativan and never witnessed an adverse reaction. The only proper follow-up to vec is a BVM or a vent.

 

I give up.

[klone, MSN, RN]

Same, Max. So, so frustrating.

 

floydnightingale said:

I'm unaware of her history, ICU or whatever, but if she exhibited incompetence she should have been watched until they realized she wasn't safe and let her go.

Interesting, reading a lot comments and people are saying she didn't follow protocol for monitoring after Versed, but it wasn't Versed that she gave. I've administered plenty of Versed either as a part of procedural sedation or to snow agitated patients as a stronger alternative to Ativan and never witnessed an adverse reaction. The only proper follow-up to vec is a BVM or a vent.

 

Incompetence often goes without detection until....a mistake is discovered. Would you expect someone who has been a nurse in that specialty for 4 years to be able to work independently, without supervision? You seem to think that most mistakes that are made by nurses happen when they're brand new and still in orientation, which is false. By that logic, no nurse should ever work without supervision, ever. 

We keep talking about monitoring after Versed because that is what she thought she was giving. She gave what she THOUGHT was Versed, pushed it in, and then walked away. Did not monitor the patient for response, which is one of the basic things they teach you to do in nursing school when giving an IV push medication. She failed in her duties on multiple levels.

[33Weeker]

This case has many aspects for discussion, but her med error was avoidable. You can't just pull a med that starts with the same letter and hope you got the right one. You need to know what you're giving. She should have looked it up.

[SoTexasLVN]

This type of situation is precisely why I am reluctant to give assistance in an area I may be unfamiliar with. You go the extra mile just to get yourself into trouble. NOT worth it