On December 26, 2017, Charlene Murphey was a patient at Vanderbilt Medical Center where she was being treated for a subdural hematoma.  A PET scan was ordered and she was transported to that department where she stated she suffered from claustrophobia and was afraid to have the PET scan.  Versed was ordered.  Why Versed was ordered is unknown without monitoring.

Radonda Vaught, a Tennessee Registered Nurse since 2015 went to the medication dispensary machine to find Versed for the patient.  Since the order was not put in the system, the Versed did not pop up on the patient’s profile.  Ms. Vaught overrode the system and entered the first 2 letter V-E and selected the first medication, vecuronium.

30 minutes after the medication was administered, they realized the patient, in the PET scan tube, was not breathing.  They resuscitated her but by then she had suffered considerable brain damage and shortly thereafter removed from life-saving equipment.

Nurse Vaught was indicted by a grand jury on January 5, 2018, on charges of reckless homicide and impaired adult abuse.

I have pieced together what I could from numerous articles. 

Evidently, Vanderbilt Medical Center swept this matter under the rug and claimed the patient’s death was natural.  It was not until a year later, when the Center for Medicaid and Medicare Services (CMS) investigated Vanderbilt and issued its report that the truth of this matter was disclosed and the family was informed.

CMS could have suspended Vanderbilt Medicare reimbursement payments if the hospital did not take steps to prevent future accidents.  Vanderbilt quickly provided CMS with a corrective plan so that the reimbursements were no longer in jeopardy.

Surprisingly, Vanderbilt told the Davidson County Medical Examiner that the patient succumbed to a medication error was “hearsay!” 

This brings up a couple of issues.  First, why was versed ordered without monitoring?  And, second, why didn’t a warning pop up on the medication dispensing system about the vecuronium?

Usually cases like this are not just one person’s errors.

What bothers me is that Nurse Vaught is being charged in a criminal matter.  The event was negligence and flat-out malpractice for which the family has not sued.  Ms. Vaught clearly violated the Five Rights of Medication Administration and did not note the medication that she was giving.

What also concerns me is that if every nurse who fails to do something can be subject to criminal charges and loss of their livelihood and freedom, why would anyone want to go into the nursing profession?

Obviously, Ms. Vaught was a relatively new nurse and did not have experience with this medication.  There is no forgiving her actions but I believe she should not be charged criminally.  There was no intent to hurt the patient.  Nurse Vaught was just trying to do her job in the best she could.

There 4 elements needed for malpractice.  “Duty” which is what those acting under same or similar circumstances would do, “breach of that duty” meaning they didn’t do something they should have done or did something they should not have done, it must cause harm and there must be resultant damages.  This is clearly malpractice.

On the other hand, reckless homicide is the killing of another by a reckless act.  Reckless means a person acted recklessly with respect to circumstances surrounding the conduct or the result of the conduct where the person is aware of or consciously disregards a substantial and unjustifiable viable risk that the circumstances exist where the result will occur.

Usually, a reckless homicide is when someone recklessly drives another vehicle and unintentionally kills another.

In this case, was Nurse Vaught aware of the substantial and unjustified risk of giving medication and chose to ignore it?  That would be for a jury to decide.

I feel sad for her going through this and I hope this does not set a precedent to criminally charge nurses for what should be classified as malpractice.

What are your thoughts are on Nurse Vaught?  I’d love to hear your comments below.

I’ve written often about if a nurse has a second license in another state and there is an action in one state, the other state may take action as well.  But, did you know in certain states you must affirmatively report an action in a second state?

Some think that if their license is on probation that they can go to work in another state where their license is “free and clear.”  Be careful!  If you do not voluntarily tell of a license matter in another state and the situation is found out, that may be a violation of that state’s Nurse Practice Act.

If you have a license matter, you should review your state’s Nurse Practice Act in all states in which you are licensed to determine whether you have to report the action in the other states.  In fact, even if you don’t have an active license, another state still can take action against your license.  Always make sure that all Nursing Boards where you have a license are kept up-to-date with your mailing address to ensure that you don’t miss any important communications from either state Board.

The American Association of Nurse Attorneys has published a position paper on the statute of limitations and retained jurisdiction.  The Association does not feel that it is proper to be able to take action against an expired license after the fact, when sometimes it can be years later.

You also can check the Annual Survey of the National Council of State Boards of Nursing to see how each state is set up and who performs their investigation.  It makes for interesting reading.

Another source is nursys.com, a public repository of actions taken on nurses’ licenses.  As well as checking on yourself, you can look up records on your coworkers as well to make sure there’s nothing there.

