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!

[subee, MSN, CRNA]

ValarieRN08 said:

Hello, 

I believe everyone deserves a second chance. I understand the levels that she went through to override the medication. I understand we have a patient that is dead. If she gets the license reinstated it should have limitations on it. She can work in case management or with insurance companies' medication dispensing is out until the board sees fit. 

Case scenario my 70-year-old mother was in the hospital diagnosed with cancer and Mets to the brain. She was over medicated by an RN with fentanyl. They gave her Narcan to reverse the fentanyl. My mother was in agony I could hear the screams from the hallway when I arrived at the hospital. I was more upset they brought her back than the overdose. So, look at the whole picture. 75 years old female with a brain bleed. Not condoning but understanding. 

Valarie RN, BSN

This has zero to do with the RD case.  A panicked nurse gave the wrong dose of Narcan but it was the CORRECT drug to give for the situation.  She just didn't go a good job.  AND, it was an easy error to reverse!

[Hoosier_RN, MSN]

klone said:

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

I thought she'd been an ICU nurse for 2 years. Not that it matters. She'd been a nurse long enough to know to follow basic safety protocols

[FiremedicMike, BSN, RN, EMT-P]

SoTexasLVN said:

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

For the love of..

 

this wasn't a nice nurse just trying to help out, why do people continue to ignore the facts of what happened and try to argue out of some false "this could have been me" emotion.

Guess what folks, if this could have been you, surrender your license immediately, we don't need you, we don't want you. Bye.

[subee, MSN, CRNA]

FiremedicMike said:

For the love of..

 

this wasn't a nice nurse just trying to help out, why do people continue to ignore the facts of what happened and try to argue out of some false "this could have been me" emotion.

Guess what folks, if this could have been you, surrender your license immediately, we don't need you, we don't want you. Bye.

Is your forehead flat yet from the banging?  Who is spinning everyone's moral compass?  

[Tenebrae, BSN, RN]

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

I've learned from my med error and havent don it again. 

I have compassion for Charlene Murphey who died fully conscious, unable to breath, unable to speak and totally alone. 

Versed--> vercuronium

I also have compassion for the family who are without their mum, grandmother etc

[JKL33]

floydnightingale said:

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.

Yep, you're exactly right--and that's no small part of what makes her actions scary. It was versed that she thought she was giving and she blatantly did not even do the proper monitoring/basic surveillance for what she thought she was giving.

 We're giving a break by (only) judging her actions against the standard of care for what she thought she was giving.  And that is all that is needed to judge this situation, since if she had taken ANY steps that one would take when they think they are administering Versed, the patient would not be dead. That's how bad this is.

 

floydnightingale said:

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.

Well now you know that if you try to give Versed--or any medication--but aren't going to read the label and also don't stay in the vicinity to witness anything thereafter, people can die.

[subee, MSN, CRNA]

@floydnightingale:  Your patients lived because you didn't give them Vecuronium.  I've given 10's of thousands of doses of Versed, but there was that one time a patient turned blue on a bedpan after she got 2 mg.  Fortunately it was picked up immediately and just tapping her woke her up.  Never saw it before and never saw that after again.  This was a healthy, non-elderly patient.  You just have to give it enough times to have a bad reaction.

[Been there,done that, ASN, 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.

I 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.

 

Are you saying, the facility should have just handled it internally? How many more incidents would it take to decide  they would " let her go".? Then send her off .. to somewhere where she could remain incompetent. 

"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." That  remains the issue.

SoTexasLVN said:

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

She was not in an unfamiliar area. She was floating on her own unit.

[floydnightingale]

Been there,done that said:

Are you saying, the facility should have just handled it internally? How many more incidents would it take to decide  they would " let her go".? Then send her off .. to somewhere where she could remain incompetent. 

"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." That  remains the issue.

She was not in an unfamiliar area. She was floating on her own unit.

Not saying that at all and don't know how you read it that way, although I understand that the hospital did try to handle it internally or try to cover it up. Orientations at level one EDs are months of one on one close supervision by a trusted RN and if they didn't notice her failings before it got to this point there was a problem. Not everybody needs to be pushed through to independent practice, some just have to go.

[mtmkjr, BSN]

floydnightingale said:

Not saying that at all and don't know how you read it that way, although I understand that the hospital did try to handle it internally or try to cover it up. Orientations at level one EDs are months of one on one close supervision by a trusted RN and if tehy didn't notice ehr failings before it got to this point there was a problem. Not everybody needs to pushed through to independent practice, some just have to go.

She was not an ED nurse. She was not functioning in the role of an ED nurse.

She was a neuro ICU nurse of two years. On this day she was a "help all nurse"  (they had extra staff to be able to do this). She had been sent to do a swallow screen in the ED, and then was asked by a neuro ICU co-worker to give the Versed to his patient in the procedure area.  Oh and by the way, she was orienting another new nurse at the time of the tragic series of events. 

The thing is, a nurse can be less than competent but slide under the radar covering up errors that don't lead to obvious harm of the patient. 

I don't know how Radonda functioned up to this point, but she was seen as being capable of orienting new staff. So probably nothing major had happened.

However she practiced nursing, it worked for her for 2 years.....until it didn't. 

Just an observation... The division in his thread is between those who think she should not get her license back and those who think she should be getting a second chance. I can say 100% of the ones who think she should have a second chance do not know the facts of the case. 100% have not read the documents in fact most of them have not read ANY of the documents. 

[floydnightingale]

mtmkjr said:

She was not an ED nurse. She was not functioning in the role of an ED nurse.

 

How did I get the idea that she was in the ED but new to it? So she was some kind of float? I don't agree with the practice of throwing people into EDs, but a neuro ICU nurse should have had some familiarity with Versed.

[subee, MSN, CRNA]

floydnightingale said:

Not saying that at all and don't know how you read it that way, although I understand that the hospital did try to handle it internally or try to cover it up. Orientations at level one EDs are months of one on one close supervision by a trusted RN and if they didn't notice her failings before it got to this point there was a problem. Not everybody needs to be pushed through to independent practice, some just have to go.

What does the last sentence even mean?