The bottom line is that should you have an action in one state and if you have a license in another, make sure that you do not need to mandatorily report that action.  It is better to be safe than sorry and report since it is public record anyway.

With the opioid epidemic raging right now, hospitals are even more cautious of anything that could be considered abuse.  You need to protect yourself and your license so I have some tips to not only keep from endangering your license, but maybe help you avoid criminal charges as well.

1.         Do not take controlled substances.  If you are asked for a drug test, many facilities will excuse a positive result if you have a prescription.  But the Board is concerned about nurses working with controlled substances in their systems.  Even if you took something in your off time.  Whatever you do, do not take someone else’s prescription even if you are out or have taken that medication before.  This is called diversion.

2.         Make sure when you take a medication out of the Pyxis that you administer it right away followed by scanning and documenting that the drug was given. Facilities are very leery about lag time between the withdrawal of the medication and its administration.  You should not be carrying narcotics in your pockets for any length of time.

3.         Be prompt at wasting medications.  Again, do not carry any medications in your pocket for any long period of time while trying to find someone to verify your wasting.  Make sure that the witness to the wasting actually sees you waste the medication and then immediately signs that the medication was properly wasted. Facilities also do not want to see lag time between the administration of a medicine and witnessing its wasting. 

4.         If you have an emergency drug kit, make sure that there are policies and procedures in place to count the medication so that if any medication comes up missing, there will be no question that it can be accounted for during that shift.

5.         Don’t be the outlier.  This means that if you give more narcotics than anyone else, that raises a red flag.  There is software in the Pyxis that shows each time a nurse accessed the Pyxis.

There are a lot of time-consuming policies and procedures in place that seem to make your job harder.  The truth is that the policies do make it harder but they also protect you.  When you do things properly according to the policies and procedures, you can better protect your license.  If you are in a position where the proper policies are not carried out, don’t just settle in to the unit culture, do something and say something or leave.  How else do you protect yourself?  I would love to hear from you in the comments below.

Nurses are consistently ranked as the most trusted professional group according to a Gallup Poll.  Nurses again outpaced other professions for honesty and ethics.  They rate an average of 84%, a very high range.  The second highest were pharmacists followed by medical doctors.

However, I deal with nurses everyday who have an isolated violation of their ethics or, as I prefer to call it, “integrity.”

Ethics refers to the moral principles that govern a person’s behavior or the conducting of an activity.  Integrity refers to the quality of being honest and having strong principles: moral uprightness.

As nurses, we see a side of humanity that few have the privilege in which to be involved.  Patients’ lives are in our hands.

Unfortunately, the easiest way to get before the Board is a breach in ethics.  Here are some examples:

1. Covering up something that you don’t want others to know.
2. Withhold information or the truth.
3. Lying, cheating, stealing.
4. Misrepresenting yourself.
5. Not being true to yourself.
6. Abusing substances or engaging in compulsive behavior.

When I was a unit manager of a medical surgical unit, one patient’s colostomy was hooked up with the distal end exiting the body and the proximal end sewn shut.  Consequently, everything was accumulating in the proximal pouch instead of exiting through the skin to the bag.

We nurses were told by management to be quiet and not inform the patient of the mishap.  I felt SO out of integrity with that situation.

Now, I look at ethics as a line in the sand, something that you do not cross.  When you are in integrity, you feel better about yourself.  You can look in the mirror and know that you have done the right thing.

If you’re not in integrity, it’s hard to keep up with a lie.  It leads to low self-esteem, negative expectations, low effort, high anxiety, failure and self-blame.

Nurses also are “pleasers” which means when someone asks us to do something, we want to help but, if we know it is out of integrity for us, it is not worth it.

Nurses want to help and it’s easy to just help someone when it is out of integrity.  Such as filling in the holes on the MAR, providing a late entry into a medical record without identifying it as such, not taking vital signs or doing a full neuro check but still charting them, taking supplies from the hospital, giving a pill to someone for whom they have a prescription but they ran out, etc.  All are examples of breaches in integrity and, if caught, will put you in front of the Boar

If you get that gut feeling that something doesn’t feel right or that you shouldn’t be doing it, trust your gut.  We all know those days where we agree to do something but then get those pains in our stomachs.  Really, it is easier to change your mind and say “no” than to follow through with it.  Your gut always knows.

When we live in INTEGRITY, life is a lot easier and we have nothing to cover up.  We have more energy and life feels much fuller, we feel better ourselves.

Have you been asked to cover up something or do something that you felt was out of integrity?  If so, how did you handle it?  Please share your experiences and thoughts below